期刊论文详细信息
BMC Pregnancy and Childbirth
Healthy living in pregnancy: a cluster-randomized controlled trial to prevent excessive gestational weight gain - rationale and design of the GeliS study
Hans Hauner1  Kurt Ulm3  Luzia Kick2  Eva Rosenfeld2  Julia Kunath1  Kathrin Rauh2 
[1] Else Kröner-Fresenius-Centre for Nutritional Medicine, Klinikum rechts der Isar, Uptown München Campus D, Technische Universität München, Munich, Germany;Competence Centre for Nutrition (KErn), Freising, Germany;Department of Medical Statistics and Epidemiology, Technische Universität München, Munich, Germany
关键词: Pregnancy;    Obesity prevention;    Childhood obesity;    Weight retention;    Gestational diabetes;    Exercise;    Diet;    Gestational weight gain (GWG);    Lifestyle intervention;   
Others  :  1127459
DOI  :  10.1186/1471-2393-14-119
 received in 2014-02-28, accepted in 2014-03-20,  发布年份 2014
PDF
【 摘 要 】

Background

Recent studies suggest that excessive gestational weight gain (GWG) leads to adverse maternal and fetal outcomes including weight retention in the mother and an increased risk of childhood obesity in the offspring.

The aim of the GeliS study is to examine the effect of a lifestyle intervention programme during pregnancy to avoid excessive GWG and, hence, to reduce pregnancy and obstetric complications as well as the risk of maternal and offspring obesity.

Methods and design

The GeliS study is a multicentre cluster-randomized controlled trial. A total number of 2500 pregnant women (singleton pregnancy) with a pre-pregnancy BMI ≥ 18.5 kg/m2 and ≤ 40 kg/m2 will be recruited in practices of gynaecologists and midwives in ten Bavarian regions. The intervention comprises three structured and individualised counselling sessions on a healthy diet, regular physical activity as well as weight monitoring during pregnancy and one session after delivery, respectively. The counselling sessions are attached to routine pre- and postnatal visits using standardised materials and procedures. In the control regions, general recommendations for a healthy lifestyle are given. An oral glucose tolerance test is offered to all participants.

The primary outcome is the proportion of participants with excessive GWG. Secondary outcomes include pregnancy and obstetric complications such as frequency of gestational diabetes, preeclampsia and caesarean sections as well as weight retention in the mothers and BMI and other health variables in the offspring. A 5-year follow-up of both mothers and their infants is planned.

Discussion

The GeliS lifestyle intervention programme has been adapted to the existing routine health care system for pregnant women. If shown to be effective, it could be immediately implemented in routine care.

Trial registration

The study protocol is registered at the ClinicalTrials.gov Protocol Registration System (NCT01958307).

【 授权许可】

   
2014 Rauh et al.; licensee BioMed Central Ltd.

【 预 览 】
附件列表
Files Size Format View
20150220173345921.pdf 497KB PDF download
Figure 1. 61KB Image download
【 图 表 】

Figure 1.

【 参考文献 】
  • [1]Swinburn BA, Sacks G, Hall KD, McPherson K, Finegood DT, Moodie ML, Gortmaker SL: The global obesity pandemic: shaped by global drivers and local environments. Lancet 2011, 378:804-814.
  • [2]World Health Organization: WHO Obesity and overweight. http://www.who.int/mediacentre/factsheets/fs311/en/index.html webcite
  • [3]Guelinckx I, Devlieger R, Beckers K, Vansant G: Maternal obesity: pregnancy complications, gestational weight gain and nutrition. Obes Rev 2008, 9:140-150.
  • [4]Nelson SM, Matthews P, Poston L: Maternal metabolism and obesity: modifiable determinants of pregnancy outcome. Hum Reprod Update 2010, 16:255-275.
  • [5]Davies GA, Gregory AL, Maxwell C, McLeod L, Gagnon R, Basso M, Bos H, Delisle M, Farine D, Hudon L, Menticoglou S, Mundle W, Murphy-Kaulbeck L, Ouellet A, Pressey T, Roggensack A, Leduc D, Ballerman C, Biringer A, Duperron L, Jones D, Lee LS, Shepherd D, Wilson K: SOGC Clinical Practice Guidelines: Obesity in pregnancy. No. 239, February 2010. Int J Gynaecol Obstet 2010, 110:167-173.
  • [6]Adamo KB, Ferraro ZM, Brett KE: Can we modify the intrauterine environment to halt the intergenerational cycle of obesity? Int J Environ Res Public Health 2012, 9:1263-1307.
  • [7]Catalano PM, Ehrenberg HM: The short- and long-term implications of maternal obesity on the mother and her offspring. BJOG 2006, 113:1126-1133.
  • [8]Torloni MR, Betrán AP, Horta BL, Nakamura MU, Atallah AN, Moron AF, Valente O: Prepregnancy BMI and the risk of gestational diabetes: a systematic review of the literature with meta-analysis. Obes Rev 2009, 10:194-203.
  • [9]Tsoi E, Shaikh H, Robinson S, Teoh TG: Obesity in pregnancy: a major healthcare issue. Postgrad Med J 2010, 86:617-623.
  • [10]Leeners B, Rath W, Kuse S, Irawan C, Imthurn B, Neumaier-Wagner P: BMI: new aspects of a classical risk factor for hypertensive disorders in pregnancy. Clin Sci 2006, 111:81-86.
  • [11]Sebire NJ, Jolly M, Harris JP, Wadsworth J, Joffe M, Beard RW, Regan L, Robinson S: Maternal obesity and pregnancy outcome: a study of 287,213 pregnancies in London. Int J Obes Relat Metab Disord 2001, 25:1175-1182.
  • [12]Ehrenberg HM, Mercer BM, Catalano PM: The influence of obesity and diabetes on the prevalence of macrosomia. Am J Obstet Gynecol 2004, 191:964-968.
  • [13]Poobalan AS, Aucott LS, Gurung T, Smith WCS, Bhattacharya S: Obesity as an independent risk factor for elective and emergency caesarean delivery in nulliparous women-systematic review and meta-analysis of cohort studies. Obes Rev 2009, 10:28-35.
  • [14]Heslehurst N, Simpson H, Ells LJ, Rankin J, Wilkinson J, Lang R, Brown TJ, Summerbell CD: The impact of maternal BMI status on pregnancy outcomes with immediate short-term obstetric resource implications: a meta-analysis. Obes Rev 2008, 9:635-683.
  • [15]Rasmussen KM, Catalano PM, Yaktine AL: New guidelines for weight gain during pregnancy: what obstetrician/gynecologists should know. Curr Opin Obstet Gynecol 2009, 21:521-526.
  • [16]Rasmussen KM, Yaktine AL: Weight gain during pregnancy: Reexamining the guidelines. Washington, DC: National Academies Press; 2009.
  • [17]Liu Y, Dai W, Dai X, Li Z: Prepregnancy body mass index and gestational weight gain with the outcome of pregnancy: a 13-year study of 292,568 cases in China. Arch Gynecol Obstet 2012, 286:905-911.
  • [18]Ferraro ZM, Barrowman N, Prud’homme D, Walker M, Wen SW, Rodger M, Adamo KB: Excessive gestational weight gain predicts large for gestational age neonates independent of maternal body mass index. J Matern Fetal Neonatal Med 2012, 25:538-542.
  • [19]DeVader SR, Neeley HL, Myles TD, Leet TL: Evaluation of gestational weight gain guidelines for women with normal prepregnancy body mass index. Obstet Gynecol 2007, 110:745-751.
  • [20]Linné Y, Dye L, Barkeling B, Rössner S: Long-term weight development in women: a 15-year follow-up of the effects of pregnancy. Obes Res 2004, 12:1166-1178.
  • [21]Rode L, Kjærgaard H, Ottesen B, Damm P, Hegaard HK: Association between gestational weight gain according to body mass index and postpartum weight in a large cohort of Danish women. Matern Child Health J 2012, 16:406-413.
  • [22]Begum F, Colman I, McCargar LJ, Bell RC: Gestational weight gain and early postpartum weight retention in a prospective cohort of alberta women. J Obstet Gynaecol Can 2012, 34:637-647.
  • [23]Nehring I, Schmoll S, Beyerlein A, Hauner H, Kries Von R: Gestational weight gain and long-term postpartum weight retention: a meta-analysis. Am J Clin Nutr 2011, 94:1225-1231.
  • [24]Olson CM, Strawderman MS, Dennison BA: Maternal weight gain during pregnancy and child weight at age 3 years. Matern Child Health J 2009, 13:839-846.
  • [25]von Kries R, Ensenauer R, Beyerlein A, Amann-Gassner U, Hauner H, Rosario AS: Gestational weight gain and overweight in children: Results from the cross-sectional German KiGGS study. Int J Pediatr Obes 2011, 6:45-52.
  • [26]Margerison-Zilko CE, Shrimali BP, Eskenazi B, Lahiff M, Lindquist AR, Abrams BF: Trimester of maternal gestational weight gain and offspring body weight at birth and age five. Matern Child Health J 2012, 16:1215-1223.
  • [27]Beyerlein A, Nehring I, Rzehak P, Heinrich J, Müller MJ, Plachta-Danielzik S, Wabitsch M, Weck M, Brenner H, Rothenbacher D, Kries Von R: Gestational weight gain and body mass index in children: results from three german cohort studies. PLoS ONE 2012, 7:e33205.
  • [28]Ensenauer R, Chmitorz A, Riedel C, Fenske N, Hauner H, Nennstiel-Ratzel U, Kries Von R: Effects of suboptimal or excessive gestational weight gain on childhood overweight and abdominal adiposity: results from a retrospective cohort study. Int J Obes (Lond) 2013, 37:505-512.
  • [29]Moreira P, Padez C, Mourão-Carvalhal I, Rosado V: Maternal weight gain during pregnancy and overweight in Portuguese children. Int J Obes (Lond) 2007, 31:608-614.
  • [30]Oken E, Taveras EM, Kleinman KP, Rich-Edwards JW, Gillman MW: Gestational weight gain and child adiposity at age 3 years. Am J Obstet Gynecol 2007, 196(322):e1-e8.
  • [31]Reynolds RM, Osmond C, Phillips DIW, Godfrey KM: Maternal BMI, parity, and pregnancy weight gain: influences on offspring adiposity in young adulthood. J Clin Endocrinol Metab 2010, 95:5365-5369.
  • [32]Schack-Nielsen L, Michaelsen KF, Gamborg M, Mortensen EL, Sørensen TIA: Gestational weight gain in relation to offspring body mass index and obesity from infancy through adulthood. Int J Obes (Lond) 2010, 34:67-74.
  • [33]Wrotniak BH, Shults J, Butts S, Stettler N: Gestational weight gain and risk of overweight in the offspring at age 7 y in a multicenter, multiethnic cohort study. Am J Clin Nutr 2008, 87:1818-1824.
  • [34]Bergmann KE, Bergmann RL, Ellert U, Dudenhausen JW: Perinatale Einflussfaktoren auf die spätere Gesundheit. Ergebnisse des Kinder- und Jugendgesundheitssurveys (KiGGS). Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2007, 50:670-676.
  • [35]Schiessl B, Beyerlein A, Lack N, Kries Von R: Temporal trends in pregnancy weight gain and birth weight in Bavaria 2000-2007: slightly decreasing birth weight with increasing weight gain in pregnancy. J Perinat Med 2009, 37:374-379.
  • [36]Taylor PD, Poston L: Developmental programming of obesity in mammals. Exp Physiol 2007, 92:287-298.
  • [37]Battista M, Hivert M, Duval K, Baillargeon J: Intergenerational cycle of obesity and diabetes: how can we reduce the burdens of these conditions on the health of future generations? Exp Diabetes Res 2011, 2011:596060.
  • [38]Catalano PM: Obesity and pregnancy-the propagation of a viscous cycle? J Clin Endocrinol Metab 2003, 88:3505-3506.
  • [39]Dabelea D, Crume T: Maternal environment and the transgenerational cycle of obesity and diabetes. Diabetes 2011, 60:1849-1855.
  • [40]Streuling I, Beyerlein A, Kries Von R: Can gestational weight gain be modified by increasing physical activity and diet counseling? A meta-analysis of interventional trials. Am J Clin Nutr 2010, 92:678-687.
  • [41]Wolff S, Legarth J, Vangsgaard K, Toubro S, Astrup A: A randomized trial of the effects of dietary counseling on gestational weight gain and glucose metabolism in obese pregnant women. Int J Obes (Lond) 2008, 32:495-501.
  • [42]Phelan S, Phipps MG, Abrams B, Darroch F, Schaffner A, Wing RR: Randomized trial of a behavioral intervention to prevent excessive gestational weight gain: the Fit for Delivery Study. Am J Clin Nutr 2011, 93:772-779.
  • [43]Vinter CA, Jensen DM, Ovesen P, Beck-Nielsen H, Jørgensen JS: The LiP (Lifestyle in Pregnancy) study: a randomized controlled trial of lifestyle intervention in 360 obese pregnant women. Diabetes Care 2011, 34:2502-2507.
  • [44]Rauh K, Gabriel E, Kerschbaum E, Schuster T, Von KR, Amann-Gassner U, Hauner H: Safety and efficacy of a lifestyle intervention for pregnant women to prevent excessive maternal weight gain: a cluster-randomized controlled trial. BMC Pregnancy Childbirth 2013, 13:151. BioMed Central Full Text
  • [45]Oteng-Ntim E, Varma R, Croker H, Poston L, Doyle P: Lifestyle interventions for overweight and obese pregnant women to improve pregnancy outcome: systematic review and meta-analysis. BMC Med 2012, 10:47. BioMed Central Full Text
  • [46]Hannan PJ, Murray DM, Jacobs DR, McGovern PG: Parameters to aid in the design and analysis of community trials: intraclass correlations from the Minnesota Heart Health Program. Epidemiology 1994, 5:88-95.
  • [47]Donner A, Klar N: Design and analysis of cluster randomization trials in health research. London: Arnold Publishing Company; 2000.
  • [48]Gesund ins Leben - Netzwerk Junge Familie http://www.gesund-ins-leben.de/ webcite
  • [49]Koletzko B, Bauer CP, Bung P, Cremer M, Flothkötter M, Hellmers C, Kersting M, Krawinkel M, Przyrembel H, Rasenack R, Schäfer T, Vetter K, Wahn U, Weißenborn A, Wöckel A: Nutrition in pregnancy. Practice recommendations of the Network “Healthy Start – Young Family Network”. Dtsch Med Wochenschr 2012, 137(25-26):1366-1372.
  • [50]Haftenberger M, Heuer T, Heidemann C, Kube F, Krems C, Mensink Gert BM: Relative validation of a food frequency questionnaire for national health and nutrition monitoring. Nutr J 2010, 9:36. BioMed Central Full Text
  • [51]Chasan-Taber L, Schmidt MD, Roberts DE, Hosmer D, Markenson G, Freedson PS: Development and validation of a Pregnancy Physical Activity Questionnaire. Med Sci Sports Exerc 2004, 36:1750-1760.
  • [52]Helmholtz Zentrum München Deutsches Forschungszentrum für Gesundheit und Umwelt (GmbH): KORA - Kooperative Gesundheitsforschung in der Region Augsburg: KORA Startseite. http://www.helmholtz-muenchen.de/kora webcite
  • [53]Bergant AM, Nguyen T, Heim K, Ulmer H, Dapunt O: Deutschsprachige Fassung und Validierung der “Edinburgh postnatal depression scale”. Dtsch Med Wochenschr 1998, 123:35-40.
  • [54]Kleinwechter H, Schäfer-Graf U, Bührer C, Hoesli I, Kainer F, Kautzky-Willer A, Pawlowski B, Schunk K, Somville T, Sorger M: Gestationsdiabetes mellitus (GDM) - Evidenzbasierte Leitlinie zur Diagnostik, Therapie u. Nachsorge der Deutschen Diabetes-Geseelschaft (DDG) und der Deutschen Gesellschaft für Gynäkologie und Geburtshilfe (DGGG). 2011. http://www.dggg.de/fileadmin/public_docs/Dokumente/Leitlinien/3-3-3-Gestationsdiabetes-2011.pdf webcite
  • [55]Metzger BE, Gabbe SG, Persson B, Buchanan TA, Catalano PA, Damm P, Dyer AR, Leiva A, Hod M, Kitzmiler JL, Lowe LP, McIntyre HD, Oats Jeremy JN, Omori Y, Schmidt MI: International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care 2010, 33:676-682.
  • [56]Schulz R, Hölscher G, Schneider T, Hachmeister A, Scholz S, Nennstiel-Ratzel U: Gesundheit der Vorschulkinder in Bayern: Ergebnisse der Schuleingangsuntersuchung zum Schuljahr 2008/2009, Statistisch-epidemiologischer Bericht. Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit: Band 4 der Schriftenreihe Schuleingangsuntersuchung in Bayern; 2013.
  • [57]Margerison Z, Claire E, Rehkopf D, Abrams B: Association of maternal gestational weight gain with short- and long-term maternal and child health outcomes. Am J Obstet Gynecol 2010, 202(574):e1-e8.
  • [58]Durie DE, Thornburg LL, Glantz JC: Effect of second-trimester and third-trimester rate of gestational weight gain on maternal and neonatal outcomes. Obstet Gynecol 2011, 118:569-575.
  • [59]Chu SY, Callaghan WM, Bish CL, D’Angelo D: Gestational weight gain by body mass index among US women delivering live births, 2004-2005: fueling future obesity. Am J Obstet Gynecol 2009, 200(271):e1-e7.
  • [60]Lowell H, Miller DC: Weight gain during pregnancy: adherence to Health Canada’s guidelines. Health Rep 2010, 21:31-36.
  • [61]Thornton YS, Smarkola C, Kopacz SM, Ishoof SB: Perinatal outcomes in nutritionally monitored obese pregnant women: a randomized clinical trial. J Natl Med Assoc 2009, 101:569-577.
  • [62]Quinlivan JA, Lam LT, Fisher J: A randomised trial of a four-step multidisciplinary approach to the antenatal care of obese pregnant women. Aust N Z J Obstet Gynaecol 2011, 51:141-146.
  • [63]Luoto R, Kinnunen TI, Aittasalo M, Kolu P, Raitanen J, Ojala K, Mansikkamäki K, Lamberg S, Vasankari T, Komulainen T, Tulokas S: Primary prevention of gestational diabetes mellitus and large-for-gestational-age newborns by lifestyle counseling: a cluster-randomized controlled trial. PLoS Med 2011, 8:e1001036.
  • [64]Ruchat S, Davenport MH, Giroux I, Hillier M, Batada A, Sopper MM, Hammond JA, Joanne MS, Mottola MF: Nutrition and exercise reduce excessive weight gain in normal-weight pregnant women. Med Sci Sports Exerc 2012, 44:1419-1426.
  • [65]Alfaradhi MZ, Ozanne SE: Developmental programming in response to maternal overnutrition. Front Genet 2011, 2:27.
  • [66]Catalano PM, Farrell K, Thomas A, Huston-Presley L, Mencin P, De M, Sylvie H, Amini SB: Perinatal risk factors for childhood obesity and metabolic dysregulation. Am J Clin Nutr 2009, 90:1303-1313.
  • [67]Crozier SR, Robinson SM, Borland SE, Godfrey KM, Cooper C, Inskip HM: Do women change their health behaviours in pregnancy? Findings from the Southampton Women’s Survey. Paediatr Perinat Epidemiol 2009, 23:446-453.
  文献评价指标  
  下载次数:19次 浏览次数:14次