Ciara McGowan

Low glycaemic index diet in pregnancy to prevent macrosomia (ROLO study): randomised control trial

Objective To determine if a low glycaemic index diet in pregnancy could reduce the incidence of macrosomia in an at risk group. Design Randomised controlled trial. Setting Maternity hospital in Dublin, Ireland. Participants 800 women without diabetes, all in their second pregnancy between January 2007 to January 2011, having previously delivered an infant weighing greater than 4 kg. Intervention Women were randomised to receive no dietary intervention or start on a low glycaemic index diet from early pregnancy. Main outcomes The primary outcome measure was difference in birth weight. The secondary outcome measure was difference in gestational weight gain. Results No significant difference was seen between the two groups in absolute birth weight, birthweight centile, or ponderal index. Significantly less gestational weight gain occurred in women in the intervention arm (12.2 v 13.7 kg; mean difference −1.3, 95% confidence interval −2.4 to −0.2; P=0.01). The rate of glucose intolerance was also lower in the intervention arm: 21% (67/320) compared with 28% (100/352) of controls had a fasting glucose of 5.1 mmol/L or greater or a 1 hour glucose challenge test result of greater than 7.8 mmol/L (P=0.02). Conclusion A low glycaemic index diet in pregnancy did not reduce the incidence of large for gestational age infants in a group at risk of fetal macrosomia. It did, however, have a significant positive effect on gestational weight gain and maternal glucose intolerance. Trial registration Current Controlled Trials ISRCTN54392969.

The influence of maternal glycaemia and dietary glycaemic index on pregnancy outcome in healthy mothers

Infant birth weight has increased in Ireland in recent years along with levels of childhood overweight and obesity. The present article reviews the current literature on maternal glycaemia and the role of the dietary glycaemic index (GI) and its impact on pregnancy outcomes. It is known that maternal weight and weight gain significantly influence infant birth weight. Fetal macrosomia (birth weight >4000 g) is associated with an increased risk of perinatal trauma to both mother and infant. Furthermore, macrosomic infants have greater risk of being obese in childhood, adolescence and adulthood compared to normal-sized infants. There is evidence that there is a direct relationship between maternal blood glucose levels during pregnancy and fetal growth and size at birth, even when maternal blood glucose levels are within their normal range. Thus, maintaining blood glucose concentrations within normal parameters during pregnancy may reduce the incidence of fetal macrosomia. Maternal diet, and particularly its carbohydrate (CHO) type and content, influences maternal blood glucose concentrations. However, different CHO foods produce different glycaemic responses. The GI was conceived by Jenkins in 1981 as a method for assessing the glycaemic responses of different CHO. Data from clinical studies in healthy pregnant women have documented that consuming a low-GI diet during pregnancy reduces peaks in postprandial glucose levels and normalises infant birth weight. Pregnancy is a physiological condition where the GI may be of particular relevance as glucose is the primary fuel for fetal growth.

Maternal nutrient intakes and levels of energy underreporting during early pregnancy

Background/Objectives:Pregnancy is a critical period in a womans life where nutrition is of key importance for optimal pregnancy outcome. The aim of this study was to assess maternal nutrient intakes during early pregnancy and to examine potential levels of energy underreporting.Subjects/Methods:Three-day food diaries were collected from 260 healthy pregnant women sampled from the control arm of a large Irish pregnancy cohort at 14 weeks gestation (range 12–20 weeks).Results:Up to 45% of pregnant women may be underreporting daily energy intake (EI). Multiple logistic regression analysis found that having a body mass index (BMI) of ⩾25 kg/m2 compared with a BMI <25 kg/m2 (odds ratio, 4.4; 95% confidence interval, 2.5–7.7) was the main predictor of energy underreporting. Educational attainment is also an important predictor of energy underreporting. Women who underreport their EI tend to be less compliant with the current dietary recommendations for pregnancy.Conclusions:These data highlight the need for more education and public health interventions among pregnant women to achieve current dietary guidelines. In the analysis of dietary intakes, removal of extreme under reporters (Goldbergs ratio <0.9) may allow for more accurate assessment of nutritional intakes amongst pregnant women.

Prevalence of physical activity among healthy pregnant women in Ireland.

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Obstetric and metabolic implications of excessive gestational weight gain in pregnancy

To compare maternal characteristics, obstetric outcomes and insulin resistance in a cohort of women subdivided into those who did and those who did not exceed the Institute of Medicine (IOM) gestational weight gain guidelines.

The Relationship Between Maternal and Fetal Vitamin D, Insulin Resistance, and Fetal Growth:

Evidence for a role of vitamin D in maintaining normal glucose homeostasis is inconclusive. We sought to clarify the relationship between maternal and fetal insulin resistance and vitamin D status. This is a prospective cohort study of 60 caucasian pregnant women. Concentrations of 25-hydroxyvitamin D (25-OHD), glucose, insulin, and leptin were measured in early pregnancy and at 28 weeks. Ultrasound at 34 weeks assessed fetal anthropometry including abdominal wall width, a marker of fetal adiposity. At delivery birth weight was recorded and fetal 25-OHD, glucose, C-peptide, and leptin measured in cord blood. Insulin resistance was calculated using the Homeostasis Model Assessment (HOMA) equation. We found that those with lower 25-OHD in early pregnancy had higher HOMA indices at 28 weeks, (r = −.32, P = .02). No significant relationship existed between maternal or fetal leptin and 25-OHD, or between maternal or fetal 25-OHD and fetal anthropometry or birth weight. The incidence of vitamin D deficiency was high at each time point (15%-45%). These findings lend support to routine antenatal supplementation with vitamin D in at risk populations.

Insufficient vitamin D intakes among pregnant women

Vitamin D has an important role in pregnancy in promoting fetal skeletal health. Maternal dietary intake is a key factor influencing both maternal and fetal status. There are limited data available on food groups contributing to vitamin D intake in pregnancy. The aim of this study was to determine dietary intakes of vitamin D throughout pregnancy in 64 women and to determine the main food groups contributing to vitamin D intake. Results showed that median dietary intakes of vitamin D ranged from 1.9–2.1 μg/d during pregnancy, and were 80% below the current recommendation. The principal food groups contributing to vitamin D intake were meat, egg and breakfast cereal groups. Oily fish, the best dietary source of vitamin D, was consumed by <25% of women. These data call for more education; they question the role of vitamin D supplementation and highlight the contribution of other food groups more frequently consumed, namely, breakfast cereals, meat and eggs.

Maternal Diet and Weight at 3 Months Postpartum Following a Pregnancy Intervention with a Low Glycaemic Index Diet: Results from the ROLO Randomised Control Trial

Pregnancy increases the risk of being overweight at a later time period, particularly when there is excessive gestational weight gain. There remains a paucity of data into the effect of low glycaemic index (GI) pregnancy interventions postpartum. Aim: To examine the impact of a low glycaemic index diet during pregnancy on maternal diet 3 months postpartum. Methodology: This analysis examined the diet, weight and lifestyle of 460 participants of the ROLO study 3 months postpartum. Questionnaires on weight, physical activity, breastfeeding, supplement use, food label reading and dietary habits were completed. Results: The intervention group had significantly greater weight loss from pre-pregnancy to 3 months postpartum than the control group (1.3 vs. 0.1 kg, p = 0.022). The intervention group reported greater numbers following a low glycaemic index diet (p < 0.001) and reading food labels (p = 0.032) and had a lower glycaemic load (GL) (128 vs. 145, p = 0.014) but not GI (55 vs. 55, p = 0.809) than controls. Conclusions: Low GI dietary interventions in pregnancy result in improved health-behaviours and continued reported compliance at 3 months postpartum possibly through lower dietary GL as a result of portion control. Greater levels of weight loss from pre-pregnancy to 3 months postpartum in the intervention group may have important positive implications for overweight and obesity.

Maternal Nutrition and Glycaemic Index during Pregnancy Impacts on Offspring Adiposity at 6 Months of Age—Analysis from the ROLO Randomised Controlled Trial

Childhood obesity is associated with increased risk of adult obesity and metabolic disease. Diet and lifestyle in pregnancy influence fetal programming; however the influence of specific dietary components, including low glycaemic index (GI), remains complex. We examined the effect of a maternal low GI dietary intervention on offspring adiposity at 6 months and explored the association between diet and lifestyle factors in pregnancy and infant body composition at 6 months. 280 6-month old infant and mother pairs from the control (n = 142) and intervention group (n = 138), who received low GI dietary advice in pregnancy, in the ROLO study were analysed. Questionnaires (food diaries and lifestyle) were completed during pregnancy, followed by maternal lifestyle and infant feeding questionnaires at 6 months postpartum. Maternal anthropometry was measured throughout pregnancy and at 6 months post-delivery, along with infant anthropometry. No difference was found in 6 months infant adiposity between control and intervention groups. Maternal trimester three GI, trimester two saturated fats and trimester one and three sodium intake were positively associated with offspring adiposity, while trimester two and three vitamin C intake was negatively associated. In conclusion associations were observed between maternal dietary intake and GI during pregnancy and offspring adiposity at 6 months of age.

Well-being in pregnancy: an examination of the effect of socioeconomic, dietary and lifestyle factors including impact of a low glycaemic index dietary intervention.

Background/Objective:Well-being has been linked to the quality of diet and lifestyle in adults; however, there is a paucity of data in pregnancy. The aim of this study was to examine the relationship between well-being and socioeconomic status, diet and lifestyle during pregnancy and to consider the effect of intervention with low glycaemic index (GI) diet on well-being.Subjects/Methods:This was a cohort analysis of 619 participants of the ROLO study (Randomised cOntrol trial of LOw GI diet versus no dietary intervention to prevent recurrence of fetal macrosomia). The following data were collected: educational attainment, dietary intakes (food frequency questionnaire), physical activity (self-reported) and well-being (WHO-5-Item Wellbeing Index—expressed as a percentage).Results:Well-being was positively associated with education and physical activity. Third-level education was associated with a 3.07-point higher well-being percentage score, and each day that an individual achieved >30 min walking per week was associated with a 1.10-point increase in percentage well-being score, Radj2 2.4% (F=7.260, P=0.001). The intervention low GI group had a significantly lower percentage well-being score than the usual diet group (56.3% vs 59.9%, P=0.015). No correlation was noted between well-being and GI status calculated from food diaries (P=0.469). Well-being was not associated with micronutrient intake.Conclusions:Well-being in pregnancy was independently and positively associated with education and physical activity and negatively associated with low GI dietary intervention. These findings have significance not only for women at risk of low mood but also for healthcare professionals when counselling women about the importance of healthy lifestyle in pregnancy.