Maria A. Kennelly

Probiotics in obese pregnancy do not reduce maternal fasting glucose: a double-blind, placebo-controlled, randomized trial (Probiotics in Pregnancy Study)

BACKGROUND Recent studies have reported beneficial effects of probiotics on maternal glycemia in healthy pregnant women. Obesity significantly increases risk of impaired glucose tolerance in pregnancy, but glycemic effects of probiotics in this specific obstetric group require additional investigation. OBJECTIVE The aim of the Probiotics in Pregnancy Study was to investigate the effect of a probiotic capsule on maternal fasting glucose in obese pregnant women. DESIGN In this placebo-controlled, double-blind, randomized trial, 175 pregnant women with an early pregnancy body mass index (BMI; in kg/m²) from 30.0 to 39.9 were recruited from antenatal clinics at the National Maternity Hospital, Dublin, Ireland. Exclusion criteria were BMI <30.0 or >39.9, prepregnancy or gestational diabetes, age <18 y, multiple pregnancy, and fetal anomaly. Women were randomly assigned to receive either a daily probiotic or a placebo capsule from 24 to 28 wk of gestation in addition to routine antenatal care. The primary outcome was the change in fasting glucose between groups from preintervention to postintervention. Secondary outcomes were the incidence of gestational diabetes and neonatal anthropometric measures. RESULTS In 138 women who completed the study (63 women in the probiotic group; 75 women in the placebo group), mean (±SD) early pregnancy BMI was 33.6 ± 2.6, which differed significantly between probiotic (32.9 ± 2.4) and placebo (34.1 ± 2.7) groups. With adjustment for BMI, the change in maternal fasting glucose did not differ significantly between treated and control groups [-0.09 ± 0.27 compared with -0.07 ± 0.39 mmol/L; P = 0.391; B = -0.05 (95% CI: -0.17, 0.07)]. There were also no differences in the incidence of impaired glycemia (16% in the probiotic group compared with 15% in the placebo group; P = 0.561), birth weight (3.70 kg in the probiotic group compared with 3.68 kg in the placebo group; P = 0.723), or other metabolic variables or pregnancy outcomes. A secondary analysis of 110 women, excluding antibiotic users and poor compliers, also revealed no differences in maternal glucose or other outcomes between groups. CONCLUSION Probiotic treatment of 4 wk during pregnancy did not influence maternal fasting glucose, the metabolic profile, or pregnancy outcomes in obese women.

Prediction and prevention of Gestational Diabetes: an update of recent literature.

A diagnosis of Gestational Diabetes (GDM) confers adverse risk to the health of the mother and fetus both in pregnancy and later life. The background rate in pregnancy varies between 2 and 14% with incidences reported to be as high as 40% in obese populations. GDM diagnoses are escalating because of rising numbers of overweight and obesity in the reproductive age group but also because of different screening and diagnostic criteria. Lifestyle modification in those diagnosed with GDM has been proven to be an effective treatment in attenuating the metabolic dysregulation associated with this and potentially avoiding the need for medical therapy with either metformin or insulin. Emerging evidence in previous years suggests lifestyle interventions (dietary±physical activity and behavior modification) either pre-pregnancy or antenatally may reduce the incidence of GDM. The first trimester is also becoming an important interrogation period for the prediction of many adverse obstetric outcomes including abnormal glucose metabolism. This review outlines the most contemporary evidence on the prediction and non-pharmacological antenatal prevention strategies used for Gestational Diabetes.

Influences on the food choices and physical activity behaviours of overweight and obese pregnant women: A qualitative study

OBJECTIVE to qualitatively explore influences identified by overweight/obese pregnant women on food choices and physical activity (PA) behaviours; to determine the impact of pregnancy on these factors; and to inform development of future lifestyle interventions during pregnancy. DESIGN cross-sectional interview study. SETTING maternity hospital, Ireland. PARTICIPANTS pregnant women (n=22), early pregnancy Body Mass Index > 25kg/m2 MEASURES: barriers to and facilitators of healthy eating and PA in overweight/obese pregnancy. Interviews were transcribed verbatim and analysed using inductive thematic analysis. FINDINGS overweight/obese women perceived the following factors to influence their food choices and PA behaviours: personal (e.g. age, enjoyment, health, aesthetic appearance, and response to fatigue); social (e.g. social support, food modelling, social facilitation and weight bias) and environmental (e.g. food salience and the obesogenic environment). These factors affected PA and food choice trajectories differently according to socio-economic and socio-cultural context. CONCLUSION AND IMPLICATIONS personal, social and environmental factors affect food choices and PA behaviours. Pregnancy is a powerful stimulus for positive changes in food choices particularly. This change is driven by desire for healthy pregnancy outcome, and is not intrinsically motivated. Healthy lifestyle interventions should aim to sustain positive changes beyond pregnancy through: empowerment, intrinsic motivation, family-centred approach, and behavioural goals.

PPO.19 Probiotics in obese pregnancy to reduce maternal fasting glucose: A randomised controlled trial

Objectives Probiotics are live microorganisms which may confer health benefits on the host. Recent studies have demonstrated various beneficial effects of probiotics in pregnancy among healthy women.1 The aim of this study was to investigate the effects of a probiotic capsule on maternal fasting glucose and pregnancy outcome in obese pregnant women. Methods This double-blind randomised controlled trial recruited pregnant women with a body mass index of 30.0–39.9kg/m2. Women were randomised to either a daily probiotic (Lactobacillus salivarius UCC118) or placebo capsule from 24 to 28 week’s gestation. The primary outcome was a reduction in fasting glucose from pre to post-intervention and secondary outcomes were incidence of gestational diabetes and neonatal anthropometry. A sample size of 100 was required to detect a reduction in fasting glucose of 0.4 mmol/l with at least 80% power. Results Of 138 participants, 28 were excluded from analyses due to antibiotic usage and poor capsule compliance, leaving 110 women for final analysis. BMI was the only factor that differed between the intervention groups at baseline (32.9 ± 2.6 probiotic vs 34.0 ± 2.7kg/m2 placebo, p = 0.044). Adjusting for BMI, no difference was noted in fasting glucose from pre- to post-intervention (-0.07 ± 0.41 probiotic vs –0.11 ± 0.27 mmol/l placebo, p = 0.295). There was also no difference in birth weight centile, incidence of gestational diabetes or other adverse pregnancy outcomes between the groups. Conclusion While previous studies of probiotics in healthy pregnant women showed some beneficial glycaemic effect, this randomised trial demonstrated no impact on fasting glucose or on obstetric outcomes in obese pregnancy. Reference 1Lindsay KL, Walsh CA, Brennan L, McAuliffe FM. Probitoics in pregnancy and maternal outcomes: A systematic review. J Mat Fet Neonat Med2013;26:772–8