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Effect of physical activity and/or healthy eating on GDM risk: The DALI Lifestyle Study
Open accessAbstract
CONTEXT: Lifestyle approaches for preventing gestational diabetes mellitus (GDM) have produced mixed results. OBJECTIVE: The aim of the present study was to compare the effectiveness of 3 lifestyle interventions [healthy eating (HE), physical activity (PA), and both HE and PA (HE+PA)] with usual care (UC) in reducing GDM risk. DESIGN: The present study was a multicenter randomized controlled trial conducted from 2012 to 2014 [the DALI (vitamin D and lifestyle intervention for GDM prevention) lifestyle study]. SETTING: The study occurred at antenatal clinics across 11 centers in 9 European countries. PATIENTS: Consecutive pregnant women at <20 weeks of gestation with a body mass index (BMI) of ≥29 kg/m2 and without GDM using the International Association of Diabetes and Pregnancy Study Group criteria (n = 436). For the intervention, women were randomized, stratified by site, to UC, HE, PA, or HE+PA. The women received 5 face-to-face and ≤4 telephone coaching sessions using the principles of motivational interviewing. A gestational weight gain (GWG) <5 kg was targeted. The coaches received standardized training and an intervention toolkit tailored to their culture and language. MAIN OUTCOME MEASURES: The endpoints were the GWG at 35 to 37 weeks and the fasting glucose and insulin sensitivity [homeostasis model assessment insulin resistance (HOMA-IR)] at 24 to 28 weeks. RESULTS: We randomized 108 women to HE+PA, 113 to HE, 110 to PA, and 105 to UC. In the HE+PA group, but not HE or PA alone, women achieved substantially less GWG than did the controls (UC) by 35 to 37 weeks (-2.02; 95% confidence interval, -3.58 to -0.46 kg). Despite this reduction, no improvements were seen in fasting or postload glucose levels, insulin concentrations, or HOMA-IR. The birthweights and large and small for gestational age rates were similar. CONCLUSIONS: The combined HE+PA intervention was able to limit GWG but did not reduce fasting glycemia. Thus, lifestyle changes alone are unlikely to prevent GDM among women with a BMI of ≥29 kg/m2.
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“in fact, the two trials [17, 21] that found no differences in physical activity level also found no effect on GDM.”
From A systematic review and meta-analysis of exercise-based intervention to prevent gestational diabetes in women with overweight or obesity (2025) · cites this paper as [21]
In the citing paper
“Regarding the concealment of the sequence, in five studies sequence implementation was carried out by an independent person (low risk of bias) [16, 18, 19, 21, 22] and in two no information is presented [17, 20] (considered unclear risk because there was not enough information to allow an assessment of low risk or high risk).”
From A systematic review and meta-analysis of exercise-based intervention to prevent gestational diabetes in women with overweight or obesity (2025) · cites this paper as [21]
In the citing paper
“In three studies [18, 19, 21] there was blinding of the personnel analysing the data (low risk of bias), and in the rest of them there was not enough information to allow an assessment of low risk or high risk [16, 17, 20, 22].”
From A systematic review and meta-analysis of exercise-based intervention to prevent gestational diabetes in women with overweight or obesity (2025) · cites this paper as [21]
In the citing paper
“Fourth, in four of the trials [18, 19, 21, 22], it was not specified whether the weight at baseline was self-reported or measured by healthcare professionals.”
From A systematic review and meta-analysis of exercise-based intervention to prevent gestational diabetes in women with overweight or obesity (2025) · cites this paper as [21]
In the citing paper
“Physical activity increases skeletal muscle glucose uptake, improves utero-placental oxidation capacity and complements MNT by preventing excessive weight gain [11,12,13].”
From Medical Nutrition Therapy for Women with Gestational Diabetes: Current Practice and Future Perspectives (2025) · cites this paper as [13]
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Self-citation
Metadata
- Authors
- Simmons, D., Devlieger, R., van Assche, A., Jans, G., Galjaard, S., Corcoy, R., Adelantado, J. M., Dunne, F., Desoye, G., Harreiter, J., Kautzky-Willer, A., Damm, P., Mathiesen, E. R., Jensen, D. M., Andersen, L., Lapolla, A., Dalfrà, M. G., Bertolotto, A., Wender-Ozegowska, E., Zawiejska, A., Hill, D., Snoek, F. J., Jelsma, J. G., & van Poppel, M. N.
- Affiliations
- Wellcome/MRC Institute of Metabolic Science (GB)
- KU Leuven (BE)
- Erasmus MC (NL)
- Hospital de Sant Pau (ES)
- Instituto de Salud Carlos III (ES)
- Ollscoil na Gaillimhe – University of Galway (IE)
- Medical University of Vienna (AT)
- University of Copenhagen (DK)
- University of Southern Denmark (DK)
- University of Padua (IT)
- Azienda Ospedaliera Universitaria Pisana (IT)
- Poznan University of Medical Sciences (PL)
- Amsterdam UMC Location University of Amsterdam (NL)
- Amsterdam Public Health (NL)
- University of Graz (AT)
- ORCID
- Venue
- The Journal of Clinical Endocrinology & Metabolism
- Publisher
- The Endocrine Society
- Published
- 2016-12-09
- Volume
- 102
- Issue
- 3
- Pages
- jc.2016-3455
- ISSN
- 0021-972X (ISSN-L)
- 1945-7197
- PMC
- PMC5460688
- OpenAlex
- W2560342673
- Cited by
- 225
- References
- 35
- Citations by year
- 2026: 5 · 2025: 18 · 2024: 25 · 2023: 24 · 2022: 32 · 2021: 27 · 2020: 22 · 2019: 25 · 2018: 31 · 2017: 14 · 2016: 1
- FWCI
- 30.57
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Research at the University of Copenhagen (University of Copenhagen) (publishedVersion, other-oa)
- Amsterdam UMC (VU Amsterdam) - Institutional Repository (publishedVersion)
- EUR Research Repository (Erasmus University Rotterdam) (publishedVersion, other-oa)
- University of Southern Denmark Research Portal (University of Southern Denmark) (publishedVersion)
- ARAN (University of Galway Research Repository) (Ollscoil na Gaillimhe – University of Galway) (acceptedVersion, cc-by-nc-nd)
- Lirias (submittedVersion, other-oa)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- EUR Research Repository (Erasmus University Rotterdam) (submittedVersion, other-oa)
- RePub (Erasmus University Rotterdam) (submittedVersion, other-oa)
- Arrow@dit (Dublin Institute of Technology) (submittedVersion)
- ARAN (University of Galway Research Repository) (Ollscoil na Gaillimhe – University of Galway) (submittedVersion, cc-by-nc-nd)
- Pure Amsterdam UMC (submittedVersion, other-oa)
- ARAN (University of Galway Research Repository) (Ollscoil na Gaillimhe – University of Galway) (submittedVersion, cc-by-nc)
- Scholarship@Western (Western University) (submittedVersion)
- Padua Research Archive (University of Padova) (submittedVersion)
- Research Repository UCD (University College Dublin) (cc-by-nc)
- Funders
- National Institute for Health and Care Research (FP7/2007–2013)
- ZonMw (1527-B-226, 242187, 200310013)
- Novo Nordisk Fonden (NNF14OC0009275)
- Western Sydney University
- Topics
- Health Sciences › Medicine › Obstetrics and Gynecology › Gestational Diabetes Research and Management
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Maternal and Neonatal Healthcare
- Keywords
- gestational diabetes mellitus, GDM prevention, lifestyle intervention, physical activity, healthy eating, gestational weight gain, insulin resistance, fasting blood glucose, overweight in pregnancy, motivational interviewing, telephone coaching, vitamin D
- MeSH terms
- Diet, Healthy, Adult, Birth Weight, Blood Glucose, Diet Therapy, Europe, Exercise Therapy, Female, Fetal Macrosomia, Glucose Tolerance Test, Humans, Infant, Newborn, Infant, Small for Gestational Age, Insulin, Insulin Resistance, Life Style, Obesity, Pregnancy, Pregnancy Complications, Prenatal Care, Weight Gain, Exercise, Odds Ratio, Diabetes, Gestational, Overweight, Metabolic Equivalent, Motivational Interviewing
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