Loading...
Fetal macrosomia is intimately tied to the obesity epidemic: Maternal obesity raises risk for fetal macrosomia, which in turn is a risk factor for obesity later in life. Investigators at the National Maternity Hospital in Dublin conducted a randomized, controlled trial of a low-glycemic–index diet and its effects on neonatal macrosomia and maternal outcomes in 800 women with prior macrosomic deliveries but no histories of gestational diabetes. Participants were randomized during early pregnancy to receive dietary education (with a special focus on glycemic index) or routine prenatal care.
Compared with women in the control group, those in the intervention group achieved lower dietary glycemic indexes, gained less weight during pregnancy (mean difference, 1.3 kg; P=0.01), and were less likely to experience glucose intolerance. Although a significant proportion of women in each group exceeded recommended gestational weight gain goals, women in the intervention group were less likely to do so (38% vs. 48%; P=0.01). However, neither mean birth weight nor incidence of macrosomia differed between groups. Rates of preterm or cesarean delivery also did not differ.
Walsh JM et al. Low glycaemic index diet in pregnancy to prevent macrosomia (ROLO study): Randomised control trial. BMJ 2012 Aug 30; 345:e5605. (http://dx.doi.org/10.1136/bmj.e5605)
Comment
Although counseling and adherence to a low-glycemic–index diet had no effect on neonatal birth weight, this study adds evidence that nutritional counseling can curb gestational weight gain. Excessive weight gain is associated with other adverse maternal outcomes that this study might not have been powered to detect, and probably has consequences for women's health both between pregnancies and in the long term. Providing culturally appropriate nutritional counseling during pregnancy is a high priority, particularly for women at greatest risk for adverse weight-related outcomes.