Low glycemic index diet in pregnancy to prevent macrosomia (POLO study): Randomised control trial

UCD Obstetrics and Gynaecology, School of Medicine and Medical Science, University College Dublin, National Maternity Hospital, Dublin, Ireland.
BMJ (online) (Impact Factor: 17.45). 08/2012; 345(aug30 1):e5605. DOI: 10.1136/bmj.e5605
Source: PubMed


To determine if a low glycaemic index diet in pregnancy could reduce the incidence of macrosomia in an at risk group.
Randomised controlled trial.
Maternity hospital in Dublin, Ireland.
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.
Women were randomised to receive no dietary intervention or start on a low glycaemic index diet from early pregnancy.
The primary outcome measure was difference in birth weight. The secondary outcome measure was difference in gestational weight gain.
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).
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.
Current Controlled Trials ISRCTN54392969.

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    • "Maternal characteristics are listed in Table 1. Maternal characteristics did not differ between the control and intervention groups except for gestational weight gain [25,27], glucose intolerance and maternal well-being score [29] as previously described. 91.4% of the women were of “white Irish”, 6.7% of “white other”, 0.3% of “African”, 0.5% of “Chinese”, 0.1% of “Indian” and 1.0% of “Filipino/South East Asian” ethnicity. "
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    ABSTRACT: The in utero environment is known to affect fetal development however many of the mechanisms by which this occurs remain unknown. The aim of this study was to examine the association between maternal dietary macronutrient intake and lifestyle throughout pregnancy and neonatal weight and adiposity. This was an analysis of 542 mother and infant pairs from the ROLO study (Randomised cOntrol trial of LOw glycaemic index diet versus no dietary intervention to prevent recurrence of fetal macrosomia). Food diaries as well as food frequency and lifestyle and physical activity questionnaires were completed during pregnancy. Maternal anthropometry was measured throughout pregnancy and neonatal anthropometry was measured at birth. Multiple linear regression analysis revealed the main maternal factor associated with increased birth weight was greater gestational weight gain R2 adj23.3% (F = 11.547, p < 0.001). The main maternal factor associated with increased birth length was non-smoking status R2 adj27.8% (F = 6.193, p < 0.001). Neonatal central adiposity (determined using waist:length ratio) was negatively associated with maternal age, and positively associated with the following parameters: smoking status, maternal pre-pregnancy arm circumference, percentage energy from saturated fat in late pregnancy, postprandial glucose at 28 weeks gestation and membership of the control group with a positive trend towards association with trimester 2 glycaemic load R2 adj 38.1% (F = 8.000, p < 0.001). Several maternal diet and lifestyle factors were associated with neonatal anthropometry . Low glycaemic index dietary intervention in pregnancy was found to have a beneficial effect on neonatal central adiposity. Additionally, central adiposity was positively associated with maternal dietary fat intake and postprandial glucose highlighting the important role of healthy diet in pregnancy in promoting normal neonatal adiposity. Trial registration Current Controlled Trials ISRCTN54392969.
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    • "The interview sample was recruited from the ROLO study, a randomised trial of a low glycaemic index diet in pregnancy to prevent macrosomia in women with a history of macrosomic delivery [27]. Second-time mothers whose first infant was macrosomic (>4 kg) were recruited from the control group of the ROLO study. "
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    ABSTRACT: Excessive weight gain during pregnancy is a major risk factor for macrosomia (high birth weight delivery). This study aimed to explore views about weight gain and lifestyle practices during pregnancy among women with a history of macrosomia. A qualitative descriptive study was conducted. Twenty-one second-time mothers whose first infant was macrosomic (>4 kg) were recruited from a randomised trial in a large maternity hospital in the Republic of Ireland. Semi-structured interviews were conducted with participants at both 6 and 12 months after their second pregnancy. Inductive thematic analysis was used to identify distinct themes. The mothers believed in following their prenatal food cravings to meet their baby's needs, but this led some to eat excessively. Many of the women cut back heavily on physical activity during pregnancy due to perceived risks to the baby. Physical conditions and discomforts during pregnancy often limited maternal control over weight and lifestyle practices. The women were not particularly concerned about weight gain during pregnancy and most did not favour the notion of introducing weight gain guidelines into routine antenatal care. Common differences perceived by the women between their first and second pregnancy included: increased concern about weight gain in their second pregnancy due to prior difficulties with postpartum weight loss and increased time demands in their second pregnancy impeded healthy lifestyle practices. Most women did not alter their perspectives on weight gain and lifestyle practices in their second pregnancy in response to having a macrosomic infant in their first pregnancy. This analysis exposed numerous barriers to healthy pregnancy weight gain. The findings suggest that women may need to be advised to follow their prenatal food cravings in moderation. Pregnant women with children already may benefit from education on time-efficient methods of integrating healthy eating practices and physical activity into their lifestyles. Women with a history of macrosomia may need information about the importance of avoiding high weight gain in subsequent pregnancies.
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    • "Ethical approval for the study was obtained from the National Maternity Hospital Ethics Committee in November 2006. Detailed methods and principal results of the ROLO study have been previously published [11,12]. In brief, the ROLO study used a presenting sample of secundigravid women who previously delivered a macrosomic infant weighing equal to or greater than 4000 g. "
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