Fit for delivery
- Funding: Helse Sør-Øst, University of Agder
- Project leader main study: Linda Sagedal
- Lead nutritional part of study: Nina Øverby
- PhD: Elisabet Hillesund
Fit for delivery is a study performed in collaboration between Sørlandet Hospital and the University of Agder. The main aim of Fit for delivery was to evaluate whether simple dietary advice together with organized physical activities during pregnancy, could influence gestational weight gain and weight retention, serum glucose levels, the child’s birth weight and the prevalence of pregnancy complications. Our research group has been responsible for the nutrition part of Fit for delivery.
In total 606 nulliparous were included in the study and randomized into control or intervention group. The intervention group received dietary advice per telephone in addition to attending organized physical activity sessions. A diet score was developed in line with the advice given to the intervention group.
Our research centre has co-authored 12 papers from this study. Main results include:
The intervention group had lower gestational weight gain and better dietary scores compared to the control group post intervention. The intervention had no measurable effect on obstetrical or neonatal outcomes. The intervention had little effect on post-partum weight retention, although women who were compliant with the intervention demonstrated significantly lower PPWR at 12 months.
From post-hoc observational analyses we found that higher diet score either pre-pregnancy or in early pregnancy was protectively associated with excessive GWG and preterm delivery, whereas the protective association with high birthweight was confined to pre-pregnancy diet and with preeclampsia to early pregnancy diet.
You can find results from this study under Selected publications.
New Nordic Diet and pregnancy outcomes
- Funding: University of Agder
- Project leader: Nina Øverby
- PhD: Elisabet R. Hillesund
The aim of the present study was to investigate whether adhering to a healthy and potentially sustainable diet during pregnancy would be associated with the mothers’ weight gain during pregnancy and child birthweight in a large pregnancy cohort. We also investigated potential associations between maternal diet and pregnancy complications affecting newborn health such as preeclampsia and preterm birth. The study used data from approx. 70,000 women and their child who participated in the Norwegian Mother and Child Cohort Study (MoBa). We constructed a diet score that reflected adherence to a healthy and potentially sustainable Nordic diet and assessed odds ratios for the outcomes with high vs. low diet score. High vs. low diet score was associated with lower odds of excessive gestational weight gain (confined to normal weight women), lower odds of preeclampsia (all women), and lower odds of preterm birth (confined to nulliparous women). Children born to mothers with high diet score had higher mean birthweight than those born to mothers with low diet score. Women with high diet score had lower odds of giving birth to a child with low birthweight, but also higher odds of giving birth to a child with high birthweight compared to women with low diet score. Our findings support the importance of diet and diet quality during pregnancy for important aspects of maternal and child neonatal health.
Gestational diabetes
- Funding: Helse Sør-Øst (2019)
- Project leader: Linda Sagedal, SSHF
- PhD: Anam Shakil Rai, co-supervisor: Nina Øverby
Gestational diabetes considerably increases the risk of health complications for both mother and child, not only during pregnancy and delivery but also later in life. GDM has been defined as any degree of glucose intolerance with onset or first recognition during pregnancy. In 2017, the Norwegian Directorate of Health released new clinical guidelines for GDM9. Importantly, the new Norwegian2017 criteria for GDM identifies women with a higher risk of adverse outcomes than the WHO2013 criteria. As we now know that about 30-50% of women are missed if only high-risk women are offered the OGTT, the majority of pregnant women are now recommended the OGTT. Screening for GDM is a responsibility for primary antenatal care, and the new guideline implies a higher workload for General Practitioners and midwifes working in the communities. The overall goals of this project are to improve antenatal care in the communities by 1) evaluation of the new clinical guideline’s ability to correctly identify women with GDM, and 2) develop a tool to optimize clinical practice with respect to screening and diagnosis of GDM that balances benefits and harms, which will be advantageous for the pregnant woman and her unborn child in the short and long term, as well as for healthcare providers, and society as a whole. By analysing individual participant data from four Norwegian pregnancy cohorts including 3030 pregnant women, we aim to further improve screening strategies for GDM, balancing benefits and harms for women, children and health care based on new knowledge.
Two papers have been published from this project.
The aim of the first paper was to assess the prevalence of GDM by three diagnostic criteria and the predictive accuracy of commonly used risk factors. The prevalence of GDM was similar using the 1999WHO and 2017Norwegian criteria, but substantially higher with the 2013WHO criteria, in particular for ethnic non-European women. Using clinical risk factors such as age and BMI is a poor pre-diagnostic screening method, as this approach failed to identify a substantial proportion of women with GDM unless at least 70-80% were tested. https://pubmed.ncbi.nlm.nih.gov/34496778/
The aim of the second paper was to examine the risk of adverse perinatal outcomes in women diagnosed with GDM by the World Health Organization (WHO) 1999 criteria, and in those retrospectively identified by the Norwegian-2017 and WHO-2013 criteria but not by WHO-1999 criteria. We also examine the effect of maternal overweight/obesity and ethnicity. Women who met the WHO-2013 and Norwegian-2017 criteria, but were not diagnosed by the WHO-1999 criteria and therefore not treated, had an increased risk of LGA, cesarean section and operative vaginal delivery compared to women without GDM. https://pubmed.ncbi.nlm.nih.gov/37410781/