Lesley McCowan,1 John Thompson,2 Clare Wall,3 Caroline Crowther,4 Wayne Cutfield,4 Teuila Percival,5 Robyn Whittaker,6 Rinki Murphy,7 Elaine Rush,8 Judith McAra-Couper,8 Kara Okesene-Gafa9 and Janet Rowan10
1 Department of Obstetrics & Gynaecology, Faculty of Medical and Health Sciences, , Auckland; 2 Department of Paediatrics, Faculty of Medical and Health Sciences, , Auckland; 3 Department of Nutrition, Faculty of Medical and Health Sciences, , Auckland; 4 Liggins Institute, , Auckland; 5 Pacific Health, School of Population Health, , Auckland; 6 National Institute for Health Innovation, School of Population Health, , Auckland; 7 Dept of Medicine, Faculty of Medical and Health Sciences, , Auckland; 8 Faculty of Health and Environmental Sciences, AUT University, Auckland; 9 Counties Manukau Health, Middlemore, Auckland; 10 Auckland DHB Women’s Health – Maternity/Pregnancy Care, Auckland City Hospital, Auckland
65% of women who give birth in South Auckland are overweight or obese. This is associated with increased rates of most pregnancy complications including gestational diabetes mellitus (GDM, or carbohydrate intolerance first recognised in pregnancy), large for gestational age (LGA) infants and stillbirth. As rates of obesity have increased there has been a parallel increase in GDM now diagnosed in 20% of women with BMI >30 kg/m2. Women with GDM have a 50% lifetime risk of developing type 2 diabetes. The unborn baby is exposed to excessive nutrients with the consequence that more infants are excessively large and experience traumatic birth. A further pressing problem is the increasing and disparate rates of overweight and obesity in children. In 2012, 43% of Māori and 51% of Pacific 2–14 year old children were overweight or obese vs 25% of European. GDM creates a vicious cycle for the offspring as large infants with higher fat mass are more likely to become obese children and obese adults who later develop type 2 diabetes. This promotes health inequalities in the next generation as Pacific, Māori, Indian and other Asian have rates of GDM 2- to 4-fold higher than European.
A recent systematic review reported a 60% reduction in GDM and shoulder dystocia with pregnancy nutritional interventions. Similarly, a recent Finnish randomised controlled trial of probiotics also reported a 64% reduction in GDM. We are planning an innovative four-armed randomised controlled trial of probiotics or placebo plus an intensive, culturally appropriate nutritional intervention in overweight and obese pregnant women in South Auckland.
We hypothesise that: (1) oral probiotics will reduce GDM; (2) an intensive nutritional intervention will be associated with reduced GDM, gestational weight gain and newborn fat mass; (3) the combination of oral probiotics plus nutritional intervention will further improve glucose metabolism.