Abstract:
BACKGROUND:Our objective was to examine whether gestational diabetes mellitus (GDM) or newborns' high birthweight can be prevented by lifestyle counseling in pregnant women at high risk of GDM. METHOD AND FINDINGS:We conducted a cluster-randomized trial, the NELLI study, in 14 municipalities in Finland, where 2,271 women were screened by oral glucose tolerance test (OGTT) at 8-12 wk gestation. Euglycemic (n = 399) women with at least one GDM risk factor (body mass index [BMI] ≥ 25 kg/m(2), glucose intolerance or newborn's macrosomia (≥ 4,500 g) in any earlier pregnancy, family history of diabetes, age ≥ 40 y) were included. The intervention included individual intensified counseling on physical activity and diet and weight gain at five antenatal visits. Primary outcomes were incidence of GDM as assessed by OGTT (maternal outcome) and newborns' birthweight adjusted for gestational age (neonatal outcome). Secondary outcomes were maternal weight gain and the need for insulin treatment during pregnancy. Adherence to the intervention was evaluated on the basis of changes in physical activity (weekly metabolic equivalent task (MET) minutes) and diet (intake of total fat, saturated and polyunsaturated fatty acids, saccharose, and fiber). Multilevel analyses took into account cluster, maternity clinic, and nurse level influences in addition to age, education, parity, and prepregnancy BMI. 15.8% (34/216) of women in the intervention group and 12.4% (22/179) in the usual care group developed GDM (absolute effect size 1.36, 95% confidence interval [CI] 0.71-2.62, p = 0.36). Neonatal birthweight was lower in the intervention than in the usual care group (absolute effect size -133 g, 95% CI -231 to -35, p = 0.008) as was proportion of large-for-gestational-age (LGA) newborns (26/216, 12.1% versus 34/179, 19.7%, p = 0.042). Women in the intervention group increased their intake of dietary fiber (adjusted coefficient 1.83, 95% CI 0.30-3.25, p = 0.023) and polyunsaturated fatty acids (adjusted coefficient 0.37, 95% CI 0.16-0.57, p < 0.001), decreased their intake of saturated fatty acids (adjusted coefficient -0.63, 95% CI -1.12 to -0.15, p = 0.01) and intake of saccharose (adjusted coefficient -0.83, 95% CI -1.55 to -0.11, p = 0.023), and had a tendency to a smaller decrease in MET minutes/week for at least moderate intensity activity (adjusted coefficient 91, 95% CI -37 to 219, p = 0.17) than women in the usual care group. In subgroup analysis, adherent women in the intervention group (n = 55/229) had decreased risk of GDM (27.3% versus 33.0%, p = 0.43) and LGA newborns (7.3% versus 19.5%, p = 0.03) compared to women in the usual care group. CONCLUSIONS:The intervention was effective in controlling birthweight of the newborns, but failed to have an effect on maternal GDM. TRIAL REGISTRATION:Current Controlled Trials ISRCTN33885819. Please see later in the article for the Editors' Summary.
journal_name
PLoS Medjournal_title
PLoS medicineauthors
Luoto R,Kinnunen TI,Aittasalo M,Kolu P,Raitanen J,Ojala K,Mansikkamäki K,Lamberg S,Vasankari T,Komulainen T,Tulokas Sdoi
10.1371/journal.pmed.1001036subject
Has Abstractpub_date
2011-05-01 00:00:00pages
e1001036issue
5eissn
1549-1277issn
1549-1676pii
PMEDICINE-D-10-00105journal_volume
8pub_type
杂志文章,随机对照试验相关文献
PLOS MEDICINE文献大全abstract:BACKGROUND:Artemisinin-based combination therapy (ACT) is recommended for uncomplicated Plasmodium vivax malaria in areas of emerging chloroquine resistance. We undertook a systematic review and individual patient data meta-analysis to compare the efficacies of dihydroartemisinin-piperaquine (DP) and artemether-lumefan...
journal_title:PLoS medicine
pub_type: 杂志文章,meta分析
doi:10.1371/journal.pmed.1002928
更新日期:2019-10-04 00:00:00
abstract:BACKGROUND:Many low- and middle-income countries are not on track to reach the public health targets set out in the Millennium Development Goals (MDGs). We evaluated whether differential progress towards health MDGs was associated with economic development, public health funding (both overall and as percentage of avail...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.1000241
更新日期:2010-03-02 00:00:00
abstract::This month in PLOS Medicine we launched a Special Issue on New Tools and Strategies for Tuberculosis Diagnosis, Care, and Elimination. In this issue's Editorial, the Guest Editors Claudia Denkinger, Richard Chaisson, and Mark Hatherill highlight some of the research that will publish and how these studies focusing on ...
journal_title:PLoS medicine
pub_type: 社论
doi:10.1371/journal.pmed.1002795
更新日期:2019-04-30 00:00:00
abstract:BACKGROUND:There is very limited data on the time trend of diabetes incidence in Asia. Using population-level data, we report the secular trend of the incidence of type 1 and type 2 diabetes in Hong Kong between 2002 and 2015. METHODS AND FINDINGS:The Hong Kong Diabetes Surveillance Database hosts clinical information...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.1003052
更新日期:2020-02-20 00:00:00
abstract::[This corrects the article DOI: 10.1371/journal.pmed.1003293.]. ...
journal_title:PLoS medicine
pub_type: 已发布勘误
doi:10.1371/journal.pmed.1003517
更新日期:2020-12-29 00:00:00
abstract:BACKGROUND:Clinical trials of interventions designed to prevent severe falciparum malaria in children require a clear endpoint. The internationally accepted definition of severe malaria is sensitive, and appropriate for clinical purposes. However, this definition includes individuals with severe nonmalarial disease and...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.0040251
更新日期:2007-08-01 00:00:00
abstract:BACKGROUND:Published research on prescribed opioid analgesic (POA) use during pregnancy and birth outcomes is limited in scope and has not adequately adjusted for potential confounding factors. To help address these gaps, we estimated associations between maternal POAs during pregnancy and two adverse birth outcomes us...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.1002980
更新日期:2019-12-02 00:00:00
abstract:BACKGROUND:Meta-analyses of antidepressant medications have reported only modest benefits over placebo treatment, and when unpublished trial data are included, the benefit falls below accepted criteria for clinical significance. Yet, the efficacy of the antidepressants may also depend on the severity of initial depress...
journal_title:PLoS medicine
pub_type: 杂志文章,meta分析
doi:10.1371/journal.pmed.0050045
更新日期:2008-02-01 00:00:00
abstract:BACKGROUND:Socioeconomic disparities in infant mortality have persisted for decades in high-income countries and may have become stronger in some populations. Therefore, new understandings of the mechanisms that underlie socioeconomic differences in infant deaths are essential for creating and implementing health initi...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.1002831
更新日期:2019-06-14 00:00:00
abstract::How do we spot the next sexually transmitted infection? Kyle Bernstein and colleagues look for lessons from past discovery. ...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.1002474
更新日期:2017-12-27 00:00:00
abstract:BACKGROUND:Leber congenital amaurosis (LCA) is a genetically heterogeneous group of retinal diseases that cause congenital blindness in infants and children. Mutations in the GUCY2D gene that encodes retinal guanylate cyclase-1 (retGC1) were the first to be linked to this disease group (LCA type 1 [LCA1]) and account f...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.0030201
更新日期:2006-06-01 00:00:00
abstract:BACKGROUND:Rare diseases affect as many as 60 million people in the United States and Europe. However, most rare diseases lack effective therapies and are in critical need of clinical research. Our objective was to determine the frequency of noncompletion and nonpublication of trials studying rare diseases. METHODS AN...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.1002966
更新日期:2019-11-21 00:00:00
abstract::Thomas Platts-Mills and Matthew Perzanowski provide their expert Perspective on a translational study from Custovic and colleagues that identifies pairings of IgE that show value in estimating risk of concurrent asthma. ...
journal_title:PLoS medicine
pub_type: 评论,杂志文章
doi:10.1371/journal.pmed.1002696
更新日期:2018-11-20 00:00:00
abstract:BACKGROUND:Violence against women by intimate partners remains unacceptably common worldwide. The evidence base for the assumed psychological impacts of intimate partner violence (IPV) is derived primarily from studies conducted in high-income countries. A recently published systematic review identified 13 studies link...
journal_title:PLoS medicine
pub_type: 杂志文章,随机对照试验
doi:10.1371/journal.pmed.1001943
更新日期:2016-01-19 00:00:00
abstract::Harald Schmidt and Anne Barnhill highlight the need to ensure equity in the proposed Sustainable Development Goals. ...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.1001872
更新日期:2015-09-08 00:00:00
abstract:BACKGROUND:Care advances in the United States (US) have led to improved survival of children with neurological impairment (NI). Children with NI may account for an increasing proportion of hospital resources. However, this assumption has not been tested at a national level. METHODS AND FINDINGS:We conducted a study of...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.1001158
更新日期:2012-01-01 00:00:00
abstract:BACKGROUND:Experimental and observational research has suggested the potential for increased type 2 diabetes (T2D) risk among populations taking statins for the primary prevention of atherosclerotic cardiovascular disease (ASCVD). However, few studies have directly compared statin-associated benefits and harms or exami...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.1003280
更新日期:2020-08-26 00:00:00
abstract:BACKGROUND:Spurred by the creation of potential modified risk tobacco products, the US Food and Drug Administration (FDA) commissioned the Institute of Medicine (IOM) to assess the science base for tobacco "harm reduction," leading to the 2001 IOM report Clearing the Smoke. The objective of this study was to determine ...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.1001450
更新日期:2013-01-01 00:00:00
abstract:BACKGROUND:Although it has long been appreciated that ovarian carcinoma subtypes (serous, clear cell, endometrioid, and mucinous) are associated with different natural histories, most ovarian carcinoma biomarker studies and current treatment protocols for women with this disease are not subtype specific. With the emerg...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.0050232
更新日期:2008-12-02 00:00:00
abstract:BACKGROUND:Skin atrophy is a common manifestation of aging and is frequently accompanied by ulceration and delayed wound healing. With an increasingly aging patient population, management of skin atrophy is becoming a major challenge in the clinic, particularly in light of the fact that there are no effective therapeut...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.0030493
更新日期:2006-12-01 00:00:00
abstract:BACKGROUND:Perinatal mortality and morbidity continue to be major global health challenges strongly associated with prematurity and reduced fetal growth, an issue of further interest given the mounting evidence that fetal growth in general is linked to degrees of risk of common noncommunicable diseases in adulthood. Ag...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.1002220
更新日期:2017-01-24 00:00:00
abstract:BACKGROUND:In patients treated with cardiotoxic chemotherapies, the presence of cardiovascular risk factors and previous cardiac disease have been strongly correlated to the onset of cardiotoxicity. The influence of overweight and obesity as risk factors in the development of treatment-related cardiotoxicity in breast ...
journal_title:PLoS medicine
pub_type: 临床试验,杂志文章
doi:10.1371/journal.pmed.1002989
更新日期:2019-12-23 00:00:00
abstract:BACKGROUND:Malaria and hypertension are major causes of maternal mortality in tropical countries, especially during first pregnancies, but evidence for a relationship between these syndromes is contradictory. METHODS AND FINDINGS:In a cross-sectional survey of Tanzanian parturients, the rate of hypertension was simila...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.0030446
更新日期:2006-11-01 00:00:00
abstract::Xonghong Xiao and colleagues analyze the challenge of antimicrobial resistance in China. A government strategy to promote rational use of antimicrobials in health care reduced antibiotic sales and percentage of prescriptions for antimicrobials for both hospitalized patients and outpatients, and offers insights to shap...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.1001556
更新日期:2013-11-01 00:00:00
abstract:BACKGROUND:To date, drug response genes have not proved as useful in clinical practice as was anticipated at the start of the genomic era. An exception is in the treatment of chronic hepatitis C virus (HCV) genotype 1 infection with pegylated interferon-alpha and ribavirin (PegIFN/R). Viral clearance is achieved in 40%...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.1001092
更新日期:2011-09-01 00:00:00
abstract:BACKGROUND:Important differences exist in the diagnosis of malnutrition when comparing the 2006 World Health Organization (WHO) Child Growth Standards and the 1977 National Center for Health Statistics (NCHS) reference. However, their relationship with mortality has not been studied. Here, we assessed the accuracy of t...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.1000039
更新日期:2009-03-03 00:00:00
abstract:BACKGROUND:The US Food and Drug Administration Amendments Act requires results from clinical trials of Food and Drug Administration-approved drugs to be posted at ClinicalTrials.gov within 1 y after trial completion. We compared the timing and completeness of results of drug trials posted at ClinicalTrials.gov and publ...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.1001566
更新日期:2013-12-01 00:00:00
abstract:BACKGROUND:Historically, the main focus of studies of childhood mortality has been the infant and under-five mortality rates. Neonatal mortality (deaths <28 days of age) has received limited attention, although such deaths account for about 41% of all child deaths. To better assess progress, we developed annual estimat...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.1001080
更新日期:2011-08-01 00:00:00
abstract:BACKGROUND:Insecticide-treated nets (ITNs) and indoor residual spraying (IRS) of houses provide effective malaria transmission control. There is conflicting evidence about whether it is more beneficial to provide both interventions in combination. A cluster randomised controlled trial was conducted to investigate wheth...
journal_title:PLoS medicine
pub_type: 杂志文章,随机对照试验
doi:10.1371/journal.pmed.1001630
更新日期:2014-04-15 00:00:00
abstract:BACKGROUND:Electronic medical records provide large-scale real-world clinical data for use in developing clinical decision systems. However, sophisticated methodology and analytical skills are required to handle the large-scale datasets necessary for the optimisation of prediction accuracy. Myopia is a common cause of ...
journal_title:PLoS medicine
pub_type: 杂志文章,多中心研究
doi:10.1371/journal.pmed.1002674
更新日期:2018-11-06 00:00:00