Intervening to reduce weight gain in pregnancy and gestational diabetes mellitus in Cree communities: an evaluation.
Journal: 2000/December - CMAJ
ISSN: 0820-3946
PUBMED: 11107459
Abstract:
BACKGROUND
A high prevalence of gestational diabetes mellitus and type 2 diabetes has been observed among the Cree of James Bay, Quebec. To address this problem, a diet and activity intervention during pregnancy, which was based on social learning theory, was initiated in 4 Cree communities.
METHODS
A prospective intervention compared dietary, weight and glycemic indicators for 107 control subjects and for 112 women who received the intervention during the course of their pregnancy. A control period in 4 communities (July 1995-March 1996) was followed by an intervention period (April 1996-January 1997) when subjects were offered regular, individual diet counselling, physical activity sessions and other activities related to nutrition.
RESULTS
The intervention and control groups did not differ at baseline regarding their mean age (24.3 years [SD 6.29] v. 23.8 years [SD 5.86]), mean prepregnancy weight (81.0 kg [SD 19.46] v. 78.9 kg [SD 17.54]) and mean gestational age at recruitment (17.1 weeks [SD 7.06] v. 18.5 weeks [SD 6.92]). The intervention did not result in differences in diet measured at 24-30 weeks' gestation, rate of weight gain over the second half of pregnancy (0.53 kg per week [SD 0.32] v. 0.53 kg per week [SD 0.27]) or plasma glucose level (50 g oral glucose screen) between 24 and 30 weeks (7.21 mmol/L [SD 2.09] v. 7.43 mmol/L [SD 2.10]). Mean birth weights were similar (3741 g [SD 523] v. 3686 g [SD 686]), as was maternal weight at 6 weeks post partum (88.1 kg [SD 16.8] v. 86.4 kg [SD 19.0]). The only changes in dietary intake were a reduction in caffeine (pregnancy) and an increase in folate (post partum).
CONCLUSIONS
This intervention had only a minor impact on diet; finding ways of encouraging appropriate body weight and activity levels remains a challenge.
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CMAJ 163(10): 1247-1251

Intervening to reduce weight gain in pregnancy and gestational diabetes mellitus in Cree communities: an evaluation

From *the School of Dietetics and Human Nutrition, McGill University, Montreal, Que.; †the Public Health Module – Cree Region, Montreal General Hospital, Montreal, Que.; and ‡the Régie régionale de la santé et des services sociaux de Montréal-Centre, Montreal, Que.

Abstract

Background

A high prevalence of gestational diabetes mellitus and type 2 diabetes has been observed among the Cree of James Bay, Quebec. To address this problem, a diet and activity intervention during pregnancy, which was based on social learning theory, was initiated in 4 Cree communities.

Methods

A prospective intervention compared dietary, weight and glycemic indicators for 107 control subjects and for 112 women who received the intervention during the course of their pregnancy. A control period in 4 communities (July 1995–March 1996) was followed by an intervention period (April 1996–January 1997) when subjects were offered regular, individual diet counselling, physical activity sessions and other activities related to nutrition.

Results

The intervention and control groups did not differ at baseline regarding their mean age (24.3 years [SD 6.29] v. 23.8 years [SD 5.86]), mean prepregnancy weight (81.0 kg [SD 19.46] v. 78.9 kg [SD 17.54]) and mean gestational age at recruitment (17.1 weeks [SD 7.06] v. 18.5 weeks [SD 6.92]). The intervention did not result in differences in diet measured at 24–30 weeks' gestation, rate of weight gain over the second half of pregnancy (0.53 kg per week [SD 0.32] v. 0.53 kg per week [SD 0.27]) or plasma glucose level (50 g oral glucose screen) between 24 and 30 weeks (7.21 mmol/L [SD 2.09] v. 7.43 mmol/L [SD 2.10]). Mean birth weights were similar (3741 g [SD 523] v. 3686 g [SD 686]), as was maternal weight at 6 weeks post partum (88.1 kg [SD 16.8] v. 86.4 kg [SD 19.0]). The only changes in dietary intake were a reduction in caffeine (pregnancy) and an increase in folate (post partum).

Interpretation

This intervention had only a minor impact on diet; finding ways of encouraging appropriate body weight and activity levels remains a challenge.

Abstract

Footnotes

This article has been peer reviewed.

Acknowledgements: The authors thank the Cree Board of Health and Social Services of James Bay and the Cree Nation Councils in the 4 intervention communities for permission to conduct the study. We are also grateful to all health personnel in the 9 communities of James Bay for their assistance with the project. In particular, we thank Helen Smeja, Lucie Leclerc, Emily Bobbish-Rondeau, Pauline Langdon, Nellie Bobbish, Pauline Bobbish, Irene Mistacheesick, Lillian Stewart, Nathalie Gallant, Annie Bosum, Jane Loon, Helen Iserhoff, Beatrice Petawabano, Luce Bourassa, Mary Rabbitskin, Christine Longchap, Rita Mianscum, Paul Linton, Emily Gull, Harriet Charles and Helga Saudny-Hunterberger (data analyst). We would also like to thank Ingrid Kovitch for reviewing the manuscript and express our gratitude to all study participants who made this project possible.

This study was supported by National Health Research Development Program (NHRDP) grant 6605-4190-76.

Competing interests: None declared.

Reprint requests to: Dr. Katherine Gray-Donald, School of Dietetics and Human Nutrition, Macdonald Campus, McGill University, 21111 Lakeshore Rd, Ste. Anne de Bellevue QC H9X 3V9; fax 514 398-7739; ac.lligcm.dlanodcam@dlanod-yarg

Footnotes

References

  • 1. Rodrigues S, Robinson E, Gray-Donald KEstimated prevalence of gestational diabetes among the James Bay Cree. CMAJ 1999;160(9):1293-7. Abstract available: [PubMed]
  • 2. Pettitt DJ, Bennett PH, Knowler WC, Baird HR, Aleck KA. Gestational diabetes mellitus and impaired glucose tolerance during pregnancy. Long term effects on obesity and glucose tolerance in the offspring. Diabetes 1985; 34(Suppl 2):119-22. [[PubMed]
  • 3. Broussard BA, Johnson A, Himes JH, Story M, Fichtner R, Hauck F, et alPrevalence of obesity in American Indians and Alaska Natives. Am J Clin Nutr 1991;53(Suppl 6):1535S-42S. [[PubMed]
  • 4. Boyd ME, Usher RH, McLean FHFetal macrosomia: prediction, risks and proposed management. Obstet Gynecol 1993;61:715-22. [[PubMed]
  • 5. Berkowitz GS, Lapinski RH, Wein R, Lee DRace/ethnicity and other risk factors for gestational diabetes. Am J Epidemiol 1992;135:965-73. [[PubMed]
  • 6. Dooley SL, Metzger BE, Cho NH. Gestational diabetes mellitus. Influence of race on disease prevalence and perinatal outcome in a U.S population. Diabetes 1991;40(Suppl 2):25-9. [[PubMed]
  • 7. Borberg C, Gillmer MDG, Brunner EJ, Gunn PJ, Oakley NW, Beard RWObesity in pregnancy: the effect of dietary advice. Diabetes Care 1980;3:476-81. [[PubMed]
  • 8. Snyder J, Gray-Donald K, Koski KGPredictors of infant birth weight in gestational diabetes. Am J Clin Nutr 1994;59:1409-14. [[PubMed]
  • 9. Boston P, Jordan S, Macnamara E, Kozolanka K, Bobbish-Rondeau E, Iserhoff H, et alUsing participatory action research to understand the meanings aboriginal Canadians attribute to the rising incidence of diabetes. Chron Dis Can 1997;18:5-12. [[PubMed]
  • 10. Bandura A. Social foundations of thought and action: a social cognitive theory. Englewood Cliffs (NJ): Prentice-Hall; 1986.
  • 11. Institute of Medicine. Nutrition during pregnancy: report of the Committee on Nutritional Status during Pregnancy and Lactation. Washington: Food and Nutrition Board, National Academy Press; 1997.
  • 12. Sawaya AL, Tucker K, Tsay R, Willet W, Saltzman E, Dallal GE, et alEvaluation of four methods for determining energy intake in young and older women: comparisons with doubly labeled water measures of total energy expenditure. Am J Clin Nutr 1996;63:491-9. [[PubMed]
  • 13. Daveluy C, Bertrand L, editors. A dietary profile of the Cree: report of the Santé Quebechealth survey of the James Bay Cree 1991: food and nutrient intake. Montreal (QC): Santé Quebec; 1998.
  • 14. Kramer MS, McLean FH, Boyd ME, Usher RHThe validity of gestational age estimation by menstrual dating in term, pre-term and post-term gestation. JAMA 1988;260:3306-8. [[PubMed]
  • 15. National Diabetes Data groupClassification and diagnosis of diabetes mellitus and other categories of glucose intolerance. Diabetes 1979;28:1039-57. [[PubMed]
  • 16. Usher R, McLean FHIntrauterine growth of live-born Caucasian infants at sea level: standard obtained from measurements in 7 dimensions of infants born between 25 and 44 weeks gestation. J Pediatr 1969;74:901-10. [[PubMed]
  • 17. Health and Welfare Canada. Nutrition recommendations. The report of the Scientific Review Committee 1990. Ottawa: Health and Welfare Canada; 1990. Cat no H49-42/1990E.
  • 18. Campbell DM, MacGillivray IThe effect of a low calorie diet or a thiazide diuretic on the incidence of pre-eclampsia and on birth weight. Br J Obstet Gynaecol 1975;82:572-7. [[PubMed]
  • 19. Kramer MSEffects of energy and protein intakes on pregnancy outcome: an overview of the research evidence from controlled clinical trials. Am J Clin Nutr 1993;58:627-35. [[PubMed]
  • 20. Mestman JH. Follow up studies in women with gestational diabetes mellitus. The experience at LAC/USC Medical Centre. In: Weiss DA, Coustan DR, editors. Gestational diabetes. New York: Springer-Verlag; 1987. p. 191-8.
  • 21. Armstrong IE, Robinson EJ, Gray-Donald KPrevalence of low birth weight and fetal macrosomia among the James Bay Cree of Northern Quebec. Can J Public Health 1998:89:419-20.
  • 22. Joseph KS, Kramer MSRecent trends in infant mortality rates and proportions of low-birth-weight live births in Canada. CMAJ 1997;157(5):535-41. Abstract available: [PubMed]
  • 23. Vivian RP, McMillan C, Moore PE, Robertson EC, Sebrell WH, Tisdall FF, et alThe nutrition and health of the James Bay Indian. CMAJ 1948;59:505-18.
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