1. 44 th Annual Meeting

2. European Association for the Study of Diabetes Influence of pre-pregnancy glucose tolerance during A. Bertolotto,L. Volpe, S.Vignali, DEPARTMENT of ENDOCRINOLOGY AND METABOLISM,

3. Rome 7-11 September 2008 body mass index, physical pregnancy A.Calianno, M.C.Pugliese, C.Lencioni, UNIVERSITY OF PISA, ITALY

4. activity and dietary habits on M. Corfini, V. Resi, L.Benzi, G.Di Cianni

5. BACKGROUND -1 Abnormal glucose tolerance during pregnancy (AGT), including all condition from minor degree of glucose tolerance to overt gestational diabetes, confers increased risk of maternal morbidity and adverse pregnancy outcome. Maternal over-weight and obesity are considered the most important risk factors for AGT.

6. BACKGROUND - 2 To date, other factors that may influence glucose tolerance during pregnancy, such as physical activity and dietary habits, are not considered as risk factors for AGT.

7. OBJECTIVE The aim of the present study is to investigate the relative contribution of physical activity dietary habits on glucose tolerance during pregnancy.

8. MATERIALS AND METHODS - 1 Universal screening (50-g glucose challange test [GCT]) was performed at 27± 6.9 week of gestation in a cohort of 268 pregnant women. GCT was considered positive if 1-hr post-load plasma glucose (PG) was ≥140mg/dl. On the morning of the test, demographic, anthropometric and clinical data (age, family history of diabetes, obstetric history and pre- pregnancy BMI) were recorded.

9. MATERIALS AND METHODS - 2 To asses physical activity, all women were invited to fill the short form of the International Physical Activity Questionnaire (IPAQ) (Fig.1,2,3). We calculated the average amount of time per week spent during 7 days before the test (MET s /week).

10. Categories of physical activity: Vigorous physical activities refer to activities that take hard physical effort and make the breath much harder than normal. Moderate Activities refer to activities that take moderate physical effort and make the breathe somewhat harder than normal. Walking includes time spent at work and at home, to travel from place to place, and any other walking for recreation, sport, exercise, or leisure. Sitting Include time spent at work, at home, while doing course work and during leisure time. Fig.1- INTERNATIONAL PHYSICAL ACTIVITY QUESTIONNAIRE (IPAQ)

11. Questionnaire Think only about those physical activities that you did for at least 10 minutes at a time. 1. During the last 7 days, on how many days did you do vigorous physical activities like heavy lifting, digging, aerobics, or fast bicycling? _____days per week No vigorous physical activitiesSkip to question 3 2. How much time did you usually spend doing vigorous physical activities on one of those days? _____hours per day _____minutes per day Don’t know/Not sure 3. During the last 7 days, on how many days did you do moderate physical activities like carrying light loads, bicycling at a regular pace, or doubles tennis? Do not include walking. _____days per week No moderate physical activities Skip to question 5 Fig.2- INTERNATIONAL PHYSICAL ACTIVITY QUESTIONNAIRE (IPAQ)

12. 4. How much time did you usually spend doing moderate physical activities on one of those days? _____hours per day _____minutes per day Don’t know/Not sure 5. During the last 7 days, on how many days did you walk for at least 10 minutes at a time? _____ days per week No walking Skip to question 7 6. How much time did you usually spend walking on one of those days? _____hours per day _____minutes per day Don’t know/Not sure 7. During the last 7 days, how much time did you spend sitting on a week day? _____hours per day _____minutes per day Don’t know/Not sure Fig.3- INTERNATIONAL PHYSICAL ACTIVITY QUESTIONNAIRE (IPAQ)

13. To evaluate dietary habits, all women answered to a food frequency questionnaire performed by 3 trained dieticians (Fig. 4) The energy intake and dietary nutrient content were calculated by a computerized program (MetaDieta ® )(Fig. 5,6) MATERIALS AND METHODS - 3

14. Fig. 4 – FOOD FREQUENCY QUESTIONNAIRE Fig. 4 – FOOD FREQUENCY QUESTIONNAIRE (MetaDieta ® )

15. Fig. 5 PHOTOGRAPHS TO COMPARE DIFFERENT PORTIONS FOR EACH ITEM Fig. 5 - PHOTOGRAPHS TO COMPARE DIFFERENT PORTIONS FOR EACH ITEM ( (MetaDieta ® )

16. Fig. 6 - COMPUTERIZED PROGRAM TO CALCULATE ENERGY INTAKE AND DIETARY NUTRIENT CONTENT Fig. 6 - COMPUTERIZED PROGRAM TO CALCULATE ENERGY INTAKE AND DIETARY NUTRIENT CONTENT (MetaDieta ® )

17. RESULTS - 1 We studied 268 pregnant women. GCT was found positive (GCT +) in 105 (39%) and negative (GCT -) in 163 cases (61%). No difference in demographic and clinical data resulted between GCT+ and GCT-. Only pre-pregnancy BMI and weight gain were significantly different between GCT+ and GCT- groups respectively (Table 1).

18. Tab.1 - CLINICAL CHARACTERISTICS All (n=268) GCT + (n=105) CGT- (n=163) Age (years)33.3 ± 433.8 ± 4.233 ± 4.5 Pre pregnancy BMI (Kg/m 2 ) 22.6 ± 3.823.5 ± 422 ± 3.6* Weight gain (Kg)8 ± 3.78.5 ± 4.37.6 ± 3.3** Positive family history of DM (%) 1313.412.8 Primiparous (%)585660 Smokers (%)87.48.6 Data are mean ± SD. P values refer to differences between groups as derived from unpaired t test * p=0.02 GCT+ vs GCT - ; * *p=0.03 GCT+ vs GCT -

19. RESULTS - 2 The physical activity performed by women during the last 7 days was on average 18.5±14.8 MET s /week. The mean daily energy intake of the cohort was 2013 ± 400 Kcal : carbohydrates 48%, total fats 36%, proteins 16%, cholesterol intake 221±78 mg/d and fibers 18.5±5.8 g/d. All parameters referring energy, macronutrient, cholesterol and fiber intake were not different between GCT+ and GCT- (Table 2)

20. Tab. 2 - NUTRITIONAL DATA GCT+ GCT- Daily energy intake (Kcal/die) 1976 ± 4102043 ± 400 Carbohydrates (CHO) (g/die) 228.7±64.3243.8±65 Complex CHO (g/die) Refined CHO (g/die) 134±41.5 81.2±33.2 146±50 83.2±24.3 Total Fats90.5±20.790.7±22.6 Saturated Fatty Acids (g/die) Monounsaturated FA (g/die) Polyunsaturated FA (g/die) 24.5±7.5 52.8±13 9.7±2.7 25.1±7 52.3±15 9.6±2.6 Proteins (g/die)75.8±1977±17.3 Cholesterol (mg/die)212.8±73.2226±81.4 Fibers (g/die)18.5±6.118.6 ± 5.6 Data are mean ± SD.

21. RESULTS - 3 The joint analysis of pre-pregnancy BMI and physical activity we divided the population into 4 groups: 1-hr PG was not significantly different among the 4 groups (Tab.3). NORMALWEIGHT ACTIVE NORMALWEIGHT: Pre-pregnancy BMI:< 25 kg/m 2, OVERWEIGHT: Pre-pregnancy BMI ≥ 25 kg/m 2 ; ACTIVE: Exercise ≥ 21.8 MET s /week; INACTIVE: Exercise <3 MET s /week OVERWEIGHT ACTIVE NORMALWEIGHT INACTIVE OVERWEIGHT INACTIVE

22. OVERWEIGHTp ACTIVEINACTIVE 1-hr PG (mg/dl) 146±31138 ±29NS NORMALWEIGHT ACTIVEINACTIVE 1-hr PG (mg/dl) 126±23132±29NS Tab. 3: 1-hr PG ACCORDING TO BMI AND PHYSICAL ACTIVITY Data are mean ± SD. P values refer to differences between groups as derived from unpaired t test

23. After a multivariate analysis including pre-pregnancy BMI, physical activity and energy intake only the BMI (F-value 9.264, p=0.02) remained significantly associated with 1-hr PG. RESULTS - 4 1-h PG (mg/dl) BMI (kg/m 2 )

24. CONCLUSIONS Pre-pregnancy BMI is the most important risk factor for the development of AGT. This result suggests the importance of life style, especially weight reduction in overweight women during the pre-conceptional period. The contribution of physical activity and diet to the development of AGT during pregnancy remains to be studied.

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