Effect of Physical Activity and/or Healthy Eating on GDM Risk: The DALI Lifestyle Study

J Clin Endocrinol Metab. 2017 Mar 1;102(3):903-913. doi: 10.1210/jc.2016-3455.


Context: Lifestyle approaches for preventing gestational diabetes mellitus (GDM) have produced mixed results.

Objective: The aim of the present study was to compare the effectiveness of 3 lifestyle interventions [healthy eating (HE), physical activity (PA), and both HE and PA (HE+PA)] with usual care (UC) in reducing GDM risk.

Design: The present study was a multicenter randomized controlled trial conducted from 2012 to 2014 [the DALI (vitamin D and lifestyle intervention for GDM prevention) lifestyle study].

Setting: The study occurred at antenatal clinics across 11 centers in 9 European countries.

Patients: Consecutive pregnant women at <20 weeks of gestation with a body mass index (BMI) of ≥29 kg/m2 and without GDM using the International Association of Diabetes and Pregnancy Study Group criteria (n = 436). For the intervention, women were randomized, stratified by site, to UC, HE, PA, or HE+PA. The women received 5 face-to-face and ≤4 telephone coaching sessions using the principles of motivational interviewing. A gestational weight gain (GWG) <5 kg was targeted. The coaches received standardized training and an intervention toolkit tailored to their culture and language.

Main outcome measures: The endpoints were the GWG at 35 to 37 weeks and the fasting glucose and insulin sensitivity [homeostasis model assessment insulin resistance (HOMA-IR)] at 24 to 28 weeks.

Results: We randomized 108 women to HE+PA, 113 to HE, 110 to PA, and 105 to UC. In the HE+PA group, but not HE or PA alone, women achieved substantially less GWG than did the controls (UC) by 35 to 37 weeks (-2.02; 95% confidence interval, -3.58 to -0.46 kg). Despite this reduction, no improvements were seen in fasting or postload glucose levels, insulin concentrations, or HOMA-IR. The birthweights and large and small for gestational age rates were similar.

Conclusions: The combined HE+PA intervention was able to limit GWG but did not reduce fasting glycemia. Thus, lifestyle changes alone are unlikely to prevent GDM among women with a BMI of ≥29 kg/m2.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Birth Weight
  • Blood Glucose / metabolism
  • Diabetes, Gestational / prevention & control*
  • Diet Therapy / methods*
  • Diet, Healthy*
  • Europe
  • Exercise Therapy / methods*
  • Exercise*
  • Female
  • Fetal Macrosomia / epidemiology
  • Glucose Tolerance Test
  • Humans
  • Infant, Newborn
  • Infant, Small for Gestational Age
  • Insulin / metabolism
  • Insulin Resistance
  • Life Style
  • Metabolic Equivalent
  • Motivational Interviewing / methods*
  • Obesity
  • Odds Ratio
  • Overweight
  • Pregnancy
  • Pregnancy Complications
  • Prenatal Care
  • Weight Gain


  • Blood Glucose
  • Insulin