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

Background: A high prevalence of gestational diabetes mellitus and type 2 d iabetes has been observed among the Cree of lames Bay, Quebec. To address t his problem, a diet and activity intervention during pregnancy, which was b ased on social learning theory, was initiated in 4 Cree communities. Methods: A prospective intervention compared dietary, weight and glycemic i ndicators for 107 control subjects and for 112 women who received the inter vention during the course of their pregnancy. A control period in 4 communi ties (July 1995-March 1996) was followed by an intervention period (April 1 996-January 1997) when subjects were offered regular, individual diet couns elling, physical activity sessions and other activities related to nutritio n. Results: The intervention and control groups did not differ at baseline reg arding their mean age (24.3 years [SD 6.29] v. 23.8 years [SD 5.86]), mean prepreg nancy weight (81.0 kg [SD 19.46] v. 78.9 kg [SD 17.54]) and mean ge stational 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 l evel (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 w ere a reduction in caffeine (pregnancy) and an increase in folate (post par tum). Interpretation: This intervention had only a minor impact on diet; finding ways of encouraging appropriate body weight and activity levels remains a c hallenge.