@article {10565, title = {Immediate delivery or expectant management in gestational diabetes at term: the GINEXMAL randomised controlled trial.}, journal = {BJOG}, volume = {124}, year = {2017}, month = {2017 Mar}, pages = {669-677}, abstract = {

OBJECTIVE: To evaluate maternal and perinatal outcomes after induction of labour versus expectant management in pregnant women with gestational diabetes at term.

DESIGN: Multicentre open-label randomised controlled trial.

SETTING: Eight teaching hospitals in Italy, Slovenia, and Israel.

SAMPLE: Singleton pregnancy, diagnosed with gestational diabetes by the International Association of Diabetes and Pregnancy Study Groups criteria (IADPSGC), between 38 and 39 weeks of gestation, without other maternal or fetal conditions.

METHODS: Patients were randomly assigned to induction of labour or expectant management and intensive follow-up. Data were analysed by {\textquoteright}intention to treat{\textquoteright}.

MAIN OUTCOME MEASURES: The primary outcome was incidence of caesarean section. Secondary outcomes were maternal and perinatal mortality and morbidity.

RESULTS: A total of 425 women were randomised to the study groups. The incidence of caesarean section was 12.6\% in the induction group versus 11.7\% in the expectant group. No difference was found between the two groups (relative risk, RR 1.06; 95\% confidence interval, 95\% CI 0.64-1.77; P = 0.81). The incidence of non-spontaneous delivery, either by caesarean section or by operative vaginal delivery, was 21.0 and 22.3\%, respectively (RR 0.94; 95\% CI 0.66-1.36; P = 0.76). Neither maternal nor fetal deaths occurred. The few cases of shoulder dystocia were solved without any significant birth trauma.

CONCLUSIONS: In women with gestational diabetes, without other maternal or fetal conditions, no difference was detected in birth outcomes regardless of the approach used (i.e. active versus expectant management). Although the study was underpowered, the magnitude of the between-group difference was very small and without clinical relevance.

TWEETABLE ABSTRACT: Immediate delivery or expectant management in gestational diabetes at term?

}, keywords = {Adult, Delivery, Obstetric, Diabetes, Gestational, Female, Humans, Infant, Newborn, Israel, Italy, Maternal Mortality, Perinatal Mortality, Pregnancy, Pregnancy Outcome, Slovenia, Term Birth, Watchful Waiting}, issn = {1471-0528}, doi = {10.1111/1471-0528.14389}, author = {Alberico, S and Erenbourg, A and Hod, M and Yogev, Y and Hadar, E and Neri, F and Ronfani, L and Maso, G} } @article {1676, title = {Interventions for the prevention of overweight and obesity in preschool children: a systematic review of randomized controlled trials.}, journal = {Obes Rev}, volume = {12}, year = {2011}, month = {2011 May}, pages = {e107-18}, abstract = {

The objective of this study was to analyse interventions for the prevention of overweight and obesity in children under 5 years of age. We carried out a systematic review focusing exclusively on randomized controlled trials (RCTs). Data sources include Medline, Cochrane Library, EMBASE, CINHAL, PsychInfo and Web of Science. Data were extracted from seventeen articles describing seven RCTs identified through electronic search, screening of references in systematic reviews, own files and contact with authors. RCTs were assessed with the Jadad scale. Four trials were carried out in preschool settings, one with an exclusive educational component, two with an exclusive physical activity component and one with both. Two trials were family-based, with education and counselling for parents and children. The remaining trial was carried out in maternity hospitals, with a training intervention on breastfeeding. None of the interventions had an effect in preventing overweight and obesity. The failure to show an effect may be due to the choice of outcomes, the quality of the RCTs, the suboptimal implementation of the interventions, the lack of focus on social and environmental determinants. More rigorous research is needed on interventions and on social and environmental factors that could impact on lifestyle.

}, keywords = {Child Nutrition Sciences, Child Nutritional Physiological Phenomena, Child, Preschool, Exercise, Female, Health Promotion, Humans, Life Style, Male, Obesity, Overweight, Randomized Controlled Trials as Topic}, issn = {1467-789X}, doi = {10.1111/j.1467-789X.2010.00774.x}, author = {Monasta, L and Batty, G D and Macaluso, A and Ronfani, L and Lutje, V and Bavcar, A and van Lenthe, F J and Brug, J and Cattaneo, A} }