Receives lifestyle intervention with motivational interviewing focusing on following the recommended diabetes diet and gestational weight gain recommendations in addition to routine care

Was given the same routine care with the same treatment goals, but without motivational interviewing.

Type 2 Diabetes

Pregnancy

The aim is to provide a one-to-one contact every second week of approximately 10 minutes duration. An action plan for improving dietary behavior will be made during the first session and evaluated in subsequent sessions. The following dietary objectives will be set for each participant to achieve or to maintain:
Watch portion size - to be conscious about the amount of carbohydrates in each meal.
Eat mainly carbohydrates of low glycaemic index.
Reduce the intake of carbohydrate of high glycaemic index.
Watch daily weight changes - aim for the recommended weekly changes.
In addition to the motivational intervention the women are given unchanged routine care.

Motivational interviewing

Center for Pregnant Women with Diabetes

Motivational Interviewing With Focus on Diet and Weight Gain in Pregnant Women With Type 2 Diabetes

The Effect of Motivational Interviewing With Focus on Diet and Weight Gain on Prevention of Excessive Fetal Growth in Pregnant Women With Type 2 Diabetes

The difference between weight measured at gestational week 35-37 and weight from preconception (self-reported) or if not available, at first pregnancy visit within first trimester.

Birth weight ≥ 90th percentile, adjusted for gestational age and sex. Z-score ≥1.28.

De novo hypertension >140/90 mmHg after 20 weeks and the coexistence of one or more of the following new onset conditions:
Proteinuria (spot urine protein/creatinine ratio ≥ 30 mg/mmol (0.3 mg/mg) or ≥ 300 mg/day or at least 1 g/L ('2+') on dipstick testing or albumin excretion (UAE) ≥ 190 mg/day or Albumin Creatine Ratio (UACR) ≥ 190 mg/g creatinine).
Other maternal organ dysfunction:
renal insufficiency (creatinine ≥90 umol/L)
liver involvement (elevated transaminases; at least twice upper limit of normal and right upper quadrant or epigastric abdominal pain
Neurological complications (including eclampsia, altered mental status, blindness, stroke, hyperreflexia when accompanied by clonus, severe headaches when accompanied by hyperreflexia and persistent visual scotomata)
Haematological complications (thrombocytopenia: platelet count <150,000/dl, disseminated intravascular coagulation and haemolysis)
Uteroplacental dysfunction and fetal growth restriction I

Birth before 37 completed gestational weeks (259 days).

Emergency: The procedure is made within 8 hours after clinical decision.
Elective: Planned C-section.

The time in hours from onset of intervention (example Misoprostol, Cervical Ripening Balloon, amniotomy) to delivery.

Regular labor with contractions ≤ 5 minutes interval and orificium is ≥ 4 cm dilated without persistant collum. The appraisal will be made by local midwives.

Shoulder dystocia is a situation when the fetus's shoulders cannot pass below the mother's pubic symphysis after delivery of the head and specific obstetric maneuvers, usually Rubin´s or/and Wood´s maneuvers, are necessary to deliver the baby. Presence of fetal asphyxia, nerve lesions and fractures will be noted.

degree: laceration is limited to the fourchette and superficial perineal skin or vaginal mucosa.
degree: laceration extends to perineal muscles and fascia.
degree: laceration extends to the anal sphincter.
degree: laceration extends to the rectal mucosa.

Number of standard deviations from the mean of a Nordic population, adjusted for gestational age and sex.

Birth weight ≤ 10th percentile, adjusted for gestational age and sex. Z-score ≤ 1.28.

Weight divided by the third power of body length.

Neonatal hypoglycemia defined as a plasma glucose value below 2.2 mmol/L, measured within 4 hours of life.

Neonatal hypoglycemia defined as a plasma glucose value below 2.5 mmol/L, measured within 4 hours of life.

Need for phototherapy or exchange transfusion

A need for Continuous Positive Airway Pressure (CPAP) for more than 60 minutes.

Those leading to death, causing a substantial future handicap or requiring surgery.

Perinatal death includes infant deaths that occur at less than 28 days of age and fetal deaths with a stated or presumed period of gestation of 20 weeks or more.

The occurrence of at least one of the following complications: neonatal hypoglycemia, jaundice, TTN, congenital malformations, perinatal mortality or admission to neonatal special care unit (NSCU).

The examination immediately after birth on five criteria on a three point scale (0,1 and 2), with a maximum points of 10 after 5 minutes.

Underweight: < 18.5 kg/m2
Normal weight: 18.5-24.9 kg/m2
Overweight: 25.0-29.9 kg/m2
Obese: ≥ 30.0 kg/m2

Mild: Events with symptoms familiar to the patient as hypoglycemia and managed by the patient.
Severe: Events with symptoms of hypoglycemia requiring help from another person to actively administer oral carbohydrate or injection of glucagon or glucose in order to restore the blood glucose level.

Microalbuminuria or diabetic nephropathy.

U-albumine >300 mg/day or ACR, >300 mg/g of creatinine or >34 mg/mmol of creatinine

30-300 mg/day albumin or ACR, 30-300 mg/g of creatinine or 3.4-34 mg/mmol of creatinine.

Presence of any diabetic retinopathy at first visit.

-Nordic Caucasian: When pregnant woman originates from Northern Europe.

measured at the level midway between the lowest ribcage and the iliac crest

Measured between midcervical spine and mid-anterio neck

Measured with a Harpenden caliper according to the method described by Durnin and Womersly

gestational weight gain/vėmimas

Motivational Interviewing With Focus on Diet and Weight Gain in Pregnant Women With Type 2 Diabetes

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