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Xu J, Wu Y, Zou Z, Chen X. Effect of Dietary Intervention Designed with Behavior Change Wheel on Compliance with Dietary Control in Women with Gestational Diabetes Mellitus: Study Protocol for a Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10726. [PMID: 36078441 PMCID: PMC9518101 DOI: 10.3390/ijerph191710726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 08/24/2022] [Accepted: 08/26/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND AND PURPOSE Previous studies have shown that women with GDM can benefit from following dietary recommendations, which are based on food exchange serving (FES) and glycemic load (GL), but compliance with dietary recommendations in women with GDM is not ideal. Therefore, the aim of this paper is to design a dietary intervention program based on behavior change wheel (BCW) to affect GDM women's compliance with FES based on GL, and to compare the effects of this dietary intervention program versus general dietary management on compliance with dietary recommendations, improving maternal glucose metabolism, and reducing adverse pregnancy outcomes in women with GDM. METHODS This paper is a methodological description of a two-arm randomized controlled trial. In this study, eligible women with GDM will be recruited and divided into the control group (n = 30) and the intervention group (n = 30). Women with GDM will respectively receive general dietary management (control group) and dietary intervention designed with BCW (intervention group) until after delivery. Information about pregnant women will be collected through questionnaires or prenatal and delivery records. CONCLUSION This randomized controlled trial is designed specifically for women with GDM to achieve effective blood glucose control by strengthening GDM women's compliance with dietary recommendations. If this dietary intervention designed with BCW proves to be effective, then BCW may deserve to be applied to more areas of self-management in women with GDM.
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Affiliation(s)
- Jingqi Xu
- School of Nursing, Wuhan University, Wuhan 430072, China
| | - Yuanyuan Wu
- Suizhou Hospital, Hubei University of Medicine (Suizhou Central Hospital), Suizhou 441300, China
| | - Zhijie Zou
- School of Nursing, Wuhan University, Wuhan 430072, China
| | - Xiaoli Chen
- School of Nursing, Wuhan University, Wuhan 430072, China
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Sociodemographic Factors Associated with Adherence to Dietary Guidelines in Women with Gestational Diabetes: A Cohort Study. Nutrients 2021; 13:nu13061884. [PMID: 34072685 PMCID: PMC8228016 DOI: 10.3390/nu13061884] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 05/25/2021] [Accepted: 05/28/2021] [Indexed: 12/16/2022] Open
Abstract
Dietary advice is the cornerstone of care for women with gestational diabetes mellitus (GDM). However, adherence to this advice is variable. We aimed to identify the proportion of women with GDM who adhere to the New Zealand nutrition guideline recommendations and assess the sociodemographic factors linked to dietary adherence. We assessed dietary intake at 36 weeks’ gestation in a cohort of 313 women with GDM and compared this with the dietary recommendations for the management of GDM. Associations between maternal characteristics and dietary adherence were assessed using ANOVA, chi square, logistic regression, and linear regression tests. Women with GDM had an average adherence score of 6.17 out of 10 to dietary recommendations, but no one adhered to all the recommendations. Adherence to recommendations was lowest for saturated fat, and wholegrain breads and cereals. While 85% visited a dietitian, only 28% of women achieved their recommended weight gain. Maternal factors associated with lower dietary adherence were primiparity, no previous history of GDM, being underweight, and smoking. Adherence to the dietary recommendations by women with GDM in New Zealand for the management could be improved. Further research is needed to identify ways for women with GDM to improve their dietary adherence.
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Kapur K, Kapur A, Hod M. Nutrition Management of Gestational Diabetes Mellitus. ANNALS OF NUTRITION & METABOLISM 2021; 76:1-13. [PMID: 33524988 DOI: 10.1159/000509900] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 07/02/2020] [Indexed: 11/19/2022]
Abstract
Medical nutrition therapy (MNT) is the bedrock for the management of gestational diabetes mellitus (GDM). Several different types of dietary approaches are used globally, and there is no consensus among the various professional groups as to what constitutes an ideal approach. The conventional approach of limiting carbohydrates at the cost of increasing energy from the fat source may not be most optimal. Instead, allowing higher levels of complex, low-to-medium glycaemic index carbohydrates and adequate fibre through higher consumption of vegetables and fruits seems more beneficial. No particular diet or dietary protocol is superior to another as shown in several comparative studies. However, in each of these studies, one thing was common - the intervention arm included more intensive diet counselling and more frequent visits to the dieticians. For MNT to work, it is imperative that diet advice and nutrition counselling is provided by a dietician, which is easy to understand and use and includes healthy food options, cooking methods, and practical guidance that empower and motivate to make changes towards a healthy eating pattern. Various simple tools to achieve these objectives are available, and in the absence of qualified dieticians, they can be used to train other health care professionals to provide nutrition counselling to women with GDM. Given the impact of GDM on the future health of the mother and offspring, dietary and lifestyle behaviour changes during pregnancy in women with GDM are not only relevant for immediate pregnancy outcomes, but continued adherence is also important for future health.
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Affiliation(s)
| | - Anil Kapur
- World Diabetes Foundation, FIGO Pregnancy and NCD Committee, Bagsvaerd, Denmark
| | - Moshe Hod
- Clalit Health Services and Mor Women's Health Center, FIGO Pregnancy and NCD Committee, Tel Aviv, Israel,
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Chioveanu M, Bălălău OD, Sima RM, Pleș L, Bălălău C, Stănescu AD. Gestational diabetes – Diagnostic and therapeutic novelties. JOURNAL OF CLINICAL AND INVESTIGATIVE SURGERY 2019. [DOI: 10.25083/2559.5555/4.2/66.71] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Cheng E, Longmore DK, Barzi F, Barr ELM, Lee IL, Whitbread C, Boyle JA, Oats J, Connors C, McIntyre HD, Kirkwood M, Dempsey K, Zhang X, Thomas S, Williams D, Zimmet P, Brown ADH, Shaw JE, Maple-Brown LJ. Birth outcomes in women with gestational diabetes managed by lifestyle modification alone: The PANDORA study. Diabetes Res Clin Pract 2019; 157:107876. [PMID: 31586661 DOI: 10.1016/j.diabres.2019.107876] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 09/08/2019] [Accepted: 10/02/2019] [Indexed: 12/16/2022]
Abstract
AIMS To assess outcomes of women in the Pregnancy and Neonatal Diabetes Outcomes in Remote Australia (PANDORA) cohort with gestational diabetes mellitus (GDM) managed by lifestyle modification compared with women without hyperglycaemia in pregnancy. METHODS Indigenous (n = 97) and Europid (n = 113) women managed by lifestyle modification were compared to women without hyperglycaemia (n = 235). Multivariate linear and logistic regressions assessed whether GDM-lifestyle women had poorer outcomes compared to women without hyperglycaemia. RESULTS Women with GDM-lifestyle had higher body mass index and lower gestational weight gain than women without hyperglycaemia. On univariate analysis, gestational age at delivery was lower and induction rates were higher in women with GDM-lifestyle than without hyperglycaemia. On multivariable regression, GDM-lifestyle was associated with lower gestational age at delivery (by 0.73 weeks), lower birthweight z-score (by 0.26, p = 0.007), lower likelihood of large for gestational age (LGA) [OR (95% CI): 0.55 (0.28, 1.02), p = 0.059], and greater likelihood of labour induction [2.34 (1.49, 3.66), p < 0.001] than women without hyperglycaemia. CONCLUSION Women with GDM managed by lifestyle modification had higher induction rates and their offspring had lower birthweight z-scores, with a trend to lower LGA than those without hyperglycaemia in pregnancy. Further studies are indicated to explore reasons for higher induction rates.
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Affiliation(s)
- E Cheng
- Menzies School of Health Research, NT, Australia; Division of Obstetrics and Gynaecology, Royal Darwin Hospital, NT, Australia; Danila Dilba Health Service, Darwin, NT, Australia.
| | - D K Longmore
- Menzies School of Health Research, NT, Australia.
| | - F Barzi
- Menzies School of Health Research, NT, Australia.
| | - E L M Barr
- Menzies School of Health Research, NT, Australia; Baker Heart and Diabetes Institute, VIC, Australia.
| | - I L Lee
- Menzies School of Health Research, NT, Australia.
| | - C Whitbread
- Menzies School of Health Research, NT, Australia; Division of Medicine, Royal Darwin Hospital, NT, Australia.
| | - J A Boyle
- Menzies School of Health Research, NT, Australia; Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Australia.
| | - J Oats
- Melbourne School of Population and Global Health, University of Melbourne, Australia.
| | - C Connors
- Primary Health Care Branch, Top End Health Service, NT, Australia.
| | - H D McIntyre
- Mater Medical Research Institute, University of Queensland, Australia.
| | - M Kirkwood
- Menzies School of Health Research, NT, Australia.
| | - K Dempsey
- Menzies School of Health Research, NT, Australia.
| | - X Zhang
- Innovation and Research, Department of Health, NT, Australia.
| | - S Thomas
- Division of Obstetrics and Gynaecology, Royal Darwin Hospital, NT, Australia.
| | - D Williams
- Darwin Midwifery Group, NT Health, Australia.
| | - P Zimmet
- Department of Diabetes, Central Clinical School, Monash University, Australia.
| | - A D H Brown
- South Australian Health and Medical Research Institute, Australia; Faculty of Health and Medical Science, University of Adelaide, Australia.
| | - J E Shaw
- Baker Heart and Diabetes Institute, VIC, Australia.
| | - L J Maple-Brown
- Menzies School of Health Research, NT, Australia; Division of Medicine, Royal Darwin Hospital, NT, Australia.
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Kintiraki E, Goulis DG. Gestational diabetes mellitus: Multi-disciplinary treatment approaches. Metabolism 2018; 86:91-101. [PMID: 29627447 DOI: 10.1016/j.metabol.2018.03.025] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 03/25/2018] [Accepted: 03/27/2018] [Indexed: 02/08/2023]
Abstract
Gestational diabetes mellitus (GDM) is the most common metabolic disease of pregnancy, associated with several perinatal complications. Adequate glycemic control has been proved to decrease risk of GDM-related complications. Several studies have shown the beneficial effect of exercise and medical nutrition treatment on glycemic and weight control in GDM-affected women. Moreover, pharmacological agents, such as insulin and specific oral anti-diabetic agents can be prescribed safely during pregnancy, decreasing maternal blood glucose and, thus, perinatal adverse outcomes. Multi-disciplinary treatment approaches that include both lifestyle modifications (medical nutritional therapy and daily physical exercise) and pharmacological treatment, in cases of failure of the former, constitute the most effective approach. Insulin is the gold standard pharmacological agent for GDM treatment. Metformin and glyburide are two oral anti-diabetic agents that could serve as alternative, although not equal in terms of effectiveness and safety, treatment for GDM. As studies on short-term safety of metformin are reassuring, in some countries it is considered as first-line treatment for GDM management. More studies are needed to investigate the long-term effects on offspring. As safety issues have been raised on the use of glyburide during pregnancy, it must be used only when benefits surpass possible risks.
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Affiliation(s)
- Evangelia Kintiraki
- Unit of Reproductive Endocrinology, First Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece.
| | - Dimitrios G Goulis
- Unit of Reproductive Endocrinology, First Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Abstract
PURPOSE OF REVIEW Ethnicity has long been described as a major risk factor for the development of gestational diabetes mellitus (GDM), and it is widely recognised that women from ethnicities other than Europids are at higher risk of developing GDM. There are also described differences between ethnicities in key GDM pregnancy outcomes. This review describes some of the factors that relate to the ethnic disparities in GDM. RECENT FINDINGS The global prevalence of GDM has been steadily increasing and estimated to be 16.2% from the International Diabetes Federation extrapolation. Reported prevalence rates may understate the true prevalence, due to factors of access and attitudes to GDM diagnosis and screening in low resource settings for foreign-born women and indigenous populations. Other factors may relate to genes associated with specific ethnicities, obesity, body composition and gestational weight gain. Various factors such as access to screening, body composition, genetics and gestational weight gain may result in ethnic disparities in the prevalence and outcomes of GDM.
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Affiliation(s)
- Lili Yuen
- School of Medicine, Western Sydney University, Sydney, NSW, Australia.
| | - Vincent W Wong
- Diabetes and Endocrine Service, Liverpool Hospital, Liverpool, NSW, Australia
- University of New South Wales, Liverpool, NSW, Australia
| | - David Simmons
- School of Medicine, Western Sydney University, Sydney, NSW, Australia
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