The Role of Energy, Nutrients, Foods, and Dietary Patterns in the Development of Gestational Diabetes Mellitus: A Systematic Review of Observational Studies

Time of day and glycaemic response in pregnant women: A gap in current guidelines?

BACKGROUND & AIMS

Advice to monitor and distribute carbohydrate intake is a key recommendation for treatment of gestational diabetes, but fails to consider circadian regulation of glucose homeostasis. In the non-pregnant state, glucose responses to a meal at night-time are significantly higher than during the day and are associated with an increased risk of developing type 2 diabetes. However, the impact of night time eating on postprandial glucose in pregnancy is uncertain. Using a systematic approach we explored postprandial glucose responses to dietary intake at night compared to during the day in pregnant women.

METHODS

Searches were conducted in four databases (Ovid MEDLINE, Ovid Embase, CINAHL plus and Scopus), in September 2022 (updated, June 2023). Eligible studies reported on postprandial glucose at a minimum of two times a day, after identical meals or an oral glucose tolerance test, in pregnant women with or without gestational diabetes. Publication bias was assessed using the ROBINS-I tool.

RESULTS

Four eligible studies were retrieved. Two studies reported within group comparison of two timepoints, and observed reduced glucose tolerance in the afternoon compared to the morning in pregnant women, irrespective of diabetes status. The other two studies meeting inclusion criteria did not report time of day comparisons.

CONCLUSION

It is unclear as to whether the higher (and extended) postprandial glucose levels observed at night in non-pregnant populations are observed in pregnancy. Clinical studies are needed to explore the impact of circadian rhythmicity on glucose metabolism during pregnancy, and the implications of current dietary advice on when and what to eat for management of gestational diabetes.

The association of red and processed meat with gestational diabetes mellitus: Results from 2 Canadian birth cohort studies

OBJECTIVE

Red and processed meat is considered risk factors of gestational diabetes mellitus (GDM), but the evidence is inconclusive. We aimed to examine the association between red and processed meat intake and odds of GDM among South Asian and White European women living in Canada.

METHODS

This is a cross-sectional analysis of pregnant women from two birth cohorts: SouTh Asian biRth cohorT (START; n = 976) and Family Atherosclerosis Monitoring In earLY life (FAMILY; n = 581). Dietary intake was assessed using a validated 169-item semi-quantitative food-frequency questionnaire (FFQ). Multivariate logistic regression models were used to examine the associations between gestational diabetes and: 1) total red and processed meat; 2) unprocessed red meat; 3) processed meat and GDM after adjustment for potential confounders.

RESULTS

There were 241 GDM cases in START and 91 in FAMILY. The median total red and processed meat intake were 1.5 g/d (START) and 52.8 g/d (FAMILY). In START, the multivariable-adjusted odds ratio (OR) showed neither lower nor higher intakes of unprocessed red meat (p-trend = 0.68), processed meat (p-trend = 0.90), or total red and processed meat (p-trend = 0.44), were associated with increased odds of GDM, when compared with medium intake. Similar results were observed in FAMILY except for processed meat intake [OR = 0.94 (95% CI 0.47-1.91), for medium versus low and OR = 1.51 (95% CI 0.77-2.29) for medium versus high; p-trend = 0.18] after adjusting for additional dietary factors such as the diet quality score, total fiber, saturated fat and glycemic load.

CONCLUSION

Medium compared with low or high red and processed meat intake is not associated with GDM in White Europeans and South Asians living in Canada.

Dietary Intake and Oral Glucose Tolerance Test Results in Women with Gestational Diabetes

Background/Objective: Diet is a risk factor for gestational diabetes mellitus (GDM). There are few studies on women's diet and glucose tolerance test (GTT) results during pregnancy. The objective of this study was to evaluate the relationship between one's previous diet and the number of abnormal values on the diagnostic GTT in women with GDM. We hypothesized that there would be an inverse relation between antioxidant micronutrient consumption and the number of abnormal GTT values. Methods: This cross-sectional study included 60 women diagnosed with GDM (2-h, 75 g-GTT), divided in two groups as follows: 1 abnormal glucose value and 2-3 abnormal values. Shortly after the diagnosis, participants answered a validated food frequency questionnaire to assess their food consumption in the last 6 months. The Mann-Whitney test was used to compare the dietary intake of the participants in the two groups. Results: The participant characteristics were similar. The median intake of total calories, carbohydrates, lipids, and proteins did not differ significantly between groups. Participants with 1 abnormal GTT value had significantly higher intakes of fiber (11.9 vs. 11.0 g/day p = 0.049), vitamin D (40.6 vs. 40.4 mcg/day p = 0.049), and vitamin C (180.0 vs. 151.0 mg/day p = 0.008) than those with 2-3 abnormal values. Conclusions: Our results suggest a possible association between the consumption of fiber and antioxidant micronutrients and the number of abnormal GTT values.

Diet, lifestyle and gut microbiota composition among Malaysian women with gestational diabetes mellitus: a prospective cohort study

The study addressed a significant gap in the profiling and understanding of the gut microbiota's influence on Malaysian Malay women with gestational diabetes mellitus (GDM). This prospective cohort study aimed to explore the intricate relationship between gut microbiota, dietary choices, and lifestyle factors among Malay women, both with and without GDM. The research specifically focused on participants during the second (T0) and third (T1) trimesters of pregnancy in Johor Bahru, Malaysia. In Part 1 of the study, a diverse pool of pregnant women at T0 was categorized into two groups: those diagnosed with GDM and those without GDM, with a total sample size of 105 individuals. The assessments encompassed demographic, clinical, lifestyle, and dietary factors at the T0 and T1 trimesters. Part 2 of the study delved into microbiome analysis, targeting a better understanding of the gut microbiota among the participants. Stool samples were randomly collected from 50% of the individuals in each group (GDM and non-GDM) at T0 and T1. The collected samples underwent processing, and 16s rRNA metagenomic analysis was employed to study the microbial composition. The results suggested an association between elevated body weight and glucose levels, poor sleep quality, lack of physical activity, greater intake of iron and meat, and reduced fruit consumption among women with GDM compared to non-GDM groups. The microbiome analysis revealed changes in microbial composition over time, with reduced diversity observed in the GDM group during the third trimester. The genera Lactiplantibacillus, Parvibacter, Prevotellaceae UCG001, and Vagococcus positively correlated with physical activity levels in GDM women in the second trimester. Similarly, the genus Victivallis exhibited a strong positive correlation with gravida and parity. On the contrary, the genus Bacteroides and Roseburia showed a negative correlation with omega-3 polyunsaturated fatty acids (PUFAs) in women without GDM in the third trimester. The study highlighted the multifaceted nature of GDM, involving a combination of lifestyle factors, dietary choices, and changes in gut microbiota composition. The findings emphasized the importance of considering these interconnected elements in understanding and managing gestational diabetes among Malaysian Malay women. Further exploration is essential to comprehend the mechanisms underlying this relationship and develop targeted interventions for effective GDM management.

Meat and meat products - a scoping review for Nordic Nutrition Recommendations 2023

Meat is not only a source of several nutrients but also a proposed risk factor for several non-communicable diseases. Here, we describe the totality of evidence for the role of meat intake for chronic disease outcomes, discuss potential mechanistic pathways, knowledge gaps, and limitations of the literature. Use of the scoping review is based on a de novo systematic review (SR) and meta-analysis on the association between poultry intake and cardiovascular disease (CVD) and type 2 diabetes (T2D), qualified SRs (as defined in the Nordic Nutrition Recommendations 2023 project) on meat intake and cancer by the World Cancer Research Fund (WCRF), the International Agency for Research on Cancer (IARC), and a systematic literature search of SRs and meta-analyses. The quality of the SRs was evaluated using a modified AMSTAR 2 tool, and the strength of evidence was evaluated based on a predefined criteria developed by the WCRF. The quality of the SRs was on average critically low. Our findings indicate that the evidence is too limited for conclusions for most of the chronic disease outcomes. However, findings from qualified SRs indicate strong evidence that processed meat increases the risk of colorectal cancer and probable evidence that red meat (unprocessed, processed, or both) increases the risk. The evidence suggests that both unprocessed red meat and processed meat (also including processed poultry meat) are probable risk factors for CVD mortality and stroke, and that total red meat and processed meat are risk factors for CHD. We found no sufficient evidence suggesting that unprocessed red meat, processed red meat, total red meat, or processed meat (including red and white meat) would be protective of any chronic disease. There was also no sufficient evidence to conclude on protective effect of poultry on any chronic diseases; effects on the risk of CVD, stroke, and T2D, to any direction, were regarded as unlikely.

Dietary protein in early pregnancy and gestational diabetes mellitus: a prospective cohort study

PURPOSE

The relationship between dietary protein intake and the risk of gestational diabetes mellitus (GDM) remains inconsistent and unclear. Here, we examined the correlation between the various sources of protein intake among Chinese pregnant women and GDM.

METHODS

This prospective cohort study included 1060 pregnant women at 6-13+6 weeks of gestation from Guangdong Provincial Hospital for Women and Children, South China. The participants' intake of dietary protein was assessed using a validated quantitative food frequency questionnaire during the early trimester. GDM was diagnosed via an oral glucose tolerance test performed at 24-28 gestational weeks. Logistic regression analysis was used to evaluate the association between dietary protein intake during pregnancy and GDM. Furthermore, we applied restricted cubic splines to determine their linear relationship.

RESULTS

About 26.3% (n = 279) of pregnant women were diagnosed with GDM. Animal protein intake was revealed to have a positive correlation with GDM risk (Q4 vs. Q1: OR, 2.78; 95% CI, 1.46-5.34; P = 0.015), whereas high intake levels of dietary plant protein were linked to reduced GDM risk (Q4 vs. Q1: OR, 0.43; 95% CI, 0.25-0.73). In stratified analysis, the relationship between protein and GDM was stronger during early pregnancy in women with obesity. However, total protein intake did not show a significant association with GDM.

CONCLUSIONS

Our study findings suggest that a plant protein-based diet was associated with reduced GDM risk, whereas the dietary intake of animal protein was positively associated with GDM risk among Chinese women during early pregnancy.

Cholesterol-rich dietary pattern during early pregnancy and genetic variations of cholesterol metabolism genes in predicting gestational diabetes mellitus: a nested case-control study

BACKGROUND

Higher dietary cholesterol intake during pregnancy increases risk of gestational diabetes mellitus (GDM). However, no studies have investigated interindividual variability in cholesterol metabolism and the association of genetics and diet on GDM.

OBJECTIVE

; To prospectively evaluate the joint association of cholesterol-rich dietary patterns and polymorphisms of genes coding for cholesterol metabolism pathway proteins with GDM.

METHODS

A total of 1116 pregnant females from the Tongji Birth Cohort were enrolled. GDM was diagnosed according to a 75-g 2-h oral glucose tolerance test at 24-28 wk of gestation. Dietary data were collected by a validated food frequency questionnaire. The reduced-rank regression method was used to identify dietary patterns using dietary cholesterol as the response variable. Time-of-flight mass spectrometry was used for genotyping. The genetic risk score (GRS) for GDM was constructed with genetic variants in 28 cholesterol metabolism-related single-nucleotide polymorphisms (SNPs). Conditional logistic regression models were used to assess the odds ratio (OR) for GDM.

RESULTS

The cholesterol-rich dietary pattern was rich in livestock and poultry meat and eggs but lower in cereals. The multivariable-adjusted ORs for GDM were 1.24 (95% confidence interval: 1.06-1.44) per SD increment of cholesterol-rich pattern scores and 1.28 (1.09-1.49) per tertile GRS. The variants of the CYP7A1 rs3808607 G→T/rs8192871 G→A/rs7833904 A→T, as well as AGGG and TTGA haplotypes of 4 CYP7A1-spanning SNPs, were significantly associated with GDM. For the joint effect, the OR was 3.53 (1.71-7.31) in the highest categories of both dietary pattern scores and GRS compared with individuals with the lowest strata without significant interaction (P for interaction = 0.101).

CONCLUSIONS

Both a cholesterol-rich dietary pattern and genetic variants of cholesterol metabolism genes are associated with risk of GDM. Adherence to a cholesterol-rich dietary pattern during early pregnancy promotes the chance of GDM, especially in women with higher GRS.

CLINICAL TRIAL REGISTRY

This trial was registered at http://www.chictr.org.cn (Registration number: ChiCTR1800016908). URL: =https://www.chictr.org.cn/showprojEN.html?proj=28081.

Association between exposure to air pollution during preconception and risk of gestational diabetes mellitus: The role of anti-inflammatory diet

BACKGROUND

Regarding the association between the sensitive time-windows of air pollution (AP) exposure and gestational diabetes mellitus (GDM), epidemiological findings are inconsistent. The dietary inflammatory potential has been implicated in the development of GDM, but it is unclear whether an anti-inflammatory diet during pregnancy reduces the association between AP and GDM.

OBJECTIVE

We aimed to characterize the sensitive time-windows of AP to GDM risk. Further, to verify whether a maternal anti-inflammatory diet can reduce the risk of AP-induced GDM, by inhibiting inflammation.

METHODS

A total of 8495 pregnant women were included between 2015 and 2021 in the Maternal & Infants Health in Hefei study. Weekly mean AP exposure to fine particles (PM2.5 and PM10), SO2, and NO2 was estimated from the data of Hefei City Ecology and Environment Bureau. High-sensitivity C-reactive protein (hs-CRP) concentrations were measured to evaluate systemic inflammation. The empirical dietary inflammatory pattern (EDIP) score based on a validated food frequency questionnaire was used to assess the dietary inflammatory potential of pregnant women. Logistic regression models with distributed lags were used to identify the sensitive time-window for the effect of AP on GDM. Mediation analysis estimated the mediated effect of hs-CRP, linking AP with GDM. Stratified analysis was used to investigate the potential effect of anti-inflammatory diet on GDM risk.

RESULTS

The increased risks of GDM were found to be positively associated with exposure to PM2.5 (OR = 1.11, 95% CI:1.07-1.15), PM10 (OR = 1.12, 95% CI:1.09-1.16), and SO2 (OR = 1.42, 95% CI:1.25-1.60) by distributed lag models, and the critical exposure windows were 21st to 28th weeks of preconception. The proportion of association between PM2.5, PM10, and SO2 with GDM mediated by hs-CRP was 25.9%, 21.1%, and 19.4%, respectively, according to mediation analysis. In the stratified analyses by EDIP, the association between AP and GDM was not statistically significant among women those with anti-inflammatory diets.

CONCLUSIONS

Exposure to AP, especially in 21st to 28th week of preconception, is associated with risk of GDM, which is partly mediated by hs-CRP. Adherence to the anti-inflammatory dietary pattern may reduce the risk of AP-induced GDM.

Association of diet quality during pregnancy with maternal glucose metabolism in Chinese women

Overall diet quality during pregnancy has played an important role on maternal glucose metabolism. However, evidence based on the adherence to the dietary guideline is limited, especially for Asian populations. We aimed to examine the association between adherence to the Chinese dietary guideline measured by the Diet Balance Index for Pregnancy (DBI-P) and maternal glucose metabolism, including gestational diabetes mellitus (GDM) status, fasting and 2-h plasma glucose. Data were obtained from the baseline survey of the Yuexiu birth cohort. We recruited 942 pregnant women at 20-28 weeks of gestation in 2017-2018. Dietary intakes during the past month were collected using a validated semi-quantitative FFQ. The scores of DBI-P were calculated to assess dietary quality. Lower absolute values of the scores indicate higher adherence to the Chinese dietary guidelines. All participants underwent a 75 g of oral glucose tolerance test (OGTT). Multiple linear regression and logistic regression were conducted. The Benjamini-Hochberg method was used to adjust multiple comparisons across DBI-P food components. The value of high bound score indicator, reflecting excessive total food intake, was positively associated with OGTT-2h glucose levels (β = 0·037, P = 0·029). After adjustment for multiple comparisons, the score of animal food intake was positively associated with OGTT-2 h glucose levels (β = 0·045, P = 0·045) and risk of GDM (OR = 1·105, P = 0·030). In conclusion, excessive total food intake was associated with higher postprandial glucose in pregnant women. Lower compliance with the dietary guideline for animal food was associated with both higher postprandial glucose and increased risk of GDM during pregnancy.

Fat Intake and Fat Quality in Pregnant and Lactating Women, Infants, Children, and Adolescents and Related Health Outcomes: A Scoping Review of Systematic Reviews of Prospective Studies

INTRODUCTION

Dietary fat intake during pregnancy and childhood is important for health. However, several health aspects are inconclusive.

METHODS

We systematically searched Medline, Cochrane Library, and Epistemonikos for systematic reviews (SRs) of randomized controlled trials (RCTs) and/or prospective cohort studies published from January 01, 2015, to December 31, 2019, assessing the association of dietary fat intake (including dietary supplements) during pregnancy and across childhood with pregnancy, perinatal, and child health outcomes.

RESULTS

Thirty-one SRs, mainly of RCTs, were included. Omega-3 fatty acids supplementation during pregnancy reduced the risk of early preterm birth, and in some SRs also any preterm birth, increased gestation length and birth weight, but mostly was not associated with other pregnancy/perinatal outcomes. Pre- and postnatal polyunsaturated fatty acids (PUFAs) intake was not consistently associated with growth, neurological, visual and cognitive outcomes, allergic diseases, cardiovascular, and metabolic health in childhood. Reduced saturated fatty acids (SFAs) intake and its replacement with PUFA/monounsaturated fatty acids had favourable effects on blood pressure and blood lipids in children. No apparent effects of total or trans fat on health outcomes across target groups were observed.

CONCLUSION

Omega-3 PUFA supplementation during pregnancy and SFA intake reduction in childhood require further consideration in dietary recommendations targeting these populations.

Metabolic drivers of dysglycemia in pregnancy: ethnic-specific GWAS of 146 metabolites and 1-sample Mendelian randomization analyses in a UK multi-ethnic birth cohort

Introduction

Gestational diabetes mellitus (GDM) is the most common pregnancy complication worldwide and is associated with short- and long-term health implications for both mother and child. Prevalence of GDM varies between ethnicities, with South Asians (SAs) experiencing up to three times the risk compared to white Europeans (WEs). Recent evidence suggests that underlying metabolic difference contribute to this disparity, but an investigation of causality is required.

Methods

To address this, we paired metabolite and genomic data to evaluate the causal effect of 146 distinct metabolic characteristics on gestational dysglycemia in SAs and WEs. First, we performed 292 GWASs to identify ethnic-specific genetic variants associated with each metabolite (P ≤ 1 x 10-5) in the Born and Bradford cohort (3688 SA and 3354 WE women). Following this, a one-sample Mendelian Randomisation (MR) approach was applied for each metabolite against fasting glucose and 2-hr post glucose at 26-28 weeks gestation. Additional GWAS and MR on 22 composite measures of metabolite classes were also conducted.

Results

This study identified 15 novel genome-wide significant (GWS) SNPs associated with tyrosine in the FOXN and SLC13A2 genes and 1 novel GWS SNP (currently in no known gene) associated with acetate in SAs. Using MR approach, 14 metabolites were found to be associated with postprandial glucose in WEs, while in SAs a distinct panel of 11 metabolites were identified. Interestingly, in WEs, cholesterols were the dominant metabolite class driving with dysglycemia, while in SAs saturated fatty acids and total fatty acids were most commonly associated with dysglycemia.

Discussion

In summary, we confirm and demonstrate the presence of ethnic-specific causal relationships between metabolites and dysglycemia in mid-pregnancy in a UK population of SA and WE pregnant women. Future work will aim to investigate their biological mechanisms on dysglycemia and translating this work towards ethnically tailored GDM prevention strategies.

In utero metabolomic signatures of refined grain intake and risk of gestational diabetes: A metabolome-wide association study

BACKGROUND

Epidemiologic evidence has linked refined grain intake to a higher risk of gestational diabetes (GDM), but the biological underpinnings remain unclear.

OBJECTIVES

We aimed to identify and validate refined grain-related metabolomic biomarkers for GDM risk.

METHODS

In a metabolome-wide association study of 91 cases with GDM and 180 matched controls without GDM (discovery set) nested in the prospective Pregnancy Environment and Lifestyle Study (PETALS), refined grain intake during preconception and early pregnancy and serum untargeted metabolomics were assessed at gestational weeks 10-13. We identified refined grain-related metabolites using multivariable linear regression and examined their prospective associations with GDM risk using conditional logistic regression. We further examined the predictivity of refined grain-related metabolites selected by least absolute shrinkage and selection operator regression in the discovery set and validation set (a random PETALS subsample of 38 individuals with and 336 without GDM).

RESULTS

Among 821 annotated serum (87.4% fasting) metabolites, 42 were associated with refined grain intake, of which 17 (70.6% in glycerolipids, glycerophospholipids, and sphingolipids clusters) were associated with subsequent GDM risk (all false discovery rate-adjusted P values <0.05). Adding 7 of 17 metabolites to a conventional risk factor-based prediction model increased the C-statistic for GDM risk in the discovery set from 0.71 (95% CI: 0.64, 0.77) to 0.77 (95% CI: 0.71, 0.83) and in the validation set from 0.77 (95% CI: 0.69, 0.86) to 0.81 (95% CI: 0.74, 0.89), both with P-for-difference <0.05.

CONCLUSIONS

Clusters of glycerolipids, glycerophospholipids, and sphingolipids may be implicated in the association between refined grain intake and GDM risk, as demonstrated by the significant associations of these metabolites with both refined grains and GDM risk and the incremental predictive value of these metabolites for GDM risk beyond the conventional risk factors. These findings provide evidence on the potential biological underpinnings linking refined grain intake to the risk of GDM and help identify novel disease-related dietary biomarkers to inform diet-related preventive strategies for GDM.

Associations between plant-based diets, plant foods and botanical supplements with gestational diabetes mellitus: a systematic review protocol

INTRODUCTION

Gestational diabetes mellitus (GDM) is one of the most common health complications during pregnancy. Medical nutrition therapy is the mainstay of treatment for GDM, however, there is no current consensus on optimal dietary approaches to prevent or control hyperglycaemia in pregnancy. The aim of this systematic review is to assess the relationships between plant-based dietary patterns, plant foods and botanical dietary supplements with GDM and maternal glycaemic biomarkers.

METHODS AND ANALYSIS

A predefined search strategy was used on 16 June 2021, to search PubMed, Embase and CINAHL Plus with Full Text (EBSCOhost), as well as ClinicalTrials.gov, for studies published as original articles in English. Articles will be included if they are human observational studies or clinical trials and will be excluded if they are review articles or conference abstracts. We will use Cochrane's risk of bias tools for interventions that are parallel arm (Risk of Bias tool for randomised trials version 2 (RoB 2)) and single arm, non-randomised intervention studies (Risk of Bias In Non-randomised Studies-of Interventions (ROBINS-I)). For observational, case-control and cross-sectional studies, we will use the National Heart, Lung and Blood Institute's quality assessment tools. Data will be synthesised in a narrative format describing significant results as well as presenting the results of the quality assessment of studies.

ETHICS AND DISSEMINATION

This systematic review does not require ethical approval as primary data will not be collected. The review will be published in a peer-reviewed journal and disseminated electronically and in print.

PROSPERO REGISTRATION NUMBER

CRD42022306915.

Pre-Pregnancy Adherence to Mediterranean Diet and Risk of Gestational Diabetes Mellitus: A Prospective Cohort Study in Greece

Gestational Diabetes Mellitus (GDM) is a growing epidemic affecting pregnant women and their offspring. This study aimed to identify the relationship between adherence to a Mediterranean diet (MD) before conception and the risk of GDM in a contemporary Greek pregnant cohort. A prospective cohort of pregnant women was recruited at the routine first trimester visit. Nutritional intake was evaluated using a population specific validated food frequency questionnaire (FFQ). Pre-pregnancy adherence to MD was derived using two different scoring systems, the Mediterranean diet index score (MDS), and a modified version. Adjusted odds ratios (aOR) were computed using multiple logistic regression models for each score derived. Of 743 participating women, 112 (15.1%) developed GDM. The MDS index showed that scoring 5-9 points (high adherence) was associated with a lower GDM incidence (aOR: 0.57 95% CI (0.32, 0.90), p = 0.02), while the modified MDS index showed no significant association for any level of adherence. Pre-pregnancy consumption of "meat and derivatives" and "fatty meat and processed meat" was associated with a higher risk of GDM, with both scoring systems (p = 0.008, p = 0.004, respectively). A higher adherence to a MD pre-pregnancy, especially with less meat consumption, may have a protective effect on the occurrence of GDM.

The effect of diet quality on the risk of developing gestational diabetes mellitus: A systematic review and meta-analysis

Objective

To examine the effect of diet quality on the risk of gestational diabetes mellitus.

Methods

This review included cohort and case-control studies reporting an association between diet quality and gestational diabetes mellitus. We searched PubMed, Cochrane Library, Web of Science, Embase, PsycINFO, CINAHL Complete, Chinese Periodical Full-text Database, China National Knowledge Infrastructure, Chinese Biomedical Literature Database, and China Wanfang Database for studies published from inception to November 18, 2022. The Newcastle-Ottawa Scale was used for quality assessment, and the overall quality of evidence was assessed using the GRADEpro GDT.

Results

A total of 19 studies (15 cohort, four case-control) with 108,084 participants were included. We found that better higher diet quality before or during pregnancy reduced the risk of developing gestational diabetes mellitus, including a higher Mediterranean diet (OR: 0.51; 95% CI: 0.30-0.86), dietary approaches to stop hypertension (OR: 0.66; 95% CI: 0.44-0.97), Alternate Healthy Eating Index (OR: 0.61; 95% CI: 0.44-0.83), overall plant-based diet index (OR: 0.57; 95% CI: 0.41-0.78), and adherence to national dietary guidelines (OR: 0.39; 95% CI:0.31-0.48). However, poorer diet quality increased the risk of gestational diabetes mellitus, including a higher dietary inflammatory index (OR: 1.37; 95% CI: 1.21-1.57) and overall low-carbohydrate diets (OR: 1.41; 95% CI: 1.22-1.64). After meta-regression, subgroup, and sensitivity analyses, the results remained statistically significant.

Conclusions

Before and during pregnancy, higher diet quality reduced the risk of developing gestational diabetes mellitus, whereas poorer diet quality increased this risk.

Systematic review registration

https://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42022372488.

Impact of Ultra-Processed Food Consumption on Quality of Diet among Brazilian Pregnant Women Assisted in Primary Health Care

The quality of diet and nutritional status during pregnancy are crucial to optimize maternal and fetal health. Ultra-processed foods (UPFs) are increasingly prevalent in pregnancy groups despite being nutritionally unbalanced and associated with adverse perinatal outcomes. This cross-sectional study, conducted with data from 229 pregnant women, aimed to investigate the association between UPFs consumption and dietary nutrient intake of pregnant women assisted by Primary Health Care (PHC) in Federal District (DF), Brazil. Food consumption was assessed through two non-consecutive 24-h food records and categorized by the extent of processing using the NOVA classification. Multivariate linear regression models were used to analyze the association between the quintiles of UPF consumption and the total energy and nutrients intake. Mean daily energy intake was 1741 kcal, with 22.6% derived from UPFs. Greater UPF consumption was associated with reduced intake of unprocessed and minimally processed food. The highest quintile of UPFs was positively associated with higher total energy, trans fat, and sodium intake; and inversely associated with the diet content of protein, fiber, iron, magnesium, potassium, copper, zinc, selenium, and folate. Greater UPFs intake negatively impacts the nutritional quality of the diet and impoverishes the nutrient intake of pregnant women. Reducing UPF consumption may broadly improve dietary guidelines adherence in pregnant women and promote maternal and neonatal health.

A global view of hypertensive disorders and diabetes mellitus during pregnancy

Two important maternal cardiometabolic disorders (CMDs), hypertensive disorders in pregnancy (HDP) (including pre-eclampsia) and gestational diabetes mellitus (GDM), result in a large disease burden for pregnant individuals worldwide. A global consensus has not been reached about the diagnostic criteria for HDP and GDM, making it challenging to assess differences in their disease burden between countries and areas. However, both diseases show an unevenly distributed disease burden for regions with a low income or middle income, or low-income and middle-income countries (LMICs), or regions with lower sociodemographic and human development indexes. In addition to many common clinical, demographic and behavioural risk factors, the development and clinical consequences of maternal CMDs are substantially influenced by the social determinants of health, such as systemic marginalization. Although progress has been occurring in the early screening and management of HDP and GDM, the accuracy and long-term effects of such screening and management programmes are still under investigation. In addition to pharmacological therapies and lifestyle modifications at the individual level, a multilevel approach in conjunction with multisector partnership should be adopted to tackle the public health issues and health inequity resulting from maternal CMDs. The current COVID-19 pandemic has disrupted health service delivery, with women with maternal CMDs being particularly vulnerable to this public health crisis.

Iron Supplementation in Pregnancy and Risk of Gestational Diabetes: A Narrative Review

Pregnant women frequently supplement their diets with iron to treat any cryptic anemia, on the assumption that if anemia is not present, there will be no negative consequences. However, in women who are already iron-replete, it has been suggested that this can lead to iron overload and an increased risk of certain pregnancy complications. One such complication is gestational diabetes. Fourteen clinical trials, case-control or cohort studies (found using Pubmed/Scopus/Web of Science) have investigated links between iron supplementation in pregnancy and risk of gestational diabetes, several of them finding significant associations with increased risk. Potential mechanisms include increased oxidative stress leading to insulin resistance and inadequate compensatory insulin secretion. Current evidence suggests that dietary supplementation with iron in pregnancy may increase a pregnant woman's chance of developing gestational diabetes, although available evidence is somewhat contradictory, and the magnitude of any increased risk appears relatively small. Meta-analyses have suggested the presence of significant heterogeneity in results between studies, urging a degree of caution in interpreting these results. It is currently suggested that advice to pregnant women about whether to supplement their diets with iron or not should consider both their current iron status and their other established risk factors for gestational diabetes.

Greater Ultra-Processed Food Intake during Pregnancy and Postpartum Is Associated with Multiple Aspects of Lower Diet Quality

Low diet quality during pregnancy and postpartum is associated with numerous adverse maternal and infant health outcomes. This study examined relations of ultra-processed food intake with diet quality during pregnancy and postpartum. Using data from 24-h recalls, ultra-processed food intake was operationalized as percent energy intake from NOVA-classified ultra-processed foods; diet quality was measured using Healthy Eating Index 2015 (HEI) total and component scores. Pearson correlations examined associations of ultra-processed food intake with HEI total and component scores, and food group intake was compared across four levels of ultra-processed food intake. On average, ultra-processed food comprised 52.6 ± 15.1% (mean ± SD) of energy intake in pregnancy and 50.6 ± 16.6% in postpartum. Ultra-processed food intake was inversely correlated with HEI total and 8 of 13 component scores. Compared to participants with the highest ultra-processed food intake (≥60% energy), those with the lowest ultra-processed food intake (<40% energy) had a 17.6-point higher HEI total score and consumed 2−3 times more fruit, vegetables, and seafood and plant proteins, and 1½ times more total protein. Additionally, they consumed 2/3 as much refined grains and 1/2 as much added sugar. Greater ultra-processed food intake was associated with lower diet quality across most HEI components. Reducing ultra-processed food intake may broadly improve adherence to dietary guidelines in pregnant and postpartum populations.

Adiponectin, leptin, and leptin/adiponectin ratio with risk of gestational diabetes mellitus: A prospective nested case-control study among Chinese women

AIMS

To examine the associations of serum concentrations of adiponectin and leptin and leptin/adiponectin ratio (LAR) in early pregnancy with risk of gestational diabetes mellitus (GDM) in Chinese women. The predictive ability of those biomarkers for GDM was also assessed.

METHODS

Within the Tongji-Shuangliu Birth Cohort, a nested case-control study was established with 332 GDM cases and 664 matched controls at 1:2 ratio on age (±3 years) and gestational age (±4 weeks). Serum adiponectin and leptin levels were measured in early pregnancy (median gestational week, 11; range, 6-15). Conditional logistic regression models with adjustment for potential covariates were used to evaluate the associations.

RESULTS

Multivariable-adjusted odds ratios (ORs) comparing extreme quartiles of adiponectin, leptin and LAR were 0.55 (95 % CI, 0.35, 0.85), 1.96 (95 % CI, 1.19, 3.24), and 2.72 (95 % CI, 1.63, 4.54) for GDM, respectively (All P-trend < 0.02). Adding adiponectin and leptin to a conventional prediction model (including traditional risk factors and fasting glucose) increased the C-statistics from 0.708 (95 % CI, 0.674, 0.741) to 0.728 (95 % CI, 0.695, 0.760), and achieved a net reclassification improvement of 0.292.

CONCLUSIONS

Our findings indicate that adiponectin is inversely associated with GDM, while leptin and LAR are positively associated with GDM in Chinese pregnant women.

Association between whole blood metallic elements concentrations and gestational diabetes mellitus in Japanese women: The Japan environment and Children's study

BACKGROUND

Exposure to several metallic elements has been suggested as a risk factor for gestational diabetes mellitus (GDM), but inconsistent findings have been reported. This study aimed to examine the association between the maternal whole blood concentration of metallic elements (Hg, Pb, Cd, Mn, and Se) and GDM using the dataset of the Japan Environment and Children's Study (JECS), a nationwide birth cohort study, which was designed to examine the adverse effects of pre/post-natal exposure to hazardous environment.

METHODS

The data of 78,964 pregnant women who were participants of JECS were used. Blood samples were collected from the pregnant women at second/third trimester of gestation. We employed logistic regression analysis, quantile g-computation (QGC) and a distributed lag nonlinear model (DLNM) to examine the association between the blood concentration of metallic elements and the risk of GDM.

RESULTS

The prevalence of GDM was 2.1%. In the logistic regression analyses, maternal blood Hg was associated with an increased risk of GDM. In QGC analysis, although metallic elements mixtures were not related to an increased risk of GDM, Hg (52.6%) may be the main contributor. According to the results of DLNM, for maternal exposure to Hg, 4.99 ng/g was identified as its susceptible minimum window for elevated risk of GDM.

CONCLUSIONS

Our findings highlighted an association between Hg exposure and an increased risk of GDM. Studies of the underlying mechanisms and potential contributing factors, including fish intake, of this association are warranted.

Gestational Health Outcomes Among Pregnant Women in the United States by Level of Dairy Consumption and Quality of Diet, NHANES 2003-2016

Objectives

Diet is an important factor in gestational health. Many pregnant women have suboptimal diets and dairy foods are an excellent source of key nutrients. The aim of this work was to investigate the relationships between dairy consumption (cup equivalents/day) or diet quality assessed using the Healthy Eating Index-2015 and gestational diabetes mellitus (GDM) or gestational weight gain (GWG) among pregnant women in the United States (US).

Methods

Study populations were subsets of pregnant, non-lactating women (20–44 years) in the National Health and Nutrition Examination Surveys 2003–2016, which was approved by the National Center for Health Statistics Research Ethics Review Board. GDM and GWG were classified according to national guidelines. General characteristics were compared across categories of dietary variables. Adjusted regression models estimated associations between diet and GDM and GWG.

Results

No statistically significant linear associations between dairy consumption or diet quality and GDM or GWG were observed.

Conclusions for Practice

Future research should aim to address the limitations of the current cross-sectional analyses and further elucidate the underlying relationships between diet and gestational health.

Gestational diabetes mellitus according to different diagnostic criteria: Prevalence and related factors

OBJECTIVE

Gestational diabetes mellitus (GDM) has an impact on maternal health; however, there is no consensus about the diagnostic criterion and frequency of disease. The objective of this study was to estimate the prevalence of GDM and to evaluate the clinical characteristics of normoglycemic pregnant women and of those diagnosed with gestational diabetes mellitus, based on each criterion.

METHODS

Prospective cohort study. Third-trimester pregnant women participated, with the occurrence of GDM being verified, according to two different diagnostic criteria. Prevalence was estimated in each category, and the prevalence ratios (PR) and 95% confidence intervals were adjusted using Poisson Regression.

RESULTS

A total of 8.7% of women were diagnosed with GDM (glycemia ≥95) and 8% had glycemic levels ≥92mg/dL according to IADPSG diagnosis. Factors related to the disease were the same, although the magnitude of the associations differed according to the diagnosis criteria. Pre-gestational obesity (PR 3.59 CI 1.28-10,07), previous diseases (PR 3.03 CI 1.15-7.94), and excessive weight gain (PR 4.71 CI 1.80-12.33) were factors related to total GDM, plus low nutritional knowledge (PR 3.17 CI 1.10-9.11). Regardless of the diagnostic criterion, women with GDM were at higher risk of intercurrences during pregnancy.

CONCLUSION

Nutritional knowledge and status were associated with GDM occurrence, independently of the diagnosis criteria. The adoption of the glycemic cutoff point of ≥ 92mg/dL indicated an important portion of the population without a diagnosis, suggesting that this cutoff point, more sensitive, should be used in order to guide women and minimize untoward outcomes.

Procyanidins and its metabolites by gut microbiome improves insulin resistance in gestational diabetes mellitus mice model via regulating NF-κB and NLRP3 inflammasome pathway

Gestational Diabetes Mellitus (GDM) has an effect on the health of pregnant women and fetuses. Procyanidins (PA) is a flavonoid with anti-diabetic activity, but its effects and mechanisms on GDM have not been defined. Herein, we studied further the functions and mechanisms of PA on insulin resistance (IR) in GDM mice, as well as on postpartum and offspring mice. GDM mice model was built by feeding a high-fat-high-sucrose diet, and PA intervention (27.8 mg/kg/d) was performed from 4 weeks before pregnancy to delivery. Intestinal flora deficient (IFD) mice model was established by broad spectrum antibiotics. PA decreased the gestational weight gain, and the levels of fasting blood glucose, insulin, homeostasis model of assessment for IR index, yet increased the levels of HOMA for insulin sensitivity index. Interestingly, in IFD mice the effect of PA on improving IR was significantly weakened. PA inhibited inflammation by decreasing the levels of IL-6, TNF-α, IL-17 and CRP, which also been blocked in the IFD mice. Moreover, PA improved glycometabolism and reduced the secretion of inflammatory factors and hepatic inflammation infiltration of mice at 4 weeks postpartum, but had no significant effect on offspring mice. Mechanistically, PA treatment suppressed the nuclear factor-κB (NF-κB) p65 nuclear translocation and nucleotide-binding domain like receptor protein 3 (NLRP3) inflammasome activation. In vitro studies, 4-hydroxyphenylacetic acid and 3-(4-hydroxyphenyl) propionic acid, main intestinal flora metabolites of PA restrained NF-κB/NLRP3 activation. In conclusions, PA improved IR via NF-κB/NLRP3 pathway in GDM and postpartum mice, which partly through its metabolites by gut microbiome.

Development and preliminary validity of an Indonesian mobile application for a balanced and sustainable diet for obesity management

Background

Mobile applications such as personalized tracking tools and food choice aids may enhance weight loss programs. We developed and assessed client preferences for the content, user interface, graphics, and logic flow of a mobile application, and evaluated its validity for tracking compliance with weight control and making healthy and sustainable food choices.

Methods

Our four-stage study comprised formative research, application development, acceptance assessment, and validity. The formative research included literature reviews and six focus groups with 39 respondents aged 19–64 years at high risk for obesity. The development stage included programmer selection, defining application specifications, design, and user interface. Prototype acceptability was assessed with 53 respondents who graded 17 features of content, graphic design, and application flow (ranked as good, moderate, and poor). A feature was considered to have "good" acceptance if its mean response was higher than the mean of overall responses. The validity was assessed in 30 obese women using Bland–Altman plots to compare results from dietary intake assessment from the application to conventional paper-based methods.

Results

The application was named as EatsUp®. The focus group participants defined the key requirements of this app as being informative, easy, and exciting to use. The EatsUp® core features consisted of simple menu recommendations, health news, notifications, a food database, estimated portion sizes, and food pictures. The prototype had a "good" overall acceptance regarding content, graphics, and flow. Fourteen out of 17 parameters were graded as "good" from > 70% of respondents. There was no significant difference between the rated proportions for content, graphics, and app flow (Kolmogorov–Smirnov Z-test, p > .05). The agreement using the Bland–Altman plots between EatsUp® and the paper-based method of measuring food intake was good, with a mean difference of energy intake of only 2.63 ± 28.4 kcal/day (p > 0.05), well within the 95% confidence interval for agreement.

Conclusions

The EatsUp® mobile application had good acceptance for graphics and app flow. This application can support the monitoring of balanced and sustainable dietary practice by providing nutritional data, and is comparable with conventional dietary assessment tools, and performed well in tracking energy, macronutrient, and selected micronutrients intakes.

Trial registration

NCT03469869. The registration date was March 19, 2018.

Peri-conceptional diet patterns and the risk of Gestational diabetes mellitus in South Indian women

OBJECTIVE

To identify peri-conceptional diet patterns among women in Bangalore, and examine their associations with risk of gestational diabetes mellitus.

DESIGN

BANGLES, started in June 2016, was a prospective observational study, in which women were recruited at 5-16 weeks' gestation. Peri-conceptional diet was recalled at recruitment, using a validated 224-item food frequency questionnaire. GDM was assessed by a 75-gram oral glucose tolerance test at 24-28 weeks' gestation, applying WHO 2013 criteria. Diet patterns were identified using principal component analysis and diet pattern-GDM associations were examined using multivariate logistic regression, adjusting for 'a priori' confounders.

SETTING

Antenatal clinics of two hospitals, Bangalore, South India.

PARTICIPANTS

785 pregnant women of varied socio-economic status.

RESULTS

GDM prevalence was 22%. Three diet patterns were identified: a) High-diversity, urban (HDU) characterised by diverse, home-cooked and processed foods was associated with older, more affluent, better-educated and urban women; b) Rice-fried snacks-chicken-sweets (RFCS), characterised by low diet-diversity, was associated with younger, less-educated, and lower income, rural and joint families; c) Healthy, traditional vegetarian (HTV), characterised by home-cooked-vegetarian and non-processed foods was associated with less-educated, more affluent, and rural and joint families. The HDU pattern was associated with a lower GDM risk (aOR: 0.80 per SD, 95% CI: 0.64, 0.99, p=0.04) after adjusting for confounders. BMI was strongly related to GDM risk and possibly mediated diet-GDM associations.

CONCLUSIONS

The findings support global recommendations to encourage women to attain a healthy pre-pregnancy BMI and increase diet-diversity. Both healthy and unhealthy foods in the patterns indicate low-awareness about healthy foods and a need for public-education.

An Investigation of the Relationship Between Dietary Patterns in Early Pregnancy and Maternal/Infant Health Outcomes in a Chinese Cohort

Background

Studies assessing links between maternal diet and pregnancy outcomes have focused predominantly on individual nutrients or foods. However, nutrients are typically consumed in combinations of foods or beverages (i.e., dietary patterns). Taking into account the diet as a whole appreciates that nutrient absorption and metabolism are influenced by other nutrients and the food matrix.

Objective

The aim of this study was to investigate the relationship between dietary pattern consumption in early pregnancy and pregnancy/infant outcomes, including gestational diabetes mellitus, gestational weight gain, preeclampsia, placental weight, gestational age at delivery, small-for-gestational-age, large-for-gestational-age, macrosomia, measures of infant body composition, and scores on two main indices of the Bayley Scales of Infant Development [Mental Development Index (MDI) and the Psychomotor Development Index (PDI)] at 12 months.

Design

Our study included 1,437 participants from a mother-infant cohort in Chongqing, China. Maternal diet was assessed using a 96-item food frequency questionnaire at 11–14 weeks gestation. Dietary patterns were constructed using principal component analysis. Multivariate regressions were performed to assess associations between maternal dietary pattern scores and pregnancy and infant outcomes, adjusting for confounders.

Results

Two dietary patterns were derived: a pattern high in pasta, sweetened beverages, and oils and condiments (PSO-based dietary pattern) and a pattern high in fish, poultry, and vegetables (FPV-based dietary pattern). Higher scores on the PSO-based dietary pattern were associated with lower infant standardized scores on the PDI of the Bayley Scales of Infant Development, β (95% confidence interval) = −1.276 (−2.392, −0.160); lower placental weight, β (95% CI) = −6.413 (−12.352g, −0.473); and higher infant's tricep skinfold thickness at 6 weeks of age. β (95% CI) = 0.279 (0.033, 0.526). Higher scores on the FPV-based dietary pattern were associated with higher gestational weight gain between visit 1 (11–14 week's gestation) and 3 (32–34 week's gestation). β (95% CI) = 25.612 (13.255, 37.969). No significant associations were observed between dietary pattern scores and the remaining pregnancy/infant outcomes investigated or MDI scores on the Bayley Scales of Infant Development. This was the first study to investigate the association between dietary patterns in early pregnancy and infant neurocognition in a Chinese cohort.

Development and evaluation of an online questionnaire to identify women at high and low risk of developing gestational diabetes mellitus

BACKGROUND

Established risk factors for Gestational Diabetes Mellitus (GDM) include age, ethnicity, family history of diabetes and previous GDM. Additional significant influences have recently been demonstrated in the literature. The oral glucose tolerance test (OGTT) used for GDM diagnosis has sub-optimal sensitivity and specificity, thus often results in GDM misdiagnoses. Comprehensive screening of risk factors may allow more targeted monitoring and more accurate diagnoses, preventing the devastating consequences of untreated or misdiagnosed GDM. We aimed to develop a comprehensive online questionnaire of GDM risk factors and triangulate it with the OGTT and continuous glucose monitoring (CGM) parameters to better evaluate GDM risk and diagnosis.

METHODS

Pregnant women participating in two studies on the use of CGM for GDM were invited to complete the online questionnaire. A risk score, based on published literature, was calculated for each participant response and compared with the OGTT result. A total risk score (TRS) was then calculated as a normalised sum of all risk factors. Triangulation of OGTT, TRS and CGM score of variability (CGMSV) was analysed to expand evaluation of OGTT results.

RESULTS

Fifty one women completed the questionnaire; 29 were identified as 'high-risk' for GDM. High-risk ethnic background (p < 0.01), advanced age, a family diabetic history (p < 0.05) were associated with a positive OGTT result. The triangulation analysis (n = 45) revealed six (13%) probable misdiagnoses (both TRS and CGMSV discordant with OGTT), consisting of one probable false positive and five probable false negative by OGTT results.

CONCLUSIONS

This study identified pregnant women at high risk of developing GDM based on an extended evaluation of risk factors. Triangulation of TRS, OGTT and CGMSV suggested potential misdiagnoses of the OGTT. Future studies to explore the correlation between TRS, CGMSV and pregnancy outcomes as well as additional GDM pregnancy biomarkers and outcomes to efficiently evaluate OGTT results are needed.

Dietary Protein Patterns during Pregnancy Are Associated with Risk of Gestational Diabetes Mellitus in Chinese Pregnant Women

Controversies around the association between dietary protein intake and gestational diabetes mellitus (GDM) persist. To the best of our knowledge, this association has not previously been reported from the perspective of dietary protein patterns. We aimed to investigate the relationship between dietary protein patterns and GDM risk in pregnant women, and 1014 pregnant women (20–28 weeks of gestation) were recruited in Guangzhou, China, during 2017–2018. Maternal dietary information was collected by a validated food frequency questionnaire, which covered the most common foods consumed in Guangzhou, China. GDM was identified by a 75g oral glucose tolerance test. A K-means cluster analysis was conducted to aggregate individuals into three groups, which were determined by the major sources of protein. Logistic regression was employed to explore the relationship between dietary protein patterns and the risk of GDM. Among the 1014 participants, 191 (18.84%) were diagnosed with GDM. In the total population, when comparing the highest quartile with the lowest, we found that total protein and animal protein intake increased the risk of GDM with the adjusted odds ratios (95%CI) being 6.27, 5.43 (1.71–23.03, 1.71–17.22), respectively. Pregnant women were further divided into three dietary protein patterns, namely, white meat, plant–dairy–eggs, and red meat protein patterns. Compared to women with the plant–dairy–eggs protein pattern, those with the red meat protein pattern (OR: 1.80; 95%CI: 1.06–3.07) or white meat protein pattern (OR: 1.83; 95%CI: 1.04–3.24) had an increased risk of GDM. Higher dietary intakes of total or animal protein during mid-pregnancy were related to an increased risk of GDM. Furthermore, we first found that, compared to women with the plant–dairy–eggs protein pattern, women with the red meat or white meat protein patterns had a higher risk of GDM.

Gestational Diabetes and Hypertensive Disorders of Pregnancy by Maternal Birthplace

INTRODUCTION

Gestational diabetes mellitus and hypertensive disorders of pregnancy increase the risk for future adverse health outcomes in the pregnant woman and baby, and disparities exist in the rates of gestational diabetes mellitus and hypertensive disorders of pregnancy by race/ethnicity. The objective of this study is to identify the differences in gestational diabetes mellitus and hypertensive disorders of pregnancy rates by maternal place of birth within race/ethnicity groups.

METHODS

In women aged 15-44 years at first live singleton birth in U.S. surveillance data between 2014 and 2019, age-standardized rates of gestational diabetes mellitus and hypertensive disorders of pregnancy and the rate ratios of gestational diabetes mellitus and hypertensive disorders of pregnancy in women born outside versus those born in the U.S. were evaluated, stratified by race/ethnicity. Analyses were conducted in 2021.

RESULTS

Of 8,574,264 included women, 6,827,198 were born in the U.S. (mean age=26.2 [SD 5.7] years), and 1,747,066 were born outside the U.S. (mean age=28.2 [SD=5.8] years). Overall, the gestational diabetes mellitus rate was higher in women born outside than in those born in the U.S. (70.3, 95% CI=69.9, 70.7 vs 53.2, 95% CI=53.0, 53.4 per 1,000 live births; rate ratio=1.32, 95% CI=1.31, 1.33), a pattern observed in most race/ethnic groups. By contrast, the overall hypertensive disorders of pregnancy rate was lower in those born outside than in those born in the U.S. (52.5, 95% CI=52.2, 52.9 vs 90.1, 95% CI=89.9, 90.3 per 1,000 live births; rate ratio=0.58, 95% CI=0.58, 0.59), a pattern observed in most race/ethnic groups.

CONCLUSIONS

In the U.S., gestational diabetes mellitus rates were higher and hypertensive disorders of pregnancy rates were lower in women born outside the U.S. than in those born in the U.S. in most race/ethnicity groups.

Soy foods and nuts consumption during early pregnancy are associated with decreased risk of gestational diabetes mellitus: a prospective cohort study

AIMS

To study the relationship of soy foods and nuts consumption during early pregnancy with the risk of gestational diabetes mellitus (GDM).

METHODS

This was a prospective observational study conducted in Southwest China. Dietary information was assessed through 3-day 24-h dietary recalls at 6-14 gestational weeks. For soy foods and nuts, non-consumers were used as the reference category and the consumers were categorized into tertiles. GDM was assessed with the 75-g, 2-h oral glucose tolerance test at 24-28 gestational weeks. Log-binomial models were used to assess the effects of soy foods and nuts on GDM.

RESULTS

Of the 1495 pregnant women, 529 were diagnosed with GDM. Median (IQRs) intakes of soy foods and nuts were 2.9 (0.0, 10.3) and 5.0 (0.0, 15.0) g/d, respectively. Our study found that, compared with the non-consumers, the highest tertile of soy foods intake was associated with a decrease in risk of GDM (RR = 0.73, 95%CI: 0.54-0.99, p = .049). Similarly, compared with the non-consumers, a negative relationship between the highest tertile of nuts intake and GDM risk was identified (RR = 0.65, 95%CI: 0.48-0.89, p = .007).

CONCLUSIONS

Consumption of soy foods and nuts are independently inversely associated with the risk of GDM during early pregnancy.

Association of types of diabetes and insulin dependency on birth outcomes

BACKGROUND

Diabetes rates among pregnant women in the United States have been increasing and are associated with adverse pregnancy outcomes.

AIM

To investigate differences in birth outcomes (preterm birth, macrosomia, and neonatal death) by diabetes status.

METHODS

Cross-sectional design, using linked Missouri birth and death certificates (singleton births only), 2010 to 2012 (n = 204057). Exposure was diabetes (non-diabetic, pre-pregnancy diabetes-insulin dependent (PD-I), pre-pregnancy diabetes-non-insulin dependent (PD-NI), gestational diabetes- insulin dependent (GD-I), and gestational diabetes-non-insulin dependent (GD-NI)]. Outcomes included preterm birth, macrosomia, and infant mortality. Confounders included demographic characteristics, adequacy of prenatal care, body mass index, smoking, hypertension, and previous preterm birth. Bivariate and multivariate logistic regression assessed differences in outcomes by diabetes status.

RESULTS

Women with PD-I, PD-NI, and GD-I remained at a significantly increased odds for preterm birth (aOR 2.87, aOR 1.77, and aOR 1.73, respectively) and having a very large baby [macrosomia] (aOR 3.01, aOR 2.12, and aOR 1.96, respectively); in reference to non-diabetic women. Women with GD-NI were at a significantly increased risk for macrosomia (aOR1.53), decreased risk for their baby to die before their first birthday (aOR 0.41) and no difference in risk for preterm birth in reference to non-diabetic women.

CONCLUSION

Diabetes is associated with the poor birth outcomes. Clinical management of diabetes during pregnancy and healthy lifestyle behaviors before pregnancy can reduce the risk for diabetes and poor birth outcomes.

Associations Among Food Security, Diet Quality, and Dietary Intake During Pregnancy in a Predominantly African American Group of Women from North Carolina

BACKGROUND

Low food security during pregnancy can negatively affect women's physical and mental health. Although many women make a greater effort to eat a healthy diet during pregnancy, the influence of low food security during pregnancy on maternal diet is not well understood.

OBJECTIVE

This study aimed to assess the association between adult food security and maternal diet during pregnancy in a sample from North Carolina.

DESIGN

This was a cross-sectional, secondary data analysis of food security (marginal, low, and very low vs high) and maternal diet during pregnancy.

PARTICIPANTS AND SETTING

This study included 468 predominantly Black/African American women during pregnancy from the Nurture cohort, enrolled through prenatal clinics in central North Carolina between 2013 and 2016.

MAIN OUTCOME MEASURE

Diet quality was assessed using the Alternate Healthy Eating Index-Pregnancy and the Mediterranean Diet Score. Dietary intake from seven food groups included in the Alternate Healthy Eating Index-Pregnancy and/or Mediterranean Diet Score was assessed as well.

STATISTICAL ANALYSIS PERFORMED

Multiple linear regression models were used to examine the association between food security and diet quality and dietary intake during pregnancy, adjusting for race/ethnicity; participation in the Special Supplemental Nutrition Program for Women, Infants, and Children; education; prepregnancy body mass index; age; parity; and mean daily energy intake.

RESULTS

In this study, there was no association between maternal food security status and diet quality during pregnancy. However, researchers observed an association between low and marginal food security and greater intake of red and processed meats (marginal: β = 2.20 [P = 0.03]; low: β = 2.28 [P = 0.04]), as well as an association between very low food security and decreased vegetable consumption (β = -.43; P = 0.03).

CONCLUSIONS

Very low food security was associated with reduced vegetable intake. In addition, low and marginal food security were associated with greater red and processed meat intake. Future research should focus on nationally representative populations and include longitudinal assessments to allow for the study of the influence of food security on health during pregnancy.

Significantly Increased Risk of All-Cause Mortality Among Type 2 Diabetes Patients Living Alone

Background

There is a lack of studies evaluating the association between living status and subsequent outcomes in patients with type 2 diabetes (T2DM).

Objectives

This study aimed to assess the association between living alone and the risk of all-cause mortality in T2DM patients.

Methods

We performed a secondary analysis in patients with long-lasting T2DM from the Action to Control Cardiovascular Risk in Diabetes (ACCORD) study. The primary outcome was all-cause mortality. Multivariable Cox proportional hazard models was used to analyze and compare the hazard ratios (HRs) in patients living alone and with one or more adults.

Results

This study included 10,249 patients with T2DM. Of these, 2,078 (20.28%) were living alone and 8,171 (79.72%) lived with one or more adults. Over a median total follow-up of 8.8 years, 1,958 patients developed the primary endpoint. The all-cause mortality rates in patients living alone or living with one or more adults were 23.24 and 18.05%, respectively. Cox proportional hazard analysis showed that T2DM patients living alone had significantly higher rate of all-cause mortality than those living with others (HR, 1.34; 95% confidence interval [CI], 1.20–1.48; p < 0.001). After multivariable adjustment, living alone was an independent risk factor for all-cause mortality in patients with T2DM (adjusted HR, 1.27; 95% CI, 1.14–1.41; p < 0.001). Furthermore, the risks of both congestive heart failure (CHF) and fatal coronary heart disease (CHD) among 4,050 propensity score-matched patients were higher for patients living alone (respectively HR, 1.37; 95% CI, 1.08–1.74; p = 0.010; and HR, 1.16; 95% CI, 1.00–1.34; p = 0.047).

Conclusions

The risk of all-cause mortality was significantly higher in T2DM patients living alone than in those living with one or more adults.

The role of nutrition in the development and management of gestational diabetes among Iranian women: a systematic review and meta-analysis

Purpose

We aimed to review existing evidence on nutrition associations with gestational diabetes mellitus (GDM) development and management among Iranian women.

Methods

Web of Science, PubMed, Scopus, SID, and Magiran were searched up to August 2020. Observational studies on associations between circulatory markers of vitamins and minerals, dietary intakes, and GDM and clinical trials of the effects of nutritional supplementations or dietary modifications on management or prevention of GDM among Iranian women were selected.

Results

We reviewed 49 publications. Pooled analyses revealed that GDM women had lower serum vitamin D (-8.31 nmol/l (95% CIs= -14.4, -2.19), higher serum iron (26.2 μg/dl (95% CIs= 2.52, 49.8), ferritin (24.1 ng/ml (95% CIs= 15.0, 33.4), and haemoglobin (1.14 g/dl (95% CIs: 0.32, 1.96) levels than non-GDM women. Single studies found the inverse associations of the Mediterranean diet, dietary approaches to stop hypertension diet, plant-based dietary index, and the direct associations of dietary acid load and dietary inflammatory index with the odds of GDM. Vitamin D supplementation early in pregnancy prevented GDM in two clinical trials. In two studies, iron supplementation's effect on GDM in non-anemic women was inconsistent. Pooled analyses of probiotic supplementation in women with GDM showed no significant impact on maternal glycemia.

Conclusions

Vitamin D supplementation early in pregnancy may reduce the incidence of GDM. There is no compelling evidence that vitamin D or probiotics can help with GDM management. There is currently inadequate data to recommend a specific dietary pattern to prevent GDM in Iranian women.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40200-021-00944-7.

Synthesis, Characterization and Biomedical Application of Silver Nanoparticles

Silver nanoparticles (AgNPs) have been employed in various fields of biotechnology due to their proven properties as an antibacterial, antiviral and antifungal agent. AgNPs are generally synthesized through chemical, physical and biological approaches involving a myriad of methods. As each approach confers unique advantages and challenges, a trends analysis of literature for the AgNPs synthesis using different types of synthesis were also reviewed through a bibliometric approach. A sum of 10,278 publications were analyzed on the annual numbers of publication relating to AgNPs and biological, chemical or physical synthesis from 2010 to 2020 using Microsoft Excel applied to the Scopus publication database. Furthermore, another bibliometric clustering and mapping software were used to study the occurrences of author keywords on the biomedical applications of biosynthesized AgNPs and a total collection of 224 documents were found, sourced from articles, reviews, book chapters, conference papers and reviews. AgNPs provides an excellent, dependable, and effective solution for seven major concerns: as antibacterial, antiviral, anticancer, bone healing, bone cement, dental applications and wound healing. In recent years, AgNPs have been employed in biomedical sector due to their antibacterial, antiviral and anticancer properties. This review discussed on the types of synthesis, how AgNPs are characterized and their applications in biomedical field.

How does antenatal lifestyle affect the risk for gestational diabetes mellitus? A secondary cohort analysis from the GeliS trial

OBJECTIVES

We aimed to investigate the predictive potential of early pregnancy factors such as lifestyle, gestational weight gain (GWG) and mental well-being on gestational diabetes mellitus (GDM) beyond established risk factors.

METHODS

GDM risk was investigated in the cohort of the German 'Gesund leben in der Schwangerschaft'/healthy living in pregnancy study. Women were recruited up to the 12th week of gestation. GDM was diagnosed with a 75 g oral glucose tolerance test between the 24th and 28th weeks of gestation. Pre-pregnancy age and weight, mental health and lifestyle were assessed via questionnaires. Maternal weight was measured throughout pregnancy. Early excessive GWG was defined based on the guidelines of the Institute of Medicine. The association between several factors and the odds of developing GDM was assessed using multiple logistic regression analyses.

RESULTS

Of 1694 included women, 10.8% developed GDM. The odds increased with pre-pregnancy BMI and age (women with obesity: 4.91, CI 3.35-7.19, p < 0.001; women aged 36-43 years: 2.84, CI 1.45-5.56, p = 0.002). Early excessive GWG, mental health and general lifestyle ratings were no significant risk factors. A 31% reduction in the odds of GDM was observed when <30% of energy was consumed from fat (OR 0.69, CI 0.49-0.96, p = 0.026). Vigorous physical activity tended to lower the odds without evidence of statistical significance (OR 0.59 per 10 MET-h/week, p = 0.076).

CONCLUSIONS

Maternal age and BMI stand out as the most important drivers of GDM. Early pregnancy factors like dietary fat content seem to be associated with GDM risk. Further evaluation is warranted before providing reliable recommendations.

Ethnic-specific associations between dietary consumption and gestational diabetes mellitus incidence: A meta-analysis

Globally, one in seven pregnant women are diagnosed with gestational diabetes mellitus (GDM), conferring short- and long-term health risks to both mother and child. While dietary prevention strategies are common in clinical practice, their effectiveness in different ethnicities is uncertain. To better inform prevention strategies, here the effects of unhealthy and healthy diets on GDM risk within distinct ethnic or cultural populations and geographic regions were evaluated and summarised. Pubmed, Scopus, Cochrane and OVID were systematically searched to identify randomised controlled trials (RCTs) and observational studies that investigated diet and GDM. A grouped analysis of common 'healthy' and 'unhealthy' diets was performed first, before analysing individual dietary patterns (e.g., prudent, Mediterranean). Random effect models and dose response analyses were performed where possible. PROSPERO (CRD42019140873). Thirty-eight publications provided information on 5 population groups: white European (WE), Asian, Iranian, Mediterranean and Australian. No associations were identified between healthy diets and GDM incidence in RCTs in any population. However, when synthesizing observational studies, healthy diets reduced odds of GDM by 23% (95% CI: 0.70-0.89, p<0.001, I2 = 75%), while unhealthy diets increased odds of GDM by 61% (95% CI: 1.41-1.81, p<0.0001, I2 = 0%) in WE women. No evidence of consistent effects in other populations were observed, even when adequately powered. Diet consistently associated with GDM risk in WEs but not in other populations. Heterogenous use and reporting of ethnically and culturally appropriate diets and dietary assessment tools, particularly in RCTs, raises uncertainty regarding the lack of association found in non-WE populations. Future studies require the use of culturally appropriate tools to confidently evaluate dietary and metabolic mediators of GDM and inform culturally-specific dietary prevention strategies.

A low-carbohydrate dietary pattern characterised by high animal fat and protein during the first trimester is associated with an increased risk of gestational diabetes mellitus in Chinese women: a prospective cohort study

We aimed to examine the association between low-carbohydrate diet (LCD) scores during the first trimester and gestational diabetes mellitus (GDM) risk in a Chinese population. A total of 1455 women were included in 2017. Dietary information during the first trimester was collected by 24-h dietary recalls for 3 d. The overall, animal and plant LCD scores, which indicated adherence to different low-carbohydrate dietary patterns, were calculated. GDM was diagnosed based on the results of a 75-g, 2-h oral glucose tolerance test at 24-28 weeks gestation. Log-binomial models were used to estimate relative risks (RR) and 95 % CI. The results showed that the multivariable-adjusted RR of GDM from the lowest to the highest quartiles of the overall LCD score were 1·00 (reference), 1·15 (95 % CI 0·92, 1·42), 1·30 (95 % CI 1·06, 1·60) and 1·24 (95 % CI 1·01, 1·52) (P = 0·026 for trend). Multivariable-adjusted RR (95 % CI) of GDM from the lowest to the highest quartiles of the animal LCD score were 1·00 (reference), 1·20 (95 % CI 0·96, 1·50), 1·41 (95 % CI 1·14, 1·73) and 1·29 (95 % CI 1·04, 1·59) (P = 0·002 for trend). After additional adjustment for gestational weight gain before GDM diagnosis, the association of the overall LCD score with GDM risk was non-significant, while the association of animal LCD score with GDM risk remained significant. In conclusion, a low-carbohydrate dietary pattern characterised by high animal fat and protein during the first trimester is associated with an increased risk of GDM in Chinese women.

Dietary Intake in Early Pregnancy and Glycemia in Late Pregnancy among Women with Obesity

Women with obesity have increased risk for hyperglycemia during pregnancy, with negative health consequences for mother and child. We aimed to investigate adherence to nutritional recommendations in early pregnancy and to examine associations between early pregnancy dietary intake and late pregnancy glycemia among women with obesity. We included 120 women with pre-pregnancy body mass index (BMI) ≥30 kg/m² who participated in one of two randomized controlled trials. The participants completed a food frequency questionnaire in early pregnancy (gestational weeks 12–22). Fasting and 120 min glucose tolerance after ingestion of 75 g glucose were assessed in late pregnancy (gestational weeks 32–37). About 90% of the participants reported early pregnancy diary intake within the recommendations. Average intakes of vitamin D, iron, and folate were below recommended levels. High intakes of dairy products and protein in early pregnancy were associated with lower fasting glucose in late pregnancy, whereas high intake of bread was associated with lower 120 min glucose. There were no clear associations between single dietary variables and gestational diabetes mellitus (GDM) diagnosis in late pregnancy. In conclusion, some early pregnancy dietary variables were associated with late pregnancy glycemia. Potential causality of these findings should be investigated in future studies.

Relationships Among Pre-Pregnancy BMI, Gestational, and Postpartum Oral Glucose Tolerance Results in Women With Gestational Diabetes Mellitus

Background and Aims: To investigate the relationship among maternal demographic and clinical characteristics, gestational and postpartum oral glucose tolerance test (ppOGTT) results in patients with gestational diabetes mellitus (GDM).

Methods: Patients with gestational diabetes mellitus from January 1, 2016, to August 31, 2019, were enrolled. General characteristics, dietary energy intake, pre-gestational body mass index (BMI), gestational oral glucose tolerance test (gOGTT), and 42 days ppOGTT results of all participants were collected. The relationships among maternal clinical characteristics, fasting glucose of gOGTT (gOGTT-FPG), 1 h postprandial glucose of gOGTT (gOGTT-1h PG), 2 h postprandial glucose of gOGTT (gOGTT-2h PG), and maternal postpartum glucose outcomes were evaluated.

Results: A total of 156 patients with GDM were included in this study. Among them, 73.7% had inadequate daily total energy intake, an insufficient ratio of carbohydrates and protein, and an excessive fat ratio. Most of the patients (81.4%) were normal in their ppOGTT examination. Less than 20% of the patients (16.7%) were in the pre-diabetic situation, and 3 patients (1.9%) had diabetes. Pre-pregnancy BMI of patients with GDM was a risk factor for increased gOGTT-FPG levels. Those who were overweight before pregnancy had a greater risk for a higher gOGTT-FPG compared to those who had normal pre-pregnancy BMI (P = 0.021, odds ratio [OR] = 4.583). Abnormal gOGTT-2hPG was a risk factor for abnormal ppOGTT (P = 0.04). Those who had an elevated gOGTT-2hPG (≧8.5 mmol/L) had a 2.426 times higher risk for abnormal ppOGTT than those who had normal gOGTT-2hPG (<8.5 mmol/L) results.

Conclusion: For women who are overweight before pregnancy, it is better to control their BMI to normal before getting pregnant. Women who had abnormal gOGTT-2h PG should pay more attention to the ppOGTT results.

Higher Animal Protein Intake During the Second Trimester of Pregnancy Is Associated With Risk of GDM

Background and Aims: This study aimed to examine the associations between the total protein intake as well as types and sources of proteins with the gestational diabetes mellitus (GDM) risk. Method and Results: This was a prospective cohort study of the pregnant women in Malaysia. In this study, the total, animal, and plant protein intakes were assessed using a semi-quantitative food frequency questionnaire. Of the 452 women, 48 (10.62%) were diagnosed with GDM. From pre-pregnancy to second trimester, most of the women had 10-20% of energy intake from protein (88.9-90.3%) and ≥75% of recommended protein intake (74.6-86.5%). The women in the highest tertile (T3) of total animal protein intake [adjusted odds ratio (AOR) = 2.76, 95% CI = 1.27-6.04] and red meat protein (AOR = 2.69, 95% CI = 1.27-5.70), specifically in the second trimester, had significantly higher GDM risk compared with the women in the middle tertile of intake (T2). Interestingly, the women in the T3 of egg protein in the second trimester were significantly at lower GDM risk (AOR = 0.43, 95% CI = 0.18-0.91) compared with those in T2. Conclusion: The highest tertile of animal protein (≥42.15 g/day) intake, particularly red meat protein in the second trimester was positively associated with the GDM risk, whereas the highest tertile of egg protein was inversely associated with the GDM risk. Protein intake before or during early pregnancy was not associated with the GDM risk. These findings underscore the importance of sources and types of protein intake, particularly after the first trimester of pregnancy, in relation to GDM risk.

The Efficacy of a Personalized mHealth Coaching Program During Pregnancy on Maternal Diet, Supplement Use, and Physical Activity: Protocol for a Parallel-Group Randomized Controlled Trial

Background

Adequate intake of macro- and micronutrients and adoption of an active lifestyle during pregnancy are essential for optimum maternal and fetal health and offspring development. Dietary counseling and advice regarding adequate physical activity are integral components of antenatal care. Personalized coaching through the use of mobile health (mHealth) that supports behavior modification is an innovative approach that needs exploration.

Objective

Our primary aim is to assess the efficacy of an mHealth program in improving diet, supplement use, and physical activity during pregnancy. Secondary objectives include evaluation of the program’s effect on maternal and offspring health outcomes and assessment of its compliance and usability.

Methods

A randomized controlled trial was initiated at the Aga Khan University Hospital in Karachi, Pakistan, in January 2020. We aim to recruit 300 pregnant women in their first trimester who have smartphones, do not have comorbidities, and are not taking medications. The intervention group will be trained to use an mHealth app called PurUmeed Aaghaz. Through this app, the subjects will report information about their diet, supplement use, and physical activity and will receive personalized advice and three push messages as weekly reminders. The research assistant will obtain similar information from the control group via a paperless questionnaire; this group will receive standard face-to-face counseling regarding diet, supplement use, and physical activity. Data will be collected at enrollment and during four follow-up sessions scheduled 6 weeks apart. Primary study outcomes include improvements in diet (ie, change in mean dietary risk score from baseline to each follow-up), supplement use (ie, changes in mean supplement use score and biochemical levels of folic acid, iron, calcium, and vitamin D on a study subset), and mean duration of reported physical activity (minutes). Secondary study outcomes relate to maternal health (ie, gestational diabetes mellitus, gestational hypertension, pre-eclampsia, and gestational weight gain), newborn health (ie, birth weight and length and gestational age at delivery), and infant health (ie, BMI and blood pressure at 1 year of age). Compliance will be determined by the proportion of participants who complete the 6-month coaching program. Usability will be assessed based on features related to design, interface, content, coaching, perception, and personal benefit.

Results

The study was approved by the Ethics Review Committee of the Aga Khan University in 2017. The recruitment of study participants was completed in September 2021. All follow-ups and outcome assessments are expected to be completed by March 2023 and analysis is expected to be completed by June 2023. We expect the results to be published by the end of 2023.

Conclusions

This study will be an important step toward evaluating the role of mHealth in improving behaviors related to a healthy diet, supplement use, and promotion of physical activity during pregnancy, as well as in influencing maternal and offspring outcomes. If proven effective, mHealth interventions can be scaled up and included in antenatal care packages at tertiary care hospitals of low- and middle-income countries.

Trial Registration

ClinicalTrials.gov NCT04216446; https://clinicaltrials.gov/ct2/show/NCT04216446

International Registered Report Identifier (IRRID)

DERR1-10.2196/31611

Pregnancy; an opportunity to return to a healthy lifestyle: a qualitative study

Background

The lifestyle of the mother during pregnancy can affectthe health of their baby. Since lifestyle change is a sociocultural act and the motivations associated with lifestyle patterns during pregnancy cannot be explained in quantitative studies, a comprehensive study of the lifestyle during pregnancy and factors influencing its patterns was needed to investigate it from different aspects. Thus, the present study aimed to explore ‘mothers’ perceptions and experiences about lifestyle patterns during and after pregnancy and the reasons for adopting these lifestyles.

Methods

The present study, conducted on 20 pregnant or postpartum women living in Bushehr, Iran, has used a conventional content analysis approach.

The purposeful sampling method was used with maximum diversity and continued until data saturation. data were collected through face-to-face, in-depth, semi-structured interviews. Informed consent was obtained from all participants, and assuringthe confidentiality of their information. MAXQDA 10 software was used to analyze the data.

Results

Four main themes were defined after data analysis; "Being a mother as motivation for adopting a new healthy lifestyle"; "Access to information from media and supports from physicians as facilitators of adopting healthy lifestyle"; "Aspects of lifestyle modifications" and "Durability of healthy lifestyles". When women become pregnant, they feel a responsibility tohave a healthy pregnancy. They care about their fetuses more than themselves, which motivated them to look for the best lifestyle. In this way, access information from mass media and recommendations from professionals (physicians, midwives, and other health care providers) were helpful factors to have a healthy lifestyle, leading to modifying physical, mental, and religious aspects of lifestyle. However, despite reminding the advantages of a healthy lifestyle, these changesshift to a pre-pregnancy lifestyle due to the cessation of support and care provided during pregnancy.

Conclusion

The study results showed that pregnant women should be motivated to modify their lifestyle andadopt healthy lifestyles. Pregnant women seek to modify their lifestyle because of motherhood responsibility and and having a healthy baby. Access to information and supports from various sources promote a mother’s inner decision to change, leading to modifying different aspects of life. However, these modifications often shift to the pre-pregnancy lifestyle due to cessation of supports and care, despite reminding the benefits of the lifestyle change.

Health care providers should consider supportive measures during pregnancy and postpartum.

Universal versus selective screening for gestational diabetes mellitus among antenatal clinic attendees in Abakaliki: using the one-step 75 gram oral glucose tolerance test

AIM

To compare universal screening with selective risk factor based screening for GDM, using the one-step 75 g oral glucose tolerance test (OGTT).

MATERIALS AND METHOD

A cross-sectional, comparison between universal and selective risk factor based screening for GDM, among 400 antenatal care clients at Alex-Ekwueme Federal University Teaching Hospital Abakaliki (AE-FUTHA). All the participants had 75 g OGTT at 24-28 weeks of gestation and risk factor screening for GDM. All 400 participants formed the universal group while participants with one or more of the considered risk factors formed the selective risk factor group. Data were analyzed using IBM SPSS version 20. Statistical comparison was done using t- test for continuous variables. Logistics regression was used to determine the level of associations of the independent predictors for hyperglycemia. Level of significance was set at P < 0.05.

RESULTS

The point prevalence of GDM using universal and selective screening were 11.51 and 7.93% respectively, giving a selective screening miss rate of 31.11%. The sensitivity, specificity, positive predictive value and negative predictive value were 73.58, 48.82, 19.12 and 92.51% respectively for the selective risk factor based screening compared to universal screening. On multivariate analysis; age ≥ 35 years, weight ≥ 90 kg, history of previous GDM and hypertension were significantly related to the development of hyperglycemia.

CONCLUSION

Selective risk factor based screening missed 31.11% of patients with GDM when compare to Universal screening with one step 75 g OGTT. Universal screening for GDM using the one step 75 g OGTT is recommended for pregnant women and more studies are needed to compare pregnancy outcomes for pregnant women diagnosed with GDM with and without risk factors.

Do Older Women of Reproductive Age Have Better Diet Quality than Younger Women of Reproductive Age?

There is increasing recognition of the importance of nutrition for reproductive health, but little is known regarding the diet quality of younger vs. older reproductive aged women, and how their intakes relate to dietary recommendations. The purpose of the study was to examine the diets of younger (19–35 years old) compared to older (35–50 years old) reproductive aged women, and how they align with dietary recommendations. Women aged 19–50 years from the 2011–13 Australian National Nutrition and Physical Activity Survey were included (n = 2323). Dietary intakes were assessed by a single 24-h dietary recall and were compared to (i) Australian Dietary Guidelines; (ii) Acceptable Macronutrient Distribution for protein, carbohydrates, and fat; and (iii) Dietary Guideline Index (DGI). Regression analyses comparing younger and older women against recommendations were undertaken, with confounders determined a priori. There was no difference between older and younger women in meeting food group recommendations, with 26% of all women meeting recommendations for fruit, and meat and alternatives, and <20% meeting recommendations for vegetables and alternatives, grains, and dairy. Although there was no difference between older and younger women in total DGI score (mean (SE) 75.6 (1.7) vs. 74.5 (2.5), p > 0.05), older women had higher component scores in limiting saturated fat, consuming low-fat milk, and limiting adding salt during cooking. Continued health promotion for women of reproductive age should be a key priority to improve their own health and that of future generations.

Association of maternal pre-pregnancy dietary intake with adverse maternal and neonatal outcomes: A systematic review and meta-analysis of prospective studies

This study aimed to summarize the evidence regarding the effects of dietary intake before conception on pregnancy outcomes by performing a systematic review and meta-analysis of prospective studies. Electronic databases were searched from inception up to August 2021. Overall, 65 studies involving 831 798 participants were included and 38 studies were quantitatively pooled. With regard to maternal outcomes, pre-pregnancy intake of fried food, fast food, red and processed meat, heme iron and a low-carbohydrate dietary pattern was positively associated with the risk of gestational diabetes mellitus (GDM) (all P < 0.05). However, a high dietary fiber intake and folic acid supplementation were negatively associated with GDM risk (both P < 0.05). With regard to neonatal outcomes, maternal caffeine intake before pregnancy significantly increased the risk of spontaneous abortion, while folic acid supplementation had protective effects on total adverse neonatal outcomes, preterm birth, and small-for-gestational age (SGA, all P < 0.05). However, no significant associations were found between adverse pregnancy outcomes (i.e., GDM and SGA) and the pre-pregnancy dietary intake of sugar-sweetened beverages, potato, fish, and carbohydrates and the Healthy Eating Index. Our study suggests that maintaining a healthy diet before conception has significant beneficial effects on pregnancy outcomes.Supplemental data for this article is available online at https://doi.org/10.1080/10408398.2021.1989658.

Early pregnancy essential and non-essential metal mixtures and gestational glucose concentrations in the 2nd trimester: Results from project viva

Metals are involved in glucose metabolism, and some may alter glycemic regulation. However, joint effects of essential and non-essential metals on glucose concentrations during pregnancy are unclear. This study explored the joint associations of pregnancy exposures to essential (copper, magnesium, manganese, selenium, zinc) and non-essential (arsenic, barium, cadmium, cesium, lead, mercury) metals with gestational glucose concentrations using 1,311 women enrolled 1999-2002 in Project Viva, a Boston, MA-area pregnancy cohort. The study measured erythrocyte metal concentrations from 1st trimester blood samples and used glucose concentrations measured 1 h after non-fasting 50-gram glucose challenge tests (GCT) from clinical gestational diabetes screening at 26-28 weeks gestation. Bayesian Kernel Machine Regression (BKMR) and quantile-based g-computation were applied to model the associations of metal mixtures-including their interactions-with glucose concentrations post-GCT. We tested for reproducibility of BKMR results using generalized additive models. The BKMR model showed an inverse U-shaped association for barium and a linear inverse association for mercury. Specifically, estimated mean glucose concentrations were highest around 75th percentile of barium concentrations [2.1 (95% confidence interval: -0.2, 4.4) mg/dL higher comparing to the 25th percentile], and each interquartile range increase of erythrocyte mercury was associated with 1.9 mg/dL lower mean glucose concentrations (95% credible interval: -4.2, 0.4). Quantile g-computation showed joint associations of all metals, essential-metals, and non-essential metals on gestational glucose concentrations were all null, however, we observed evidences of interaction for barium and lead. Overall, we found early pregnancy barium and mercury erythrocytic concentrations were associated with altered post-load glucose concentrations in later pregnancy, with potential interactions between barium and lead.

Improving nutrition for the prevention of gestational diabetes: Current status and perspectives

Gestational diabetes mellitus (GDM) is a common complication of pregnancy and a serious public health problem. It carries significant risks of short-term and long-term adverse health effects for both mothers and their children. Risk factors, especially modifiable risk factors, must be considered to prevent GDM and its consequences. Observational studies have identified several nutritional and lifestyle factors associated with the risk of GDM. The results of intervention studies examining the effects of diet and lifestyle on the prevention of GDM are contradictory. Differences in the study populations, types and intensity of intervention, time frame of the intervention, and diagnostic criteria for GDM may explain the heterogeneity in the results of intervention studies. This review provides an overview of new diets and other factors that may help prevent GDM. The main results of epidemiological studies assessing the risk factors for GDM, as well as the results and methodological problems of intervention studies on the prevention of GDM and their meta-analyses, are discussed. In addition, the evidence that gene and lifestyle interactions influence the development of GDM, as well as prospects for increasing the effectiveness of interventions designed to prevent GDM, including new data on the possible uses of personalized diet therapy, are highlighted.

Changes in diet from pregnancy to one year after birth: a longitudinal study

Background

Pregnancy and the first year after giving birth are marked by physiological and psychological changes. While it is well known that energy requirements change during this time, the question of how a woman’s diet actually changes from pregnancy until 1 year postpartum has been left virtually unexplored. The present study employs a longitudinal design to investigate these changes.

Methods

Data were collected within the framework of the LIFE Child study (Leipzig, Germany). The diet composition and culture of eating of 110 women were assessed at 3 time points: in the 24th week of pregnancy, 3 months after giving birth (breastfeeding period), and 12 months after giving birth (after weaning). We assessed differences in nutritional health (Nutritional Health Score, NHS) and the consumption of different food items at each of these time points. We also investigated associations between nutritional health and age, socio-economic status (SES), BMI before pregnancy, and previous births at all three time points.

Results

The analyses revealed high correlations in the NHS values between the three time points (rho_t0/t1 = .55, rho_t0/t2 = .60). On average, nutritional health was lower in the breastfeeding period than during pregnancy. In more detail, women reported less healthy levels of treats and white bread consumption and a higher frequency of snacking in the breastfeeding period than during pregnancy. In contrast, overall nutritional health did not differ significantly between pregnancy and the time after weaning. Increased age was associated with a healthier diet during pregnancy, and a high SES was associated with healthier diet after weaning. Furthermore, the increase in nutritional health from the breastfeeding period to the time after weaning was significantly stronger in women with a higher BMI. We observed no significant associations between dietary nutritional health and previous births.

Conclusions

The present findings suggest that higher energy requirements in the breastfeeding period are met by consuming high-calorie and unhealthy food products rather than healthy and nutrient-rich food. Young mothers should be supported in taking care of their own nutritional health during the challenging time of breastfeeding and caring for a newborn child.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-021-04038-3.