Gestational Diabetes Mellitus and Diet: A Systematic Review and Meta-analysis of Randomized Controlled Trials Examining the Impact of Modified Dietary Interventions on Maternal Glucose Control and Neonatal Birth Weight

Effect of a Low Glycemic Index/Slow Digesting (LGI/SD) Carbohydrate Product on Maternal Glycemia and Neonatal Body Composition in Obese Pregnant Women: The NIGOHealth Randomized Clinical Trial

Background/Objectives: Obesity during pregnancy is strongly related to increased insulin resistance, and subsequent development of metabolic syndrome-like disorders, such as glucose intolerance, pre-eclampsia, as well as preterm birth, and cesarean delivery. Nutrition can influence the evolution of glycemic response and may help improve adverse pregnancy outcomes and long-term complications. The main objective of the Nutritional Intervention during Gestation and Offspring Health (NIGOHealth) randomized clinical trial (ClinicalTrials.gov Identifier: NCT02285764) was to investigate the potential effects of a low glycemic index/slow digesting (LGI/SD) carbohydrate product on maternal glycemia (glucose AUC at 27+0-28+6 weeks; maternal fasting blood glucose (MFBG) at 34+0-36+0 weeks), and neonatal body composition. Methods: Obese pregnant women were randomized: 230 in the intervention group (IG), who consumed two servings of an LGI/SD study product daily from 15 weeks of pregnancy until delivery, and 102 participants in the Standard of Care (SOC) group. Results: When analyzing baseline characteristics, significant differences were found in glucose metabolic parameters with higher values for IG than for the SOC group, compromising the group's comparability. Despite this, a statistical analysis was conducted (intention-to-treat analysis/evaluable cohort): no differences were detected regarding maternal blood glucose AUC at 27+0-28+6 weeks, nor for MFBG at 34+0-36+0 weeks. Nonetheless, HbA1c (%) at 34+0-36+0 weeks was significantly lower in the IG vs. the SOC group (5.26 ± 0.03, 5.31 ± 0.04, p = 0.007) after adjusting for baseline conditions. Conclusion: This result might suggest a potential effect of the intervention on Evaluable participants. However, it should be taken with caution, due to the limitations of the study. More RCTs should be carried out to explore the effects of LGI/SD products on glycemic response in obese pregnant women.

Association Between Plant-Based Diet and Continuous Glucose Monitoring-Derived Glycemic Dynamics Among Pregnant Women With Gestational Diabetes

We aim to investigate the association of plant-based diets with the continuous glucose monitoring (CGM)-derived glycemic metrics among gestational diabetes mellitus (GDM) patients. We included 1756 GDM patients in the present analyses and assessed plant-based dietary patterns through constructing a plant-based diet index (PDI), healthy PDI (hPDI), and unhealthy PDI (uPDI). CGM-glycemic metrics, such as time in range (TIR), mean blood glucose (MBG), time below range (TBR), low blood glucose index (LBGI), mean of daily differences (MODD), and glycemic risk assessment in diabetes equation (GRADE), were constructed. We found that individuals in the highest quartile of PDI were more likely to have greater TIR (β: 0.28, 95% CI: 0.14 to 0.41) and MBG (β: 0.23, 95% CI: 0.09 to 0.36), while lower TBR (β: -0.26, 95% CI: -0.39 to -0.12), LBGI (β: -0.18, 95% CI: -0.32 to -0.05), and GRADE (β: -0.25, 95% CI: -0.39 to -0.11), compared to those in the lowest quartile. Moreover, most of these associations demonstrated a dose-response relationship, and hPDI and uPDI showed distinct associations with MODD, with higher hPDI favoring a healthier MODD pattern (FDR < 0.05). This study suggests potential benefits of increasing intake of plant-based food for glycemic management among GDM patients.

Association between consumption of ultra-processed foods and glycemic self-monitoring in women with gestational diabetes mellitus and their newborns: A cohort study

OBJECTIVE

To evaluate the association between the consumption of ultra-processed foods (UPFs) and outcomes of self-monitoring of blood glucose in pregnant woman with gestational diabetes mellitus (GDM) and the occurrence of hypoglycemia in their newborns.

METHODS

Prospective cohort study of pregnant woman with GDM who were followed up from the second trimester of pregnancy in high-risk prenatal care until the immediate postpartum period. Dietary intake was assessed using 24-h recalls and analyzed according to the Nova Classification. The glycemic profile was assessed by self-monitoring of fasting and postprandial capillary glycemia (pregnant) and by capillary glycemia in the first 48 h of life (neonate). Multilevel binary logistic regression models were used to assess the relationship between increasing UPF intake, considering the highest tertile of UPF consumption, and women's glycemic control and the occurrence of neonatal hypoglycemia.

RESULTS

UPFs provided 15% of calories consumed; 33.3% (n = 30) and 52.3% (n = 45) of the women had hyperglycemia in the second and third trimesters of pregnancy, respectively. After adjustment it was observed that UPF consumption had no significant association with maternal glycemic control but it showed a positive association with the occurrence of neonatal hypoglycemia (odds ratio [OR] 1.144, 95% confidence interval [CI] 1.037-1.262, p = 0.007).

CONCLUSION

These data reinforce the need to address food processing during high-risk prenatal care in order to help reduce the negative impacts of UPF consumption on the mother-infant dyad.

Systematic development and refinement of a user-centered evidence-based digital toolkit for supporting self-care in gestational diabetes mellitus

Gestational diabetes mellitus (GDM) is a pregnancy complication affecting many women, requiring changes in behaviours, which command them to learn self-care practices shortly. Digital interventions have been developed to support women with GDM. However, they have often overlooked women's needs and characteristics and failed to frame self-care theories into their design. To address this issue, we adopted a mixed methods approach to develop and refine a user-centred, evidence-based digital Toolkit for supporting self-care in GDM, providing behavioural and educational content, particularly about nutrition. To inform the development and refinement of the Toolkit, we conducted a literature review, observed sixty-six nutrition appointments, interviewed eleven dietitians and seventeen patients, and held co-creation sessions with two dietitians, all of which were analysed using a deductive Thematic Analysis. To validate the Toolkit, we conducted a survey with seventeen healthcare professionals, which was analysed using descriptive statistics. The final version of the NUTRIA Toolkit consists of four main modules with thirty-eight artefacts, including behavioural tools to assist women in GDM management. Despite some limitations, this study robustly endorsed the development and refinement of a user-centred, evidence-based Toolkit for supporting self-care in GDM, aiming for future feasibility and trial testing.

Factors influencing healthy dietary behavior changes among patients with gestational diabetes mellitus during pregnancy: A meta-synthesis using the theoretical domains framework

AIMS

To examine factors that facilitate and impede healthy dietary behavior modification in patients with gestational diabetes mellitus (GDM). Additionally, it sought to assess the strength of the evidence for these factors and offer insights into promoting positive behaviors.

METHODS

This systematic review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting standards. We searched seven databases in February 2023 to include qualitative studies related to patients with GDM that explored their perceptions of and changes in healthy eating behaviors. Two researchers independently screened the articles, assessed their quality, extracted data, and coded the factors using the theoretical domain framework. For the factors involved, we performed a meta-synthesis based on their frequency and assigned a confidence level to determine their level of evidence.

RESULTS

We included 32 of the 536 extracted articles. Barriers identified by high levels of evidence include: "Environmental context and resources," "Social influences," "Knowledge," "Emotion," and "Social/professional roles and Identity." The facilitators identified by high levels of evidence include the following: "Beliefs about consequences," "Social influences," "Environmental context and resources," "Skill," and "Memory, attention, and decision processes."

CONCLUSION

This meta-synthesis highlights that healthy eating behavior change is influenced by the interaction of factors at different levels of individuals, organizations, and sociocultural environments. Furthermore, we established a framework that displayed the associations between these factors, giving prominence to those with higher levels of evidence. This framework will aid researchers in identifying priority areas for intervention and facilitating the implementation of high-quality strategies.

Medical Nutrition Therapy for Women with Gestational Diabetes: Current Practice and Future Perspectives

Gestational diabetes mellitus (GDM) is a complication that affects 20% of pregnancies worldwide. It is associated with adverse short- and long-term cardiometabolic outcomes for both mother and infant. Effective management of GDM involves lifestyle modifications, including medical nutrition therapy (MNT) and physical activity (PA), with the addition of insulin or metformin if glycaemic control remains inadequate. However, substantial gaps persist in the determination of optimal medical nutrition therapy (MNT) for women with GDM. Challenges in MNT include individual variation in glucose tolerance and changing maternal physiology and dietary requirements during pregnancy. Achieving optimal glycaemic control depends on careful macronutrient balance, particularly the distribution and quality of carbohydrate intake and sufficient protein and fat intake. Additionally, micronutrient deficiencies, such as inadequate vitamin D, calcium, and essential minerals, may exacerbate oxidative stress, inflammation, and glycaemic dysregulation, further impacting foetal growth and development. Cultural beliefs and dietary practices among pregnant women can also hinder adherence to recommended nutritional guidelines. Conditions like hyperemesis gravidarum (HG) affect ~1% to 2% of pregnant women can result in unintended energy and nutrient deficits. This special issue explores the current evidence and major barriers to optimising dietary therapy for women with GDM. It also identifies future research priorities to advance clinical practice, improve maternal and foetal outcomes, and address gaps in personalised nutrition interventions.

Policy Actions Required to Improve Nutrition for Brain Health

Brain health is a pressing global concern. Poor diet quality is a recognized major environmental risk factor for brain disorders and one of the few that is modifiable. There is substantial evidence that nutrition impacts brain development and brain health across the life course. So why then is the full potential of nutrition not utilized to improve brain function? This commentary, which is based on discussions of the European Brain Research Area BRAINFOOD cluster, aims to highlight the most urgent research priorities concerning the evidence base in the area of nutrition and brain health and identifies 3 major issues that need to be addressed: (1) increase causal and mechanistic evidence on the link between nutrition and brain health, (2) produce effective messages/education concerning the role of food for brain health, and (3) provide funding to support collaborative working across diverse stakeholders.

Evaluating Validated Diet Quality Indices Used in Pregnant Women in High-Income Countries: A Systematic Review

CONTEXT

Diet quality indices (DQIs) assess the level of adherence to dietary recommendations and a specified dietary pattern in populations; however, there is limited evidence regarding the construct criteria and validation methodology of DQIs used in pregnant women.

OBJECTIVES

The objectives of this study were to (i) identify and describe characteristics of DQIs that have been validated for use in pregnant women in high-income countries, and (ii) evaluate criteria used to develop DQIs and validation methodologies employed.

DATA SOURCES

CINAHL, Embase, Medline, SCOPUS, and Web of Science were systematically searched for eligible articles published between 1980 and November 2022 that focused on DQIs validated for use in pregnant women from high-income countries.

DATA EXTRACTION

Characteristics, development criteria, and validation methodologies used in the included articles were extracted by one reviewer and checked by a second reviewer.

DATA ANALYSIS

A narrative synthesis and descriptive statistics were used to summarize the review findings. Reporting was guided by the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement.

RESULTS

Six articles with 5 validated DQIs were identified. In total, 3777 participants were included - five articles had pregnant women aged 31-50 years and in their second trimester. Food frequency questionnaires were used as the dietary assessment method in all studies, and 3 DQIs were used to assess dietary intake at 1 time point, using 2 different dietary assessment methods. No indices fulfilled preferred features for the DQI development criteria developed by Burggraf et al (2018). Construct validity was assessed by all DQIs, followed by criterion validity (n = 4) and test-retest reliability (n = 2).

CONCLUSION

Limited high-quality validated DQIs for use in pregnant women in high-income countries were identified. Scoring for DQI components were not specific to nutrient requirements for pregnant women. Findings from this review may inform the development of DQIs that evaluate specific dietary requirements and specific food safety considerations applicable to pregnancy.

SYSTEMATIC REVIEW REGISTRATION

https://osf.io/u2hrq.

Microscopic changes and gross morphology of placenta in women affected by gestational diabetes mellitus in dietary treatment: A systematic review

Introduction/objective

Gestational diabetes mellitus (GDM) influences adverse maternal and fetal outcomes. Nutritional therapy and exercise are the first steps to maintain normal glucose levels. During pregnancy, metabolic status influences placental development.

Methods

This systematic review focused only on the morphology of the placenta and its microscopic changes in GMD under dietary therapy. A systematic search was performed on the main databases from inception to September 2024 (PROSPERO ID: CRD42024581621). Only original articles on GDM in diet and exercise treatment that reported at least one outcome of interest (microscopic features and macroscopic morphology of the placenta) were included.

Results

A total of 716 studies were identified, and nine met the inclusion criteria. The analysis confirmed that despite dietary control, some morphological changes in the placenta, including villus immaturity, chorangiosis, and fibrinoid necrosis, occurred at a different rate. In addition, the included studies reported an increase in placental weight in the diet-controlled GDM group.

Conclusion

Therefore, the results of the present qualitative analysis show that pregnant women with diet-controlled GDM, despite adequate glycemic control, abnormal placental development may persist. Our findings remark on the importance of the correct diet-managed GDM pregnancy monitoring due to the placental morphology abnormalities related to GMD.

Reduced-energy diet in women with gestational diabetes: the dietary intervention in gestational diabetes DiGest randomized clinical trial

Reduced-energy diets promote weight loss and improve long-term outcomes in type 2 diabetes but are untested in gestational diabetes. We aimed to identify if weight loss in pregnancy improves perinatal outcomes in gestational diabetes. We performed a multicentre parallel, randomized, controlled, double-blind trial of energy restriction in women with singleton pregnancies, gestational diabetes and body mass index ≥25 kg m-2. Participants were randomized to receive a standard-energy control diet (2,000 kcal d-1) or reduced-energy intervention diet (1,200 kcal d-1) from enrollment (29 weeks) until delivery, provided as weekly diet boxes (40% carbohydrate, 35% fat, 25% protein). The randomization was performed in a 1:1 ratio, stratified by center and blinded to the participants and study team. Primary outcomes were maternal weight change from enrollment to 36 weeks and offspring birth weight. In total, 425 participants were randomized to the control (n = 211) or intervention (n = 214). Outcome data were available for 388 of 425 (90.1%) participants at 36 weeks and 382 of 425 (89.8%) at delivery. There was no evidence of a difference in maternal weight change to 36 weeks between groups (intervention effect -0.20 (95% confidence interval -1.01, 0.61); P > 0.1) and offspring standardized birth weight (intervention effect 0.005 (-0.19, 0.20); P > 0.1). A reduced-energy diet was safe in pregnancy. ISRCTN registration no. 65152174 .

Impact of interpregnancy weight change on the risk of gestational diabetes mellitus during a second pregnancy in Chinese population: a retrospective cohort study

OBJECTIVES

This study aimed to investigate the impact of interpregnancy weight changes (IPWC) on the gestational diabetes mellitus (GDM) in the second pregnancy.

DESIGN

A single-centre retrospective cohort study was conducted in China.

SETTING

Data were collected in Peking University Shenzhen Hospital from 2013 January to 2021 February.

PARTICIPANTS

Participants include women who had two consecutive singleton deliveries after 28 gestational weeks (n=2372).

OUTCOMES

The GDM in the second pregnancy (s-GDM) was set as the outcome.

METHODS

IPWC was defined as the change in body mass index between the first trimester of the second pregnancy and that of the first pregnancy, categorised into four groups with -1 kg/m² to <1 kg/m² as the reference. Adjusted ORs (aORs) with 95% CIs attained from multivariable logistic regression were used to assess the association between IPWC and s-GDM, in both total subjects and stratified subgroups.

RESULTS

In the overall analysis, s-GDM was found to be significantly associated with IPWC value (aOR 1.111; 95% CI 1.038 to 1.190) and an IPWC category of ≥3 kg/m² (aOR 1.821; 95% CI 1.197 to 2.772). In the stratified analysis, the significant association between IPWC ≥3 kg/m² and s-GDM was evident only in the subgroups of an interpregnancy interval (IPI) of less than 36 months (aOR 2.210, 95% CI 1.251 to 3.904), under the age of 35 (aOR 1.854, 95% CI 1.204 to 2.857), non-diabetic status in the first pregnancy (f-ND) (aOR 1.872, 95% CI 1.143 to 3.065) and those with normal weight in the first pregnancy (aOR 1.936, 95% CI 1.174 to 3.193). The significant association between IPWC value and s-GDM was also shown only in these subgroups (p<0.05). In f-DN subgroup, even an IPWC category of 1 kg/m² to <3 kg/m² was significantly associated with s-GDM (aOR 1.486, 95% CI 1.044 to 2.117). IPWC < -1 kg/m² was not significantly associated with s-GDM either in the overall analysis or in the stratified analysis (p>0.05).

CONCLUSION

An IPWC of 3 kg/m² or higher may increase the risk of s-GDM, particularly among women with an IPI of less than 36 months, those under 35 years old, individuals without diabetes, or those with normal weight during their first pregnancy. The potential influence of prior GDM on the relationship between IPWC and s-GDM warrants further investigation.

Medical nutrition therapy in physiological pregnancy and in pregnancy complicated by obesity and/or diabetes: SID-AMD recommendations

Proper nutrition is essential during pregnancy to ensure an adequate supply of nutrients to the foetus and adequate maternal weight gain. In pregnancy complicated by diabetes (both gestational and pre-gestational), diet in terms of both the intake and quality of carbohydrates is an essential factor in glycaemic control. Maternal BMI at conception defines the correct weight increase during gestation in order to reduce maternal-foetal complications related to hypo- or hyper-nutrition. The recommendations presented here, which are based on national and international guidelines and the most recently published data on nutrition in physiological pregnancy and pregnancy complicated by hyperglycaemia and/or obesity, are designed to help healthcare professionals prescribe suitable eating patterns to safeguard the health of the mother and the foetus.

Associations Between Carbohydrate Intake Behaviours and Glycaemia in Gestational Diabetes: A Prospective Observational Study

Carbohydrate intake (CI) has the largest impact on the short-term glycaemia of all nutrients, yet optimal CI management in gestational diabetes remains unclear.

OBJECTIVE

To examine CI behaviours in individuals with recently diagnosed gestational diabetes and their association with self-monitored blood glucose.

METHODS

Data from 97 individuals were collected using food and blood glucose diaries. CI (including amounts, types, and timing) was manually assessed using 15 g servings over 5-8 days, while a 3-day computerised analysis examined a broader intake of macro- and micronutrients.

RESULTS

Elevated fasting glycaemia (EFG) was associated with lower total CI (Mdn 10.8 vs. 12.5 servings/day, p = 0.006), missed meals (Mdn 1.4 vs. 0.0/week, p = 0.007), missed snacks (Mdn 10.5 vs. 7.5/week, p = 0.038), low-carbohydrate meals (<30 g; Mdn 4.3 vs. 2.0/week, p = 0.004), and a higher proportion of energy intake from fat (Mdn 35% vs. 33%, p = 0.047), as compared with in-target fasting glycaemia. In contrast, elevated postprandial glycaemia (EPG) was not significantly associated with total CI, low-carbohydrate meals (<30 g), low-carbohydrate snacks (<15 g), or high-carbohydrate loads (>50 g). EPG was instead associated with high-glycaemic index meals (Mdn 1.6 vs. 0.9 lunch meals/week, p = 0.026; Mdn 0.9 vs. 0.0 dinner meals/week, p = 0.023); and a lower intake of energy (Mdn 7650 kJ vs. 9070 kJ/day, p = 0.031), protein (Mdn 91 g vs. 109 g/day, p = 0.015), fat (Mdn 61 g vs. 84 g/day, p = 0.003), and multiple micronutrients (p <0.05), as compared with in-target postprandial glycaemia.

CONCLUSIONS

CI profiles differed for individuals with EFG, as compared with EPG, emphasising the need for dietary guidelines tailored for gestational diabetes subtypes. Further interventional studies are needed to explore these findings, particularly the associations between EFG and low CI behaviours.

Glycemic control in women with GDM: insights from a randomized controlled pilot trial on plant-based Nordic healthy diet versus moderately carbohydrate restricted diet

BACKGROUND

Gestational Diabetes Mellitus (GDM) prevalence is rising worldwide, but optimal dietary strategies remain unclear. The eMOM pilot RCT compared a plant-protein rich Healthy Nordic Diet (HND) and a moderately carbohydrate restricted diet (MCRD) and their potential effects on time in glucose target range (≤ 7.8 mmol/L, %TIR), and on newborn body composition.

METHODS

Forty-two participants were randomized to either HND (n = 20) or MCRD (n = 22) face-to-face nutritional counseling from gestational weeks (GW) 24 + 0-28 + 6 (baseline) until delivery. The HND intervention had no restriction in carbohydrate intake and emphasized plant-based protein sources and Nordic food, while the MCRD had a moderate carbohydrate restriction (~ 40% in proportion to total daily energy consumption, E%). Continuous glucose monitoring was worn for 14 days to assess glucose levels and %TIR. Blood samples for glucose and lipid metabolism and 3-day food diaries were collected at baseline and at GW 34 + 0-35 + 6. Neonatal body composition was measured by air displacement plethysmography. Difference between groups were analysed with t-test and Wilcoxon test.

RESULTS

Thirty-two women completed the study. Both groups maintained the %TIR during majority of the time (98.9 and 99.3% for MCRD and HND respectively, p = 0.921) in GW 34 + 0 - 35 + 6. The mean glucose was lower in the MCRD group compared to the HND group (5.0 SD 1.03 vs. 5.2 SD 0.96 mmol/l, p < 0.001). No differences were observed in glucose variability, lipid metabolism, gestational weight gain, or in the body composition of the newborns. HND had lower diet macronutrient adherence than the MCRD, resulting in similar macronutrient composition in both groups. The mean macronutrient intakes were fat: 40.6 vs. 39.5 E%, carbohydrate: 40.5 vs. 42.4 E%, protein: 18.9 vs. 18.1 E% for the MCRD and HND groups, respectively. The HND decreased intake of meat and increased fish consumption significantly compared to the MCRD.

CONCLUSIONS

Both a moderately restricted carbohydrate diet and a diet focused on plant-based protein effectively maintained a large time within the treatment target range in women with GDM. Further research could explore the impact of protein quantity and sources in maternal diets on glycemic control and newborn outcomes.

TRIAL REGISTRATION

The eMOM pilot trial is registered in Clinicaltrials.gov (21/09/2018, NCT03681054).

Risk-Prioritised Versus Universal Medical Nutrition Therapy for Gestational Diabetes: A Retrospective Observational Study

BACKGROUND

The optimal application of medical nutrition therapy (MNT) in treating gestational diabetes remains uncertain. MNT involves individualised nutrition assessment and counselling, which is labour-intensive and is not the sole type of intervention offered by clinical dietitians.

OBJECTIVE

To determine whether pregnancy outcomes differed for individuals with gestational diabetes who were offered MNT on a risk-prioritised (RP) versus universal basis.

METHODS

Observational data from two cohorts of individuals who were offered MNT only if they met the high-risk criteria following general group-based dietary education (RP1, n = 369; RP2, n = 446) were compared with a baseline cohort who were universally offered at least one MNT consultation (UM, n = 649). The RP1 cohort were seen during community-wide COVID-19 restrictions in 2021, while RP2 were seen after restrictions had lifted in 2022. Furthermore, the RP approach primarily utilised telemedicine, while the UM approach was delivered in person.

RESULTS

MNT consultations halved under the RP approach (59 vs. 119 sessions per 100 diagnoses for RP2 vs. UM) and saved more than 20 h of dietitian time per 100 diagnoses (95 vs. 73 h for RP2 vs. UM). No significant increases were observed (p < 0.05) for any pregnancy outcomes in the RP cohorts compared with the UM cohort, including usage of diabetes medications, maternal weight gain below and above target, early deliveries, induced deliveries, emergency caesarean sections, large- and small-for-gestational-age (SGA) infants, infant macrosomia, neonatal hypoglycaemia and neonatal intensive care admissions. The use of both basal insulin (27% vs. 33%, OR 0.62, 95% CI 0.46 to 0.84) and metformin (6% vs. 10%, OR 0.52, 95% CI 0.31 to 0.88) was lower in the RP1 cohort during pandemic restrictions compared with the UM cohort; however, these differences were not retained in the RP2 cohort. Additionally, there were fewer SGA infants under the RP approach, particularly for the RP2 cohort (6% vs. 11% for RP2 vs. UM, OR 0.55, 95% CI 0.34 to 0.89).

CONCLUSIONS

Risk-prioritised MNT was a more efficient dietetic service approach to gestational diabetes than the universal MNT model, with comparable pregnancy outcomes. Similar approaches may represent a strategic way to address sustainable health service planning amidst the rising global prevalence of this condition. However, further research is needed to investigate consumer perspectives, wider service impacts and post-partum maternal and child health outcomes.

Relationship Between Amino Acid Intake in Maternal Diet and Risk of Gestational Diabetes Mellitus: Results from the BORN 2020 Pregnant Cohort in Northern Greece

Background/Objectives: Maternal amino acid intake and its biological value may influence glucose regulation and insulin sensitivity, impacting the risk of developing gestational diabetes mellitus (GDM). This study aimed to evaluate the association between amino acid intake from maternal diet before and during pregnancy and the risk of GDM. Methods: This study is part of the ongoing BORN2020 epidemiological Greek cohort. A validated semi-quantitative Food Frequency Questionnaire (FFQ) was used. Amino acid intakes were quantified from the FFQ responses. A multinomial logistic regression model, with adjustments made for maternal characteristics, lifestyle habits, and pregnancy-specific factors, was used. Results: A total of 797 pregnant women were recruited, of which 14.7% developed GDM. Higher cysteine intake during pregnancy was associated with an increase in GDM risk (adjusted odds ratio [aOR]: 5.75; 95% confidence interval [CI]: 1.42-23.46), corresponding to a 476% increase in risk. Additionally, higher intakes of aspartic acid (aOR: 1.32; 95% CI: 1.05-1.66), isoleucine (aOR: 1.48; 95% CI: 1.03-2.14), phenylalanine (aOR: 1.6; 95% CI: 1.04-2.45), and threonine (aOR: 1.56; 95% CI: 1.0-2.43) during pregnancy were also associated with increased GDM risk. Furthermore, total essential amino acid (EAA) (aOR: 1.04; 95% CI: 1.0-1.09) and non-essential amino acid (NEAA) (aOR: 1.05; 95% CI: 1.0-1.1) intakes during pregnancy were also linked to an increased risk of GDM. A secondary dose-response analysis affected by timing of assessment revealed that higher intake levels of specific amino acids showed a more pronounced risk. Conclusions: Optimizing the balance of certain amino acids during pregnancy may guide personalized nutritional interventions to mitigate GDM risk.

The effect of high-fibre diets on glycaemic control in women with diabetes in pregnancy: A systematic review and meta-analysis

Dietary fibre improves glycaemic control in type 2 diabetes, but its therapeutic role in women with diabetes in pregnancy is unclear. We assessed the effect of dietary fibre on markers of glycaemic control in women with diabetes in pregnancy.

METHODS

We searched four databases (Cochrane Library, MEDLINE, Embase and Web of Science) to identify RCTs exploring the effect of dietary fibre, high-fibre diets or fibre supplementation on fasting blood glucose (FBG), 2-h postprandial blood glucose (PBG) and requirement for insulin therapy, among other glycaemic makers in pregnant women with diabetes. Data were pooled for each outcome to calculate change from baseline mean (SD) and overall mean difference (MD) between control and intervention groups.

RESULTS

Of 1462 identified studies, data from 20 eligible trials containing 1061 participants were pooled. On meta-analysis, a higher fibre intake was associated with reduced FBG (MD: -0.35 mmol/L, 95% CI: -0.53, -0.18, p < 0.01), PBG (MD: -0.90 mmol/L, 95% CI: -1.39, -0.40, p < 0.01) and requirement for insulin (OR: 0.24, 95% CI: 0.13, 0.46, p < 0.01). There was significant heterogeneity for FBG and PBG (>90%), attributable to differences in Intervention type for PBG (Dietary Approach to Stop Hypertension [DASH] diet, low glycaemic index, supplement; p < 0.01) and study duration (for FBG: p = 0.002; not for PBG). Studies were mostly scored as high risk of bias due to lack of blinding (Cochrane Risk of Bias Tool v.2.0).

CONCLUSION

High-quality dietary intervention studies in pregnancy are lacking. Our results suggest that high-fibre diets improve fasting and postprandial glycaemia and reduce the likelihood of requiring insulin in women with diabetes in pregnancy.

Research Progress of Risk Factors Associated with Gestational Diabetes Mellitus

Gestational Diabetes Mellitus (GDM) is a common endocrine condition associated with adverse pregnancy outcomes. In recent years, a growing number of risk factors associated with gestational diabetes mellitus have been defined. GDM poses a serious threat to maternal health. The etiology is complex and multifactorial and can be divided into inherent and modifiable factors. The inherent factors have been described in other literature, while the modifiable factors are mainly the risk of lifestyle habits. In this study, we performed a narrative review of the progress of risk factors associated with gestational diabetes mellitus.

Nutritional Strategies Prescribed During Pregnancy and Weight Gain in Women with Gestational Diabetes Mellitus: A Systematic Review of Observational Studies

Background/Objectives: This systematic review aims to identify diets related to weight gain in pregnant women diagnosed with gestational diabetes mellitus (GDM). Methods: This study was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, and its protocol was registered on the International Prospective Register of Systematic Reviews (CRD42023432322). The searches used the medical subject headings in the PubMed/MEDLINE, Web of Science, Scopus, and EMBASE databases. Studies were selected, and data were extracted by three researchers. The Newcastle-Ottawa Scale (NOS) and the Joanna Briggs Institute (JBI) tool were used to assess methodological quality. Results: Six articles were included, most of them of the cohort type, with nutritional strategies lasting 2-15 weeks for overweight/obese women, based on the "macronutrient-adjusted diet" and "calorie-adjusted diet". Only one study addressed dietary counseling in weight management, and none considered the dietary pattern. The gestational weight gain was 4.91-13.8 kg, and a lower weight gain was found in all studies that used the "macronutrient-adjusted diet" nutritional strategy. However, it did not meet the gestational weight gain targets. Conclusions: Despite the limited number of studies examining the impact of nutritional strategies on weight gain in women with GDM, some research suggests that diets focused on macronutrient adjustment may lead to less weight gain but are not adequate. Therefore, future studies are needed to evaluate which type of nutritional strategies ensure weight gain control during pregnancy.

Effects of Dietary Approaches and Exercise Interventions on Gestational Diabetes Mellitus: A Systematic Review and Bayesian Network Meta-analysis

Although lifestyle interventions are recommended as the frontline therapeutic strategy for women with gestational diabetes mellitus (GDM), the optimal dietary regimen or form of exercise has yet to be definitively established. We aimed to compare the effectiveness of lifestyle therapies for GDM. Four databases (PubMed, Web of Science, EMBASE, and Cochrane Library) were systematically searched by multiple researchers for randomized controlled trials (RCTs). RCTs comparing lifestyle therapies to treat GDM with control or another treatment were included. Data extraction and synthesis were performed, estimating mean differences (MDs) or relative risk (RR) through pair-wise and network meta-analysis with a randomized or fixed-effects model when appropriate. The primary outcomes were maternal glucose control, birth weight of newborns, macrosomia and preterm birth rate, and rate of need for insulin therapy. In total, 39 trials with information obtained from 2712 women assessed 15 treatments. After sensitivity analysis, we confirmed the dietary approaches to stop hypertension (DASH) diet [MD: -11.52; 95% credible intervals (CrIs): -14.01, -9.07, very low certainty of evidence (CoE)] and low glycemic index (GI) diets (MD: -6.3; 95% CrI: -9.9, -2.7, low CoE) have shown significant advantages in fasting plasma glucose and 2-h postprandial glucose control, respectively. Furthermore, the DASH diet and resistance exercise reduced insulin requirements independently by 71% (95% CrI: 52%, 84%) and 67% (95% CrI: 48%, 85%), respectively. Additionally, both the DASH (MD: -587.6; 95% CrI: -752.12, -421.85, low CoE) and low GI diets (MD: -180.09, 95% CrI: -267.48, -94.65, low CoE) reduced birth weight significantly, with the DASH diet also demonstrating effects in reducing macrosomia by 89% (95% CrI: 53%, 98%) and lowering the cesarean section rate by 46% (95% CI: 27%, 60%). However, exercise did not affect infant outcomes. Our findings suggest that the DASH diet and low GI diet and resistance exercise may be beneficial for maternal outcomes in pregnancies with GDM. The impact on infants is primarily observed through dietary interventions. Future research, characterized by higher quality and evidence grades, is necessary to complement and substantiate our findings. This study was registered with PROSPERO as CRD 42024527587.

A prospective observational study on maternal diet pre- and post-GDM diagnosis and pregnancy outcomes in individuals with/without GDM

AIMS

To investigate (1) the association between maternal dietary choices during the first and second trimesters and the diagnosis of gestational diabetes mellitus (GDM), (2) the association between a GDM diagnosis and dietary choices during pregnancy, and (3) the differences in pregnancy outcomes between individuals with and without GDM.

METHODS

A prospective cohort study. Pregnant individuals with singleton pregnancy aged 19 ∼ 44 years, without severe pregnancy complications were enrolled in the study. Dietary data were collected at three time points during routine antenatal appointments: 8 ∼ 12 weeks gestation(n = 993), 20 ∼ 24 weeks gestation(n = 732), and 32 ∼ 36 weeks gestation(n = 536). GDM diagnosis and pregnancy outcomes were collected during follow-up from the electronic medical record (EMR).

RESULTS

A total of 93 participants (12.9%) were diagnosed with GDM. Livestock and poultry meat intake during the second trimester were associated with an increased risk of developing GDM (aOR 1.371, 95%CI 1.070-1.756, P = 0.013), and a GDM diagnosis may lead to decreased intake of cereals and its products (P = 0.001), potatoes and its products (P < 0.001), and fruit (P = 0.002) and increased intake of fish, shrimp and shellfish (P = 0.001), eggs (P = 0.015), and milk and milk products (P = 0.011) in the third trimester. Individuals with GDM related to lower risk of excessive gestational weight gain (aOR 0.384, 95%CI 0.188-0.646, P = 0.001) but may increase the risk of fetal macrosomia (aOR 3.873, 95%CI 1.364-10.996, P = 0.011).

CONCLUSIONS

Understanding maternal dietary choices around GDM diagnosis is crucial for accurate nutritional assessment and effective education programs. While our findings suggest dietary changes may occur post-diagnosis, further research is needed to confirm these patterns and the potential benefits of early dietary counseling for individuals with GDM.

Gestational Diabetes Mellitus: Unveiling Maternal Health Dynamics from Pregnancy Through Postpartum Perspectives

Gestational Diabetes Mellitus (GDM) is the most frequent pregnancy-related medical issue and presents significant risks to both maternal and foetal health, requiring monitoring and management during pregnancy. The prevalence of GDM has surged globally in recent years, mirroring the rise in diabetes and obesity rates. Estimated to affect from 5% to 25% of pregnancies, GDM impacts approximately 21 million live births annually, according to the International Diabetes Federation (IDF). However, consensus on diagnostic approaches remains elusive, with varying recommendations from international organizations, which makes the comparison between research complicated. Compounding concerns are the short-term and long-term complications stemming from GDM for mothers and offspring. Maternal outcomes include heightened cardiovascular risks and a notable 70% risk of developing Type 2 Diabetes Mellitus (T2DM) within a decade postpartum. Despite this, research into the metabolic profiles associated with a previous GDM predisposing women to T2D remains limited. While genetic biomarkers have been identified, indicating the multifaceted nature of GDM involving hormonal changes, insulin resistance, and impaired insulin secretion, there remains a dearth of exploration into the enduring health implications for both mothers and their children. Furthermore, offspring born to mothers with GDM have been shown to face an increased risk of obesity and metabolic syndrome during childhood and adolescence, with studies indicating a heightened risk ranging from 20% to 50%. This comprehensive review aims to critically assess the current landscape of Gestational Diabetes Mellitus (GDM) research, focusing on its prevalence, diagnostic challenges, and health impacts on mothers and offspring. By examining state-of-the-art knowledge and identifying key knowledge gaps in the scientific literature, this review aims to highlight the multifaceted factors that have hindered a deeper understanding of GDM and its long-term consequences. Ultimately, this scholarly exploration seeks to promote further investigation into this critical area, improving health outcomes for mothers and their children.

Dietary Regulation of Lipid Metabolism in Gestational Diabetes Mellitus: Implications for Fetal Macrosomia

The primary therapeutic approach for managing hyperglycemia today is diet therapy. Lipids are not only a source of nutrients but also play a role in initiating adipocyte differentiation in the fetus, which may explain the development of fetal macrosomia and future metabolic disorders in children born to mothers with gestational diabetes mellitus (GDM). Alterations in the maternal blood lipid profile, influenced by adherence to a healthy diet in mothers with GDM and the occurrence of fetal macrosomia, represent a complex and not fully understood process. The aim of this study was to examine the characteristics of the blood plasma lipid profile in pregnant women with GDM across all trimesters based on adherence to diet therapy. The clinical part of the study followed a case-control design, including 110 women: 80 in the control group, 20 in a GDM group adhering to the diet, and 10 in a GDM group not adhering to the diet. The laboratory part was conducted as a longitudinal dynamic study, with venous blood samples collected at three time points: 11-13, 24-26, and 30-32 weeks of pregnancy. A significant impact of diet therapy on the composition of blood lipids throughout pregnancy was demonstrated, starting as early as the first trimester. ROC analysis indicated high effectiveness of the models developed, with an AUC of 0.98 for the 30- to 32-week model and sensitivity and specificity values of 1 and 0.9, respectively. An association was found between dietary habits, maternal blood lipid composition at 32 weeks, and newborn weight. The changes in lipid profiles during macrosomia development and under diet therapy were found to be diametrically opposed, confirming at the molecular level that diet therapy can normalize not only carbohydrate metabolism but also lipid metabolism in both the mother and fetus. Based on the data obtained, it is suggested that after further validation, the developed models could be used to improve the prognosis of macrosomia by analyzing blood plasma lipid profiles at various stages of pregnancy.

The effectiveness of personalised food choice advice tailored to an individual's socio-demographic, cognitive characteristics, and sensory preferences

Personalised dietary advice has become increasingly popular, currently however most approaches are based on an individual's genetic and phenotypic profile whilst largely ignoring other determinants such as socio economic and cognitive variables. This paper provides novel insights by testing the effectiveness of personalised healthy eating advice concurrently tailored to an individual's socio-demographic group, cognitive characteristics, and sensory preferences. We first used existing data to build a synthetic dataset based on information from 3654 households (Study 1a), and then developed a cluster model to identify individuals characterised by similar socio-demographic, cognitive, and sensory aspects (Study 1b). Finally, in Study 2 we used the characteristics of 8 clusters to build 8 separate personalised food choice advice and assess their ability to motivate the increased consumption of fruit and vegetables and decreased intakes of saturated fat and sugar. We presented 218 participants with either generic UK Government "EatWell" advice, advice that was tailored to their allocated cluster (matched personalised), or advice tailored to a different cluster (unmatched personalised). Results showed that, when compared to generic advice, participants that received matched personalised advice were significantly more likely to indicate they would change their diet. Participants were similarly motivated to increase vegetable consumption and decrease saturated fat intake when they received unmatched personalised advice, potentially highlighting the power of providing alternative food choices. Overall, this study demonstrated that the power of personalizing food choice advice, based on a combination of individual characteristics, can be more effective than current approaches in motivating dietary change. Our study also emphasizes the viability of addressing population health through automatically delivered web-based personalised advice.

Gestational diabetes mellitus - Neonatal and maternal outcomes in women treated with insulin or diet: A propensity matched analysis

AIMS

Pregnant women worldwide face the risk of developing gestational diabetes mellitus (GDM), if left untreated, can cause complications. The study explores factors influencing the choice between diet control and insulin therapy for pregnant women with GDM. It aims to understand how these choices impact maternal and neonatal outcomes.

METHODS

In this quasi-experimental study, clinicians determined treatment (diet control or insulin) for 1030 individuals with GDM at a private practice from 2010 to 2020 based on baseline characteristics. Propensity scores (PS), reflecting the probability of treatment allocation, were derived through multiple logistic regression.

RESULTS

After PS matching, 386 individuals were paired from two study groups. The insulin-treated group exhibited a 4.43 times higher risk of neonatal hypoglycemia than the diet group. Insulin-treated individuals, stratified by PS, revealed that the high-risk quartile had significantly higher mean insulin requirements and a doubled dose at full term compared to the lower-risk quartiles. The mean insulin dose did not significantly differ in the first three quartiles, but the last quartile showed a significant increase (p = 0.008), particularly for individuals with PS exceeding 0.70, indicating a higher insulin dose requirement for effective glucose control.

CONCLUSION

This study reveals that individuals with a bad obstetrics history, a family history of diabetes, obesity, and elevated baseline glycemic parameters necessitate higher insulin doses. This insight improves clinicians' decision-making in diagnosis and treatment planning, enhancing the precision of medical practices.

A randomized feasibility trial of time-restricted eating during pregnancy in people with increased risk of gestational diabetes

Time-restricted eating (TRE) is a nutritional intervention that confines the daily time-window for energy intake. TRE reduces fasting glucose concentrations in non-pregnant individuals, but whether this eating protocol is feasible and effective for glycemic control in pregnancy is unknown. The aim of this randomized controlled trial was to investigate the adherence to and effect of a 5-week TRE intervention (maximum 10 h daily eating window) among pregnant individuals at risk of gestational diabetes mellitus (GDM), compared with a usual-care control group. Participants underwent 2-h oral glucose tolerance tests and estimation of body composition, before and after the intervention. Interstitial glucose levels were continuously measured, and adherence rates and ratings of hunger were recorded daily. Thirty of 32 participants completed the trial. Participants allocated to TRE reduced their daily eating window from 12.3 (SD 1.3) to 9.9 (SD 1.0) h, but TRE did not affect glycemic measures, blood pressure, or body composition, compared with the control group. TRE increased hunger levels in the evening, but not in the morning, and induced only small changes in dietary intake. Adhering to a 5-week TRE intervention was feasible for pregnant individuals with increased risk of GDM but had no effect on cardiometabolic outcomes.

Maternal Dietary Strategies for Improving Offspring Cardiovascular-Kidney-Metabolic Health: A Scoping Review

Dietary regulation has been recognized for its profound impact on human health. The convergence of cardiovascular, kidney, and metabolic disorders at the pathophysiological level has given rise to cardiovascular-kidney-metabolic (CKM) syndrome, which constitutes a significant global health burden. Maternal dietary nutrients play a crucial role in fetal development, influencing various programmed processes. This review emphasizes the effects of different types of dietary interventions on each component of CKM syndrome in both preclinical and clinical settings. We also provide an overview of potential maternal dietary strategies, including amino acid supplementation, lipid-associated diets, micronutrients, gut microbiota-targeted diets, and plant polyphenols, aimed at preventing CKM syndrome in offspring. Additionally, we discuss the mechanisms mediated by nutrient-sensing signals that contribute to CKM programming. Altogether, we underscore the interaction between maternal dietary interventions and the risk of CKM syndrome in offspring, emphasizing the need for continued research to facilitate their clinical translation.

Intuitive eating was associated with anxiety, depression, pregnancy weight and blood glucose in women with gestational diabetes mellitus: a prospective longitudinal study

Background

Outside of pregnancy, intuitive eating (IE) is associated with lower body weight, blood glucose, and higher positive mood. However, little was known about the relationship between IE and anxiety-depression in the GDM population. Thus, this study aimed to investigate the association of IE with anxiety and depression, pregnancy weight and pregnancy blood glucose in the first and second GDM visit.

Methods

Data from 310 pregnant women with GDM from the Fujian Maternal and Child Health Hospital Trial (Approval Number: 2020Y9133) were analyzed. IE was assessed using the Intuitive Eating Scale-2 subscales of Eating for Physiological Reasons rather than Emotional Reasons (EPR), Relying on Hunger and Satiety Cues (RHSC) and Body-Food Choice Consistency (B-FCC). Observations included weight, body mass index (BMI), fasting plasma glucose (FPG) and 2-h postprandial blood glucose; the Hospital Anxiety and Depression Scale (HADS) was used to assess the level of anxiety and depression in pregnant women with GDM. Linear regression analysis was used to assess the correlation between IE and anxiety, depression, pregnancy blood glucose and weight.

Results

The cross-sectional analysis showed that the EPR eating behavior was negatively correlated with anxiety and depression, and the B-FCC eating behavior was negatively correlated with depression at both the first and second GDM visit; in addition, the B-FCC eating behavior was associated with lower BMI in the third trimester (all p < 0.05). In longitudinal analyses, the EPR eating behavior in the first visit for GDM predicted lower levels of anxiety and depression in the second GDM visit, whereas the RHSC eating behavior in the first visit for GDM was associated with lower FPG in the second GDM visit (all p < 0.01).

Conclusion

These results suggest that practicing intuitive eating may be beneficial and that higher intuitive eating adherence can lead to lower levels of anxiety and depression and more ideal gestational weight and blood glucose values.

Epidemiology and management of gestational diabetes

Gestational diabetes is defined as hyperglycaemia first detected during pregnancy at glucose concentrations that are less than those of overt diabetes. Around 14% of pregnancies globally are affected by gestational diabetes; its prevalence varies with differences in risk factors and approaches to screening and diagnosis; and it is increasing in parallel with obesity and type 2 diabetes. Gestational diabetes direct costs are US$1·6 billion in the USA alone, largely due to complications including hypertensive disorders, preterm delivery, and neonatal metabolic and respiratory consequences. Between 30% and 70% of gestational diabetes is diagnosed in early pregnancy (ie, early gestational diabetes defined by hyperglycaemia before 20 weeks of gestation). Early gestational diabetes is associated with worse pregnancy outcomes compared with women diagnosed with late gestational diabetes (hyperglycaemia from 24 weeks to 28 weeks of gestation). Randomised controlled trials show benefits of treating gestational diabetes from 24 weeks to 28 weeks of gestation. The WHO 2013 recommendations for diagnosing gestational diabetes (one-step 75 gm 2-h oral glucose tolerance test at 24-28 weeks of gestation) are largely based on the Hyperglycemia and Adverse Pregnancy Outcomes Study, which confirmed the linear association between pregnancy complications and late-pregnancy maternal glycaemia: a phenomenon that has now also been shown in early pregnancy. Recently, the Treatment of Booking Gestational Diabetes Mellitus (TOBOGM) trial showed benefit in diagnosis and treatment of early gestational diabetes for women with risk factors. Given the diabesity epidemic, evidence for gestational diabetes heterogeneity by timing and subtype, and advances in technology, a life course precision medicine approach is urgently needed, using evidence-based prevention, diagnostic, and treatment strategies.

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.

Dietary Intakes of Women with Gestational Diabetes Mellitus and Pregnancy Outcomes: A Prospective Observational Study

Purpose

Nutrient intake for pregnant women with gestational diabetes mellitus (GDM) is important to ensure satisfactory birth outcomes. This study aims to explore the dietary profiles of patients with GDM, compare the results with the Chinese dietary guidelines or Dietary Reference Intakes (DRIs) from China and investigate the relationship between maternal dietary intake and pregnancy outcomes.

Patients and Methods

A total of 221 patients with GDM in the second trimester were included in the cohort. Dietary intake data were collected using a 24-hour recall method for three consecutive days. The pregnancy outcomes of these participants were subsequently monitored. Both univariate logistic regression and multivariate logistic regression analyses were conducted to explore the associations between dietary intake variables or general characteristics variables and adverse pregnancy outcomes.

Results

Participants with adverse pregnancy outcomes showed a lower intake of iodine and vitamin D, a lower percentage of dietary energy intake from carbohydrates and a higher percentage of dietary energy intake from fats, compared to participants without adverse pregnancy outcomes. The gestational weight gain and family history of diabetes were associated with an increased risk of adverse pregnancy outcomes. Conversely, regular exercise, the intake of iodine and Vitamin D, and the percentage of dietary energy intake from carbohydrates were associated with a decreased risk.

Conclusion

The daily diet of pregnant women with GDM in China did not meet the dietary guidelines or DRIs. The low intake of Vitamin D and iodine, the low dietary carbohydrate ratio, family history of diabetes, lack of exercise, and high gestational weight gain were associated with increased risk of adverse pregnancy outcomes in pregnant women with GDM.

Gestational Diabetes Mellitus: What Can Medical Nutrition Therapy Do?

Gestational diabetes mellitus (GDM) is one of the common complications during pregnancy. Numerous studies have shown that GDM is associated with a series of adverse effects on both mothers and offspring. Due to the particularity of pregnancy, medical nutrition treatment is considered to be the first choice for the treatment of GDM. This contribution reviews the research progress of medical nutrition treatment in GDM, summarizes the international recommendations on the intake of various nutrients and the influence of nutrients on the prevalence of GDM, and the improvement effect of nutritional intervention on it, in order to provide references for research in related fields of GDM and the targeted development of enteral nutrition.

Effects of maternal mild hyperglycemia associated with snack intake on offspring metabolism and behavior across the lifespan

The increasing prevalence of diabetes is of particular concern in women of childbearing age because of the short and long-term consequences of maternal diabetes for the health of the offspring, such as a greater risk of developing metabolic impairments and cognitive deficits. In addition, maternal diet during pregnancy and lactation might contribute to preventing or ameliorating adverse offspring outcomes. Recently, we described that access to snacks exacerbates glucose intolerance in mildly hyperglycemic pregnant dams. Therefore, we hypothesized that these offspring would show greater impairment in metabolic and behavioral outcomes across the lifespan. Neonatal STZ treatment was employed to induce maternal mild hyperglycemia in females. After mating, normo- and hyperglycemic dams were given access either to standard chow or standard show plus snacks. Male and female offspring were evaluated on postnatal days (PND) 30, 90, and 360. Offspring behavior was assessed in the marble burying task, the open-field test, the elevated-plus maze, and sucrose preference. Glucose tolerance and morphometric analyses were also carried out. Maternal hyperglycemia increased body weight and fat deposition only on PND 30, while retroperitoneal fat deposition was reduced in the offspring of snack-fed dams. However, maternal snack intake reduced offspring body weight and length on PND 90. Fasting glucose was increased in females born to hyperglycemic, snack-fed dams on PND 90. Glucose clearance was altered by both maternal conditions in male offspring on PND 30, however, this sex difference was reversed on PND 90, with maternal hyperglycemia impairing glucose clearance only in females. In addition, maternal hyperglycemia reduced anxiety-like behavior in female offspring on PND 30, especially in the offspring of snack-fed dams, while maternal snack intake reduced sucrose preference in both males and females in adulthood. These results suggest that the effects of maternal hyperglycemia during pregnancy and lactation on offspring outcomes were not exacerbated by snack intake. Although additive effects of the two maternal conditions were hypothesized, the absence of such effects could be related to the mild maternal hyperglycemia induced by STZ treatment even when combined with snack intake. While maternal hyperglycemia alone impaired some offspring outcomes, its association with snack intake did not aggravate those impairments but rather resulted in outcomes more similar to those of offspring born to normoglycemic dams. Finally, females were found to be more susceptible to both the effects of maternal hyperglycemia and snack intake on metabolism and behavior.

Subsidized gestational diabetes mellitus screening and management program in rural China: a pragmatic multicenter, randomized controlled trial

BACKGROUND

The increasing prevalence of gestational diabetes mellitus (GDM) is a major challenge, particularly in rural areas of China where control rates are suboptimal. This study aimed to evaluate the effectiveness of a GDM subsidy program in promoting GDM screening and management in these underserved regions.

METHODS

This multicenter, randomized controlled trial (RCT) was conducted in obstetric clinics of six rural hospitals located in three provinces in China. Eligible participants were pregnant women in 24-28 weeks' gestation, without overt diabetes, with a singleton pregnancy, access to a telephone, and provided informed consent. Participants were randomly assigned in a 1:1 ratio to either the intervention or control groups using an internet-based, computer-generated randomization system. The intervention group received subsidized care for GDM, which included screening, blood glucose retesting, and lifestyle management, with financial assistance provided to health care providers. In contrast, the control group received usual care. The primary outcomes of this study were the combined maternal and neonatal complications associated with GDM, as defined by the occurrence of at least one pre-defined complication in either the mother or newborn. The secondary outcomes included the GDM screening rate, rates of glucose retesting for pregnant women diagnosed with GDM, dietary patterns, physical activity levels, gestational weight gain, and antenatal visit frequency for exploratory purposes. Primary and secondary outcomes were obtained for all participants with and without GDM. Binary outcomes were analyzed by the generalized linear model with a link of logistic, and odds ratios (OR) with 95% confidence intervals (CIs) were reported. Count outcomes were analyzed by Poisson regression, and incidence rate ratios with 95% CIs were reported.

RESULTS

A total of 3294 pregnant women were randomly assigned to either the intervention group (n = 1649) or the control group (n = 1645) between 15 September 2018 and 30 September 2019. The proportion of pregnant women in the intervention group who suffered from combined maternal and/or neonatal complications was lower than in the control group with adjusted OR = 0.86 (0.80 to 0.94, P = 0.001), and a more significant difference was observed in the GDM subgroup (adjusted OR = 0.66, 95% CI 0.47 to 0.95, P = 0.025). No predefined safety or adverse events of ketosis or ketoacidosis associated with GDM management were detected in this study. Both the intervention and control groups had high GDM screening rates (intervention: 97.2% [1602/1649]; control: 94.5% [1555/1645], P < 0.001). Moreover, The intervention group showed a healthier lifestyle, with lower energy intake and more walking minutes (P values < 0.05), and more frequent blood glucose testing (1.5 vs. 0.4 visits; P = 0.001) compared to the control group.

CONCLUSION

In rural China, a GDM care program that provided incentives for both pregnant women and healthcare providers resulted in improved maternal and neonatal health outcomes. Public health subsidy programs in China should consider incorporating GDM screening and management to further enhance reproductive health.

TRIAL REGISTRATION

China Clinical Trials Registry ChiCTR1800017488. https://www.chictr.org.cn/.

Dietary intervention in gestational diabetes: a qualitative study of the acceptability and feasibility of a novel whole-diet intervention in healthcare professionals

Gestational diabetes is treated with medical nutrition therapy, delivered by healthcare professionals; however, the optimal diet for affected women is unknown. Randomised controlled trials, such as the DiGest (Dietary Intervention in Gestational Diabetes) trial, will address this knowledge gap, but the acceptability of whole-diet interventions in pregnancy is unclear. Whole-diet approaches reduce bias but require high levels of participant commitment and long intervention periods to generate meaningful clinical outcomes. We aimed to assess healthcare professionals' views on the acceptability of the DiGest dietbox intervention for women with gestational diabetes and to identify any barriers to adherence which could be addressed to support good recruitment and retention to the DiGest trial. Female healthcare professionals (n 16) were randomly allocated to receive a DiGest dietbox containing 1200 or 2000 kcal/d including at least one weeks' food. A semi-structured interview was conducted to explore participants' experience of the intervention. Interviews were audio-recorded, transcribed verbatim and analysed thematically using NVivo software. Based on the findings of qualitative interviews, modifications were made to the dietboxes. Participants found the dietboxes convenient and enjoyed the variety and taste of the meals. Factors which facilitated adherence included participants having a good understanding of study aims and sufficient organisational skills to facilitate weekly meal planning in advance. Barriers to adherence included peer pressure during social occasions and feelings of deprivation or hunger (affecting both standard and reduced calorie groups). Healthcare professionals considered random allocation to a whole-diet replacement intervention to be acceptable and feasible in a clinical environment and offered benefits to participants including convenience.

Analysis of risk factors and construction of a predictive model for macrosomia in deliveries with gestational diabetes

BACKGROUND

Gestational diabetes, a frequent pregnancy complication marked by elevated maternal blood glucose, can cause serious adverse effects for both mother and fetus, including increased amniotic fluid and risks of fetal asphyxia, hypoxia, and premature birth.

OBJECTIVE

To construct a predictive model to analyze the risk factors for macrosomia in deliveries with gestational diabetes.

METHODS

From January 2021 to February 2023, 362 pregnant women with gestational diabetes were selected for the study. They were followed up until delivery. Based on newborn birth weight, the participants were divided into the macrosomia group (birth weight ⩾ 4000 g) and the non-macrosomia group (birth weight < 4000 g). The data of the two groups of pregnant women were compared. ROC curves were plotted to analyze the predictive value of multiple factors for the delivery of macrosomic infants among pregnant women with gestational diabetes. A logistic regression model was constructed to identify the risk factors for delivering macrosomic infants and the model was tested.

RESULTS

A total of 362 pregnant women with gestational diabetes were included, of which 58 (16.02%) had babies with macrosomia. The macrosomia group exhibited higher metrics in several areas compared to those without: pre-pregnancy BMI, fasting glucose, 1 h and 2 h OGTT sugar levels, weight gain during pregnancy, and levels of triglycerides, LDL-C, and HDL-C, all with significant differences (P< 0.05). ROC analysis revealed predictive value for macrosomia with AUCs of 0.761 (pre-pregnancy BMI), 0.710 (fasting glucose), 0.671 (1 h OGTT), 0.634 (2 h OGTT), 0.850 (weight gain), 0.837 (triglycerides), 0.742 (LDL-C), and 0.776 (HDL-C), indicating statistical significance (P< 0.05). Logistic regression identified high pre-pregnancy BMI, fasting glucose, weight gain, triglycerides, and LDL-C levels as independent risk factors for macrosomia, with odds ratios of 2.448, 2.730, 1.884, 16.919, and 5.667, respectively, and all were statistically significant (P< 0.05). The model's AUC of 0.980 (P< 0.05) attests to its reliability and stability.

CONCLUSION

The delivery of macrosomic infants in gestational diabetes may be related to factors such as body mass index before pregnancy, blood-glucose levels, gain weight during pregnancy, and lipid levels. Clinical interventions targeting these factors should be implemented to reduce the incidence of macrosomia.

Role of dietary food intake patterns, anthropometric measures, and multiple biochemical markers in the development of pregnancy-specific urinary incontinence in gestational diabetes mellitus

OBJECTIVES

The aim of this study was to assess maternal dietary food intake patterns, anthropometric measures, and multiple biochemical markers in women with gestational diabetes mellitus and pregnancy-specific urinary incontinence and to explore whether antedating gestational diabetes mellitus environment affects the pregnancy-specific urinary incontinence development in a cohort of pregnant women with gestational diabetes mellitus and pregnancy-specific urinary incontinence.

METHODS

Maternal dietary information and anthropometric measurements were collected. At 24 wk of gestation, with a fasting venipuncture sample, current blood samples for biochemical markers of hormones, vitamins, and minerals were analyzed. The groups were compared in terms of numerical variables using analysis of variance for independent samples followed by multiple comparisons.

RESULTS

Of the 900 pregnant women with complete data, pregnant women in the gestational diabetes mellitus pregnancy-specific urinary incontinence group had higher body mass index during pregnancy, arm circumference, and triceps skinfold than the non-gestational diabetes mellitus continent and non-gestational diabetes mellitus pregnancy-specific urinary incontinence groups, characterizing an obesogenic maternal environment. Regarding dietary food intake, significant increases in aromatic amino acids, branched-chain amino acids, dietary fiber, magnesium, zinc, and water were observed in pregnancy-specific urinary incontinence group compared with the non-gestational diabetes mellitus continent group. Serum vitamin C was reduced in the gestational diabetes mellitus pregnancy-specific urinary incontinence group compared with the non-gestational diabetes mellitus pregnancy-specific urinary incontinence group.

CONCLUSIONS

This study emphasizes the necessity for a comprehensive strategy for gestational diabetes mellitus women with pregnancy-specific urinary incontinence in terms of deviation in maternal adaptation trending toward obesity and maternal micronutrients deficiencies.

Advancements in Nutritional Strategies for Gestational Diabetes Management: A Systematic Review of Recent Evidence

Gestational diabetes mellitus (GDM) is defined as hyperglycaemia first detected at any time during pregnancy with values lower than those determined by the WHO for diabetes diagnosis in adults. This pathology, with a worldwide prevalence of 13.4%, causes significant maternal and foetal risks. The first line of treatment consists of maintaining normo-glycaemia through an adequate diet and lifestyle changes. The aim is to synthesize the scientific evidence updating the nutritional recommendations for the effective management of GDM. A systematic review of the scientific literature was conducted following the PRISMA guidelines. Randomized clinical trials published within the last five years and providing information on nutritional recommendations to achieve an effective management of gestational diabetes were selected. The databases searched were PubMed, the WOS Core Collection, SCOPUS, and CINAHL, using the MeSH terms: "Diabetes, Gestational"; "Nutrition Assessment (nutrition*)"; "Diet"; "Eating"; and "Food"; with the Boolean operators "AND" and "OR". The PEDro scale (Physiotherapy Evidence Database) was used to assess the scientific quality of the studies, with a mean score of 8.9, indicating an average good scientific quality. Results: A total of 809 papers were collected, of which, after applying the inclusion and exclusion criteria, 14 randomized clinical trials were selected. Probiotic supplementation and co-supplementation with vitamin D have been found to be the most beneficial options for both mothers with GDM and neonates, but the most effective regimens are not known. Diets enriched with extra virgin olive oil (EVOO) and oat bran, as well as some recommendations focused on carbohydrates also seem effective, as well as diets designed for this group of women with GDM such as "CHOICE". Conclusions: Although there are numerous proposals that have been published in recent years focused on the diet of women with GDM in order to improve their results and those of their children, it is the supplementation with probiotics and the co-supplementation with vitamin D that is most agreed upon as beneficial; however, more research is needed into which protocols are most effective. Other proposals that could also be beneficial should be further studied.

Dietary Strategies to Reduce Triglycerides in Women of Reproductive Age: A Simulation Modelling Study

Many women of reproductive age have poor diet quality and are at higher risk of chronic diseases such as diabetes. Triglycerides are a critical risk factor for chronic diseases, and although they can be influenced by diet, there are minimal dietary intervention studies identifying key foods/food groups that reduce triglycerides. We performed data simulation modelling to estimate the potential reductions in fasting triglycerides that could be achieved by different dietary strategies in reproductive age women. The model was created using data from the 2011-2013 Australian Health Survey and incorporated various factors such as demographics, nutrient intake, and plasma biomarkers. Multiple linear regression analysis was conducted to estimate triglyceride levels, considering nutrient intake and pre-determined covariates. Dietary scenarios were developed, reducing the consumption of processed/ultra-processed foods, while increasing the intake of minimally processed foods like fruits, vegetables, fish, and nuts. A total of 606 women were included. Reducing processed foods by 50% plus increasing intakes of fruits (75-225 g/day), vegetables (75-225 g/day), or nuts (10-40 g/day) decreased triglycerides by up to 4.3%. Additionally, incorporating 80 g/day of omega 3 fish (>800 mg long-chain omega 3/100 g) decreased triglycerides by 8.2%. The clinical relevance of lowering triglycerides for cardiometabolic disease management should be tested in dietary intervention studies in women.

Various screening and diagnosis approaches for gestational diabetes mellitus and adverse pregnancy outcomes: a secondary analysis of a randomized non-inferiority field trial

INTRODUCTION

We evaluate which screening and diagnostic approach resulted in the greatest reduction in adverse pregnancy outcomes due to increased treatment.

RESEARCH DESIGN AND METHODS

This study presents a secondary analysis of a randomized community non-inferiority trial conducted among pregnant women participating in the GULF Study in Iran. A total of 35 430 pregnant women were randomly assigned to one of the five prespecified gestational diabetes mellitus (GDM) screening protocols. The screening methods included fasting plasma glucose (FPG) in the first trimester and either a one-step or a two-step screening method in the second trimester of pregnancy. According to the results, participants were classified into 6 groups (1) First-trimester FPG: 100-126 mg/dL, GDM diagnosed at first trimester; (2) First trimester FPG: 92-99.9 mg/dL, GDM diagnosed at first trimester; (3) First trimester FPG: 92-99.9 mg/dL, GDM diagnosed at second trimester; (4) First trimester FPG: 92-99.9 mg/dL, healthy at second trimester; (5) First trimester FPG<92 mg/dL, GDM diagnosed at second trimester; (6) First trimester FPG<92 mg/dL, healthy at second trimester. For our analysis, we initially used group 6, as the reference and repeated the analysis using group 2, as the reference group. The main outcome of the study was major adverse maternal and neonatal outcomes.

RESULTS

Macrosomia and primary caesarean section occurred in 9.8% and 21.0% in group 1, 7.8% and 19.8% in group 2, 5.4% and 18.6% in group 3, 6.6% and 21.5% in group 4, 8.3% and 24.0% in group 5, and 5.4% and 20.0% in group 6, respectively. Compared with group 6 as the reference, there was a significant increase in the adjusted risk of neonatal intensive care unit (NICU) admission in groups 1, 3, and 5 and an increased risk of macrosomia in groups 1, 2, and 5. Compared with group 2 as the reference, there was a significant decrease in the adjusted risk of macrosomia in group 3, a decreased risk of NICU admission in group 6, and an increased risk of hyperglycemia in group 3.

CONCLUSIONS

We conclude that screening approaches for GDM reduced the risk of adverse pregnancy outcomes to the same or near the same risk level of healthy pregnant women, except for the risk of NICU admission that increased significantly in groups diagnosed with GDM compared with healthy pregnant women. Individuals with slight increase in FPG (92-100 mg/dL) at first trimester, who were diagnosed as GDM, had an even increased risk of macrosomia in comparison to those group of women with FPG 92-100 mg/dL in the first trimester, who were not diagnosed with GDM, and developed GDM in second trimester TRIAL REGISTRATION: IRCT138707081281N1 (registered: February 15, 2017).

Weight Management during Pregnancy and the Postpartum Period in Women with Gestational Diabetes Mellitus: A Systematic Review and Summary of Current Evidence and Recommendations

BACKGROUND

Weight management during pregnancy and the postpartum period is an important strategy that can be utilized to reduce the risk of short- and long-term complications in women with gestational diabetes mellitus (GDM). We conducted a systematic review to assess and synthesize evidence and recommendations on weight management during pregnancy and the postpartum period in women with GDM to provide evidence-based clinical guidance.

METHODS

Nine databases and eighteen websites were searched for clinical decisions, guidelines, recommended practices, evidence summaries, expert consensus, and systematic reviews.

RESULTS

A total of 12,196 records were retrieved and fifty-five articles were included in the analysis. Sixty-nine pieces of evidence were summarized, sixty-two of which focused on pregnancy, including benefits, target population, weight management goals, principles, weight monitoring, nutrition assessment and counseling, energy intake, carbohydrate intake, protein intake, fat intake, fiber intake, vitamin and mineral intake, water intake, dietary supplements, sugar-sweetened beverages, sweeteners, alcohol, coffee, food safety, meal arrangements, dietary patterns, exercise assessment and counseling, exercise preparation, type of exercise, intensity of exercise, frequency of exercise, duration of exercise, exercise risk prevention, and pregnancy precautions, and seven focused on the postpartum period, including target population, benefits, postpartum weight management goals, postpartum weight monitoring, dietary recommendations, exercise recommendations, and postpartum precautions.

CONCLUSIONS

Healthcare providers can develop comprehensive pregnancy and postpartum weight management programs for women with GDM based on the sixty-nine pieces of evidence. However, because of the paucity of evidence on postpartum weight management in women with GDM, future guidance documents should focus more on postpartum weight management in women with GDM.

Differences in neonatal adverse outcomes among women with gestational diabetes mellitus managed by diet or medication: a propensity score matched analysis of a population-based sample

OBJECTIVE

Neonatal outcomes in women with and without medically managed gestational diabetes mellitus (GDM) were compared after accounting for differences in maternal baseline characteristics using a propensity score (PS) analysis.

METHODS

Women without preexisting diabetes, delivering singletons during 2010-2017 in a large hospital, were eligible for inclusion. Using nearest-neighbour PS matching, women with non-pharmacological managed GDM were matched with women whose GDM was medically managed. A conditional logistic regression consequently compared the neonatal adverse outcomes between the groups after adjusting for gestational age, induction of labor, birth type, and number of ultrasounds conducted during the pregnancy.

RESULTS

Of the overall 10028 births, GDM was diagnosed in 930 (9.3%), of whom 710 (76.3%) were successfully matched. The conditional regressions found higher risk of neonatal adverse outcomes in neonates of women with non-pharmacological managed GDM compared to neonates of women with medically managed GDM. These included a higher risk of hypoglycemia (odds ratio (OR) 1.56, 95% confidence interval (CI) 1.03-2.38, p = 0.037), hypothermia (OR 2.29, 95%CI 1.05-5.00, p = 0.037), and birth injuries (OR 3.50, 95%CI 1.62-7.58, p = 0.001), and a higher risk of being small for gestational age (OR 2.06, 95%CI 1.01-4.18, p = 0.046) and being admitted to a special care unit (OR 2.04, 95%CI 1.29-3.21, p = 0.002).

CONCLUSIONS

The increased neonatal morbidity associated with non-medicated GDM identified in our study may indicate that diet and lifestyle changes alone are not sufficient to achieve glycaemic control in some women with GDM. Our findings indicate that gestational diabetes management approach is independently associated with neonatal outcomes.

Association between eating habits during adolescence and gestational diabetes: data from the Japan environment and children's study

Purpose

It is difficult to change pre-pregnancy eating habits, yet establishing healthy eating habits before pregnancy is important for preventing gestational diabetes mellitus (GDM). This study aimed to examine whether the weight-loss behavior of avoiding between-meal and midnight snacking in teenagers is associated with a reduction in the risk of subsequent GDM.

Methods

We used a dataset (jecs-an-20,180,131) from a nationwide, prospective birth cohort study, the Japan Environment and Children's Study (JECS). We included 89,227 (85.7% of the total) mother-infant pairs with live births. Participants in their second or third trimester were asked to report their weight-loss behavior during their teenage years. The prevalence of GDM was investigated. Differences in maternal characteristics were examined using chi-square tests. Crude and adjusted logistic regression models were constructed to assess the associations of various maternal characteristics with the weight-loss behavior of avoiding between-meal and midnight snacking during teenage years.

Results

A total of 2,066 (2.3%) participants had GDM. Weight-loss behavior in teenagers was associated with a decreased risk of GDM. Among participants with normal weight or overweight prior to pregnancy, the adjusted odds ratios were 0.79 (95% confidence interval, 0.70-0.89) and 0.82 (95% confidence interval, 0.69-0.98), respectively.

Conclusions

The results suggest that teenage weight-loss behaviors, such as avoiding between-meal and midnight snacking, are associated with a decreased risk of developing GDM.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40200-023-01294-2.

Effects of online support and social media communities on gestational diabetes: A systematic review

BACKGROUND

Gestational diabetes mellitus (GDM) is a common complication in pregnancy that can lead to negative maternal and fetal outcomes. Online support interventions have been suggested as a potential tool to improve the management of GDM.

OBJECTIVE

This systematic review aimed to summarize the effectiveness of social media and online support interventions for the management of GDM.

METHODS

We conducted a thorough systematic search across Web of Science, Scopus, and PubMed, following PRISMA guidelines, and supplemented it with a manual search. Our results included both qualitative and quantitative research. We rigorously assessed quantitative studies for bias using ROBINS-I and RoB 2 tools, ensuring the reliability of our findings.

RESULTS

We incorporated a total of 22 studies, which were comprised of ten qualitative and twelve quantitative studies. Online support interventions were found to have a positive impact on promoting self-care and improving healthcare outcomes for women with GDM. Individualized diet and exercise interventions resulted in lower odds of weight gain and GDM diagnosis, while online prenatal education increased breastfeeding rates. In addition, telemedicine options reduced the need for in-person clinical visits and improved patient satisfaction.

CONCLUSIONS

Online support interventions show potential to improve outcomes in patients with GDM in this small literature review. Future research is also necessary to determine the effectiveness of different types of online interventions and identify strategies to improve engagement and the quality of the information provided through online resources.

Effect of individualised nutritional intervention on the postpartum nutritional status of patients with gestational diabetes mellitus and the growth and development of their offspring: a quasi-experimental study

This study explored the effect of individualised nutritional intervention on the postpartum nutritional status of patients with the growth and development of their offspring. This study included pregnant women with gestational diabetes mellitus (GDM) at Hangzhou Women's Hospital in 2019. At 42 days after childbirth, the HbA1c (95% CI: 0.44-0.56%, p < 0.001), the FPG (95% CI: 0.01-0.26 mmol/L, p < 0.05), 2HPG (95% CI: -0.01-0.73 mmol/L, p < 0.05) and TCH (95% CI: -0.34-0.00 mmol/L, p < 0.05) level of the control group were 0.14, 0.36, and 0.17 mmol/L higher than in the intervention group. There were no differences in TG and HGB between the two groups (all p > 0.05). There were significant differences in the number of macrosomia and neonatal weight between the two groups (both p < 0.05). Differences in WHZ after childbirth were not statistically significant between the two groups (all p > 0.05). Individualised nutritional intervention could improve blood glucose levels 42 days after childbirth and reduce macrosomia incidence in pregnant women with GDM.Impact statementWhat is already known on this subject? Individualised nutrition intervention can improve blood glucose status and complications during pregnancy, thus improving pregnancy outcomes.What the results of this study add? Individual nutrition intervention improved the blood glucose and nutritional status of patients at 42 days postpartum, but there was no difference in the growth and development indicators of their offspring at 0-24 months.What the implications are of these findings for clinical practice and/or further research? Improve nutritional intervention programs for gestational diabetes, improve blood glucose during pregnancy and postpartum, to improve pregnancy outcomes and reduce the occurrence of type 2 diabetes and other metabolic diseases; Extend the monitoring range of the growth and development of the offspring of gestational diabetes, find the problems and timely carry out the nutritional intervention, to improve the development of the offspring.

Influence of the DASH Diet on Gestational Weight Gain and Perinatal Outcomes in Women with Pre-Existing Diabetes Mellitus: A Randomized, Single-Blind, Controlled Clinical Trial

BACKGROUND

This study aimed to investigate the influence of the dietary approaches to stop hypertension (DASH) diet on gestational weight gain and perinatal outcomes in pregnant women with pre-existing diabetes mellitus (PDM).

METHODS

A randomized, single-blind, controlled clinical trial was conducted with 68 pregnant women with PDM throughout prenatal care until delivery (18 weeks) at a public maternity hospital in Rio de Janeiro, Brazil (2016-2020). The standard diet adopted by the control group (standard diet group-SDG) contained 45-55% carbohydrates, 15-20% protein, and 25-30% lipids of the total energy intake. An adapted DASH diet, with a similar macronutrient composition, but with higher calcium, potassium, magnesium, fiber, and reduced saturated fat, was prescribed for the intervention group (DASH diet group-DDG). Student's t- or Mann-Whitney U tests were used to compare outcomes between groups. To assess the trajectory of gestational weight gain throughout the intervention between the study groups, linear mixed-effects regression models were used.

RESULTS

The DDG had lower gestational weight gain at the fifth (p = 0.03) and seventh appointment (p = 0.04), with no difference in average total gestational weight gain (SDG: 10 kg [SD = 4]; DDG: 9 kg [SD = 5], p = 0.23). There was a trend for a lower length of stay of the newborns (p = 0.08) in the DDG without differences for other perinatal outcomes.

CONCLUSIONS

The DASH diet promoted less variation in gestational weight gain without promoting a difference in total gestational weight gain, and there was no difference between the study groups for perinatal outcomes.

Nutrients as Risk Factors and Treatments for Gestational Diabetes

Gestational diabetes (GDM), traditionally defined as any form of glucose intolerance first detected in pregnancy [...].

Predicting primary cesarean delivery in pregnancies complicated by gestational diabetes mellitus

BACKGROUND

Prediction models have shown promise in helping clinicians and patients engage in shared decision-making by providing quantitative estimates of individual risk of important clinical outcomes. Gestational diabetes mellitus is a common complication of pregnancy, which places patients at higher risk of primary CD. Suspected fetal macrosomia diagnosed on prenatal ultrasound is a well-known risk factor for primary CD in patients with gestational diabetes mellitus, but tools incorporating multiple risk factors to provide more accurate CD risk are lacking. Such tools could help facilitate shared decision-making and risk reduction by identifying patients with both high and low chances of intrapartum primary CD.

OBJECTIVE

This study aimed to develop and internally validate a multivariable model to estimate the risk of intrapartum primary CD in pregnancies complicated by gestational diabetes mellitus undergoing a trial of labor.

STUDY DESIGN

This study identified a cohort of patients with gestational diabetes mellitus derived from a large, National Institutes of Health-funded medical record abstraction study who delivered singleton live-born infants at ≥34 weeks of gestation at a large tertiary care center between January 2002 and March 2013. The exclusion criteria included previous CD, contraindications to vaginal delivery, scheduled primary CD, and known fetal anomalies. Candidate predictors were clinical variables routinely available to a practitioner in the third trimester of pregnancy found to be associated with an increased risk of CD in gestational diabetes mellitus. Stepwise backward elimination was used to build the logistic regression model. The Hosmer-Lemeshow test was used to demonstrate goodness of fit. Model discrimination was evaluated via the concordance index and displayed as the area under the receiver operating characteristic curve. Internal model validation was performed with bootstrapping of the original dataset. Random resampling with replacement was performed for 1000 replications to assess predictive ability. An additional analysis was performed in which the population was stratified by parity to evaluate the model's predictive ability among nulliparous and multiparous individuals.

RESULTS

Of the 3570 pregnancies meeting the study criteria, 987 (28%) had a primary CD. Of note, 8 variables were included in the final model, all significantly associated with CD. They included large for gestational age, polyhydramnios, older maternal age, early pregnancy body mass index, first hemoglobin A1C recorded in pregnancy, nulliparity, insulin treatment, and preeclampsia. Model calibration and discrimination were satisfactory with the Hosmer-Lemeshow test (P=.862) and an area under the receiver operating characteristic curve of 0.75 (95% confidence interval, 0.74-0.77). Internal validation demonstrated similar discriminatory ability. Stratification by parity demonstrated that the model worked well among both nulliparous and multiparous patients.

CONCLUSION

Using information routinely available in the third trimester of pregnancy, a clinically pragmatic model can predict intrapartum primary CD risk with reasonable reliability in pregnancies complicated by gestational diabetes mellitus and may provide quantitative data to guide patients in understanding their individual primary CD risk based on preexisting and acquired risk factors.

An unwelcome inheritance: childhood obesity after diabetes in pregnancy

Diabetes in pregnancy affects 20 million women per year and is associated with increased risk of obesity in offspring, leading to insulin resistance and cardiometabolic disease. Despite the substantial public health ramifications, relatively little is known about the pathophysiological mechanisms underlying obesity in these high-risk children, which creates a barrier to successful intervention. While maternal glucose itself is undeniably a major stimulus upon intrauterine growth, the degree of offspring hyperinsulinism and disturbed lipid metabolism in mothers and offspring are also likely to be implicated in the disease process. The aim of this review is to summarise current understanding of the pathophysiology of childhood obesity after intrauterine exposure to maternal hyperglycaemia and to highlight possible opportunities for intervention. I present here a new unified hypothesis for the pathophysiology of childhood obesity in infants born to mothers with diabetes, which involves self-perpetuating twin cycles of pancreatic beta cell hyperfunction and altered lipid metabolism, both acutely and chronically upregulated by intrauterine exposure to maternal hyperglycaemia.

Randomization to a Provided Higher-Complex-Carbohydrate Versus Conventional Diet in Gestational Diabetes Mellitus Results in Similar Newborn Adiposity

OBJECTIVE

Nutrition therapy for gestational diabetes mellitus (GDM) has conventionally focused on carbohydrate restriction. In a randomized controlled trial (RCT), we tested the hypothesis that a diet (all meals provided) with liberalized complex carbohydrate (60%) and lower fat (25%) (CHOICE diet) could improve maternal insulin resistance and 24-h glycemia, resulting in reduced newborn adiposity (NB%fat; powered outcome) versus a conventional lower-carbohydrate (40%) and higher-fat (45%) (LC/CONV) diet.

RESEARCH DESIGN AND METHODS

After diagnosis (at ∼28-30 weeks' gestation), 59 women with diet-controlled GDM (mean ± SEM; BMI 32 ± 1 kg/m2) were randomized to a provided LC/CONV or CHOICE diet (BMI-matched calories) through delivery. At 30-31 and 36-37 weeks of gestation, a 2-h, 75-g oral glucose tolerance test (OGTT) was performed and a continuous glucose monitor (CGM) was worn for 72 h. Cord blood samples were collected at delivery. NB%fat was measured by air displacement plethysmography (13.4 ± 0.4 days).

RESULTS

There were 23 women per group (LC/CONV [214 g/day carbohydrate] and CHOICE [316 g/day carbohydrate]). For LC/CONV and CHOICE, respectively (mean ± SEM), NB%fat (10.1 ± 1 vs. 10.5 ± 1), birth weight (3,303 ± 98 vs. 3,293 ± 81 g), and cord C-peptide levels were not different. Weight gain, physical activity, and gestational age at delivery were similar. At 36-37 weeks of gestation, CGM fasting (86 ± 3 vs. 90 ± 3 mg/dL), 1-h postprandial (119 ± 3 vs. 117 ± 3 mg/dL), 2-h postprandial (106 ± 3 vs. 108 ± 3 mg/dL), percent time in range (%TIR; 92 ± 1 vs. 91 ± 1), and 24-h glucose area under the curve values were similar between diets. The %time >120 mg/dL was statistically higher (8%) in CHOICE, as was the nocturnal glucose AUC; however, nocturnal %TIR (63-100 mg/dL) was not different. There were no between-group differences in OGTT glucose and insulin levels at 36-37 weeks of gestation.

CONCLUSIONS

A ∼100 g/day difference in carbohydrate intake did not result in between-group differences in NB%fat, cord C-peptide level, maternal 24-h glycemia, %TIR, or insulin resistance indices in diet-controlled GDM.