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Wong MMH, Yuen-Man Chan M, Ng TP, Louie JCY. Impact of carbohydrate quantity and quality on maternal and pregnancy outcomes in gestational diabetes mellitus: A systematic review and meta-analysis. Diabetes Metab Syndr 2024; 18:102941. [PMID: 38218096 DOI: 10.1016/j.dsx.2024.102941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 12/14/2023] [Accepted: 01/01/2024] [Indexed: 01/15/2024]
Abstract
OBJECTIVE To evaluate the impact of carbohydrate quantity and quality on maternal and pregnancy outcomes in gestational diabetes mellitus. METHODS Using a pre-defined search strategy, two researchers systematically searched MEDLINE, CINAHL Plus, and PubMed for randomized controlled trials comparing low-carbohydrate, low-glycaemic index, or low-glycaemic load diets with usual care in gestational diabetes mellitus. Mean differences and risk ratios were extracted. RESULTS Thirteen studies with 877 participants were included. Low-carbohydrate diet did not significantly differ from usual care for fasting blood glucose (3 studies; mean difference: 1.60 mmol/L; 95 % confidence interval: -1.95, 5.15), insulin requirement (2 studies; risk ratio: 1.01; 95 % confidence interval: 0.31, 3.05), birthweight (4 studies; mean difference: -0.23 kg; 95 % confidence interval: -1.90, 1.45), caesarean delivery (5 studies; risk ratio: 1.11; 95 % confidence interval: 0.66, 1.85), macrosomia (3 studies; risk ratio: 0.35; 95 % confidence interval: 0.00, 2130.64), large-for-gestational-age (2 studies; risk ratio: 0.46; 95 % confidence interval: 0.03, 7.20), and small-for-gestational-age infants (2 studies; risk ratio: 0.94; 95 % confidence interval: 0.00, 231.18). Low-glycaemic index diet did not significantly differ from usual care for the above outcomes either. However, low-glycaemic load diet reduced macrosomia risk (2 studies; risk ratio: 0.51; 95 % confidence interval: 0.43, 0.59). CONCLUSIONS Low-carbohydrate and low-glycaemic index diets do not differ from usual care for most maternal and foetal outcomes in gestational diabetes mellitus. But low-glycaemic load diet may reduce macrosomia risk.
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Affiliation(s)
- Martin Ming Him Wong
- School of Professional and Continuing Education, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Mandy Yuen-Man Chan
- Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Tsoi Pan Ng
- School of Biological Sciences, Faculty of Science, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Jimmy Chun Yu Louie
- School of Biological Sciences, Faculty of Science, The University of Hong Kong, Hong Kong Special Administrative Region, China; Department of Nursing and Allied Health, School of Health Sciences, Swinburne University of Technology, Hawthorn, VIC, 3122, Australia.
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Deng Y, Yu J, Tao A, Liu J, Wang Q, Cao Y, Han S, Xu X, Yan X, Fang X, Lian F. Effect of low-glycemic index diet advice on pregnant outcomes in women with elevated risk of gestational diabetes mellitus: A meta-analysis of randomized controlled trails. Clin Nutr ESPEN 2023; 57:501-509. [PMID: 37739699 DOI: 10.1016/j.clnesp.2023.07.091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 04/14/2023] [Accepted: 07/29/2023] [Indexed: 09/24/2023]
Abstract
BACKGROUND AND AIMS The beneficial effect of low-glycemic index (GI) diet on gestational diabetes mellitus (GDM) has been suggested in many observational studies; however, results from intervention trials remain inconsistent. This study aims to estimate the effect of interventions with low-GI dietary advice on pregnant outcomes in women with elevated risk of GDM. DESIGN PubMed, Web of Science, Embase, and Cochrane Library databases were searched for randomized clinical trials (RCTs) through March 2022. Studies reporting the effect of low-GI diet advice intervention on maternal and fetal outcomes in pregnant women with increased risks of GDM were included. Random or fixed effects model was used to calculate combined treatment effects. Publication bias was assessed via Begg's and Egger's tests and funnel plot inspection. RESULTS Nine RCTs recruiting 3416 participants were included. Low-GI diet advice did not modulate the risk of GDM. Compared with control diets, low-GI diet advice significantly reduced gestational weight gain (GWG) (weighted mean differences, WMD = -0.93 kg, 95% CI: -1.31, -0.55; p < 0.001; n = 7) and the risk of premature birth (RR = 0.55, 95% CI: 0.35, 0.88; p = 0.012; n = 5). In subgroup analyses, the effect of low-GI diet interventions on premature birth was significant only in women with BMI higher than 30 kg/m2 (RR = 0.28, 95% CI: 0.10, 0.77, p = 0.014; n = 3); the significant effect on GWG was not altered by stratification of BMI and the type of GDM risk factors. No significant changes in other maternal and newborn outcomes were found. CONCLUSIONS Low-GI diet advice interventions during pregnancy decreased GWG and the risk of premature birth in women with elevated GDM risk; however, the interventions did not significantly prevent GDM development in these women.
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Affiliation(s)
- Yuanyuan Deng
- Department of Nutrition and Toxicology, School of Public Health, Hangzhou Normal University, Hangzhou, China
| | - Jingjing Yu
- Department of Nutrition and Toxicology, School of Public Health, Hangzhou Normal University, Hangzhou, China
| | - Ahui Tao
- Department of Nutrition and Toxicology, School of Public Health, Hangzhou Normal University, Hangzhou, China
| | - Jun Liu
- Department of Nutrition and Toxicology, School of Public Health, Hangzhou Normal University, Hangzhou, China
| | - Qianqian Wang
- Department of Nutrition and Toxicology, School of Public Health, Hangzhou Normal University, Hangzhou, China
| | - Yifei Cao
- Department of Nutrition and Toxicology, School of Public Health, Hangzhou Normal University, Hangzhou, China
| | - Shufen Han
- Department of Nutrition and Toxicology, School of Public Health, Hangzhou Normal University, Hangzhou, China
| | - Xianrong Xu
- Department of Nutrition and Toxicology, School of Public Health, Hangzhou Normal University, Hangzhou, China
| | - Xiao Yan
- Department of Nutrition and Toxicology, School of Public Health, Hangzhou Normal University, Hangzhou, China
| | - Xuexian Fang
- Department of Nutrition and Toxicology, School of Public Health, Hangzhou Normal University, Hangzhou, China
| | - Fuzhi Lian
- Department of Nutrition and Toxicology, School of Public Health, Hangzhou Normal University, Hangzhou, China.
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Lin Q, Zhang Z, Meng Q, Xie Y, Liu Z, Hu C, Wang G, Qin P, Bo Q. Effects of different dietary patterns during pregnancy on birth outcomes and glucose parameters in women with gestational diabetes mellitus: A systematic review and meta-analysis. Prim Care Diabetes 2023:S1751-9918(23)00086-4. [PMID: 37127452 DOI: 10.1016/j.pcd.2023.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 03/13/2023] [Accepted: 04/21/2023] [Indexed: 05/03/2023]
Abstract
PURPOSE Dietary interventions are the cornerstone of gestational diabetes mellitus (GDM) treatment. This study aimed to evaluate the effects of dietary patterns during pregnancy on birth outcomes and glucose parameters in women with GDM. METHODS PubMed, Embase, and The CoChrane Library were searched from the time of database creation to November 30, 2021, along with manual searches. Data analyses were performed using Stata 15.4 software. RESULTS From 2461 studies, 27 RCTs involving 1923 women were eligible. The pooled results showed that dietary pattern interventions during pregnancy reduced birth weight (WMD: -0.14 kg; 95% CI: -0.24, -0.00), hemoglobin A1 C (HbA1 C) (WMD: -0.19, 95% CI: -0.34, -0.05), and macrosomia incidence (RR 0.65 [95% CI 0.48, 0.88]). Low glycemic index (GI) diet reduced macrosomia incidence (RR 0.31 [95% CI 0.11, 0.93]) and fasting plasma glucose (FPG) levels (WMD: -0.10 mmol/L; 95% CI: -0.14, -0.05); a low carbohydrate (CHO) diet reduced large for gestational age (LGA) incidence (RR 0.33 [95% CI 0.13, 0.82]) and HbA1 C (WMD: -0.32; 95% CI: -0.51, -0.14); dietary approaches to stop hypertension (DASH) diet reduced birth weight (WMD:-0.59 kg; 95% CI: -0.64, -0.55), insulin use (RR 0.31 [95% CI 0.18, 0.56), macrosomia incidence (RR 0.12 [95% CI 0.03, 0.50]), and cesarean sections incidence (RR 0.57 [95% CI 0.40, 0.82]). CONCLUSION Dietary patterns during pregnancy can improve certain birth outcomes and glycemic parameters. Due to limitations in the quality and number of included studies, the above findings still need to be validated by further randomized controlled trials with high quality and large samples.
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Affiliation(s)
- Qiulin Lin
- Department of Nutrition and Food Hygiene, School of Public Health, Anhui Medical University, Hefei, China
| | - Zhiqiang Zhang
- Department of Nutrition and Food Hygiene, School of Public Health, Anhui Medical University, Hefei, China
| | - Qingchong Meng
- Department of Nutrition and Food Hygiene, School of Public Health, Anhui Medical University, Hefei, China
| | - Yali Xie
- Department of Nutrition and Food Hygiene, School of Public Health, Anhui Medical University, Hefei, China
| | - Zhengxiang Liu
- Department of Nutrition and Food Hygiene, School of Public Health, Anhui Medical University, Hefei, China
| | - Chunqiu Hu
- Department of Nutrition and Food Hygiene, School of Public Health, Anhui Medical University, Hefei, China
| | - Guoxiu Wang
- Department of Nutrition and Food Hygiene, School of Public Health, Anhui Medical University, Hefei, China
| | - Panzhu Qin
- Department of Nutrition and Food Hygiene, School of Public Health, Anhui Medical University, Hefei, China
| | - Qingli Bo
- Department of Nutrition and Food Hygiene, School of Public Health, Anhui Medical University, Hefei, China.
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Jardine IR, Christie HE, Oetsch K, Sabag A, Kennedy M, Meyer BJ, Francois ME. Physical Activity, but Not Glycaemic Load, Is Associated with Lower Real-Time Glycaemic Control in Free-Living Women with Gestational Diabetes Mellitus. Nutrients 2023; 15:nu15081974. [PMID: 37111193 PMCID: PMC10142701 DOI: 10.3390/nu15081974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 03/29/2023] [Accepted: 04/06/2023] [Indexed: 04/29/2023] Open
Abstract
Maintaining blood glucose within the target range is the primary treatment goal for women with gestational diabetes mellitus (GDM). Foods with low glycaemic loads are recommended in clinical practice; however, the relative importance of other key lifestyle variables is unexplored. This pilot study explored the associations of glycaemic load, carbohydrates and physical activity parameters on blood glucose concentrations in free-living women with GDM. Twenty-nine women (28-30 weeks gestation, 34 ± 4 years) with GDM were enrolled. Continuous glucose monitoring, physical activity (ActivPAL inclinometer) and dietary intake and dietary quality were measured concurrently for 3 days. Pearson correlation analyses determined the association between glucose levels and lifestyle variables. Despite all receiving the same nutrition education, only 55% of women were following a low glycaemic load diet with a large range of carbohydrate intakes (97-267 g/day). However, the glycaemic load did not correlate with 3-hr postprandial glucose (r2 = 0.021, p = 0.56) or 24-h glucose iAUC (r2 = 0.021, p = 0.58). A significant relationship between total stepping time and lower 24-h glucose iAUC (r2 = 0.308, p = 0.02) and nocturnal glucose (r2 = 0.224, p = 0.05) was found. In free-living women with diet-controlled GDM, more physical activity, i.e., steps accumulated across the day, may be a simple and effective strategy for improving maternal blood glucose concentrations.
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Affiliation(s)
- Isabelle R Jardine
- School of Medical, Indigenous and Health Sciences, Faculty of Science, Medicine and Health University of Wollongong, Wollongong, NSW 2522, Australia
| | - Hannah E Christie
- School of Medical, Indigenous and Health Sciences, Faculty of Science, Medicine and Health University of Wollongong, Wollongong, NSW 2522, Australia
- Illawarra Health and Medical Research Institute, Wollongong, NSW 2522, Australia
| | - Kate Oetsch
- School of Medical, Indigenous and Health Sciences, Faculty of Science, Medicine and Health University of Wollongong, Wollongong, NSW 2522, Australia
- Illawarra Health and Medical Research Institute, Wollongong, NSW 2522, Australia
| | - Angelo Sabag
- NICM Health Research Institute, Western Sydney University, Westmead, NSW 2145, Australia
| | - Meredith Kennedy
- School of Medical, Indigenous and Health Sciences, Faculty of Science, Medicine and Health University of Wollongong, Wollongong, NSW 2522, Australia
- Illawarra Shoalhaven Local Health District, Diabetes Service, Wollongong, NSW 2500, Australia
| | - Barbara J Meyer
- School of Medical, Indigenous and Health Sciences, Faculty of Science, Medicine and Health University of Wollongong, Wollongong, NSW 2522, Australia
- Illawarra Health and Medical Research Institute, Wollongong, NSW 2522, Australia
- Molecular Horizons, University of Wollongong, Wollongong, NSW 2522, Australia
| | - Monique E Francois
- School of Medical, Indigenous and Health Sciences, Faculty of Science, Medicine and Health University of Wollongong, Wollongong, NSW 2522, Australia
- Illawarra Health and Medical Research Institute, Wollongong, NSW 2522, Australia
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Churchill M, Zawawi H, Elisia I, Seider M, Noseworthy R, Thompson A, Glenn AJ, Ramdath DD, O’Connor D, Darling P, Wolever T, Barre DE, Feig DS, Kitts DD, Grant SM. The Antioxidant Capacity of Breast Milk and Plasma of Women with or without Gestational Diabetes Mellitus. Antioxidants (Basel) 2023; 12:antiox12040842. [PMID: 37107217 PMCID: PMC10135328 DOI: 10.3390/antiox12040842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 03/24/2023] [Accepted: 03/27/2023] [Indexed: 04/03/2023] Open
Abstract
Women with gestational diabetes (GD) have reduced antioxidant capacity; however, the relationship between maternal diet, maternal biochemical capacity, breast milk concentration, and infant intake has not been adequately explored in the literature. An exploration of underlying mechanism(s) is warranted, particularly for nutrient antioxidants impacted by maternal intake. These nutrients may provide a means for modifying maternal and infant antioxidant capacity. Oxygen radical absorbance capacity (ORAC), alpha-tocopherol, ascorbic acid, and beta-carotene concentrations were measured in breast milk of women with and without GD. Plasma, three-day diet records, and breast milk were collected at 6 to 8 weeks postpartum. Student’s t-test was used to compare breast milk ORAC, nutrient antioxidant concentration and plasma ORAC between women with and without GD. Pearson correlations were used to determine associations among antioxidant concentrations in breast milk and dietary antioxidant intake. Breast milk antioxidant concentrations were associated with maternal intake of beta-carotene (r = 0.629, p = 0.005). Breast milk and plasma ORAC and antioxidant vitamin concentrations were not significantly different between GD and NG women. Breast milk ORAC associated with breast milk alpha-tocopherol for NG (r = 0.763, p = 0.010), but not GD women (r = 0.385, p = 0.35), and with breast milk ascorbic acid for GD (r = 0.722, p = 0.043) but not NG women (r = 0.141, p = 0.70; interaction p = 0.041). In GD participants, breast milk ORAC was significantly associated with plasma ORAC (r = 0.780, p = 0.039). ORAC and antioxidant vitamin concentrations in breast milk in women with GD were comparable to women with NG; however, the relationships between breast milk ORAC and vitamin concentrations differed in GD versus NG women for alpha-tocopherol and ascorbic acid.
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Dingena CF, Arofikina D, Campbell MD, Holmes MJ, Scott EM, Zulyniak MA. Nutritional and Exercise-Focused Lifestyle Interventions and Glycemic Control in Women with Diabetes in Pregnancy: A Systematic Review and Meta-Analysis of Randomized Clinical Trials. Nutrients 2023; 15:323. [PMID: 36678193 PMCID: PMC9864154 DOI: 10.3390/nu15020323] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 01/05/2023] [Indexed: 01/11/2023] Open
Abstract
Diabetes disrupts one in six pregnancies, bestowing immediate and long-term health risks to mother and child. Diet and exercise are commonly prescribed to control dysglycemia, but their effectiveness across sub-populations and types of diabetes (type-1; type-2; or gestational diabetes mellitus, GDM) is uncertain. Therefore, a systematic review and meta-analysis on the effect of diet and/or exercise on glycemia in pregnant women with diabetes was conducted. Random effects models were used to evaluate effect sizes across studies and anticipated confounders (e.g., age, ethnicity, BMI). Of the 4845 records retrieved, 26 studies (8 nutritional supplements, 12 dietary, and 6 exercise interventions) were included. All studies were conducted in patients with GDM. Overall, supplement- and exercise-based interventions reduced fasting glucose (−0.30 mmol/L; 95% CI = −0.55, −0.06; p = 0.02; and 0.10 mmol/L; 95% CI = −0.20, −0.01; p = 0.04); and supplement- and diet-based interventions reduced HOMA-IR (−0.40; 95% CI = −0.58, −0.22; p < 0.001; and −1.15; 95% CI = −2.12, −0.17; p = 0.02). Subgroup analysis by confounders only confirmed marginal changed effect sizes. Our results suggest a favorable role of certain nutritional supplements, diet, and exercise practices on glycemia in women with GDM and underline a lack of evidence in ~20% of other diabetes-related pregnancies (i.e., women with pre-existing diabetes).
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Affiliation(s)
- Cassy F. Dingena
- Nutritional Epidemiology Group, School of Food Science and Nutrition, University of Leeds, Leeds LS2 9JT, UK
| | - Daria Arofikina
- Nutritional Epidemiology Group, School of Food Science and Nutrition, University of Leeds, Leeds LS2 9JT, UK
| | - Matthew D. Campbell
- School of Nursing and Health Sciences, Institute of Health Sciences and Wellbeing, University of Sunderland, Sunderland SR1 3SD, UK
| | - Melvin J. Holmes
- Nutritional Epidemiology Group, School of Food Science and Nutrition, University of Leeds, Leeds LS2 9JT, UK
| | - Eleanor M. Scott
- Division of Clinical and Population Sciences, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds LS2 9JT, UK
| | - Michael A. Zulyniak
- Nutritional Epidemiology Group, School of Food Science and Nutrition, University of Leeds, Leeds LS2 9JT, UK
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Igwesi-Chidobe CN, Okechi PC, Emmanuel GN, Ozumba BC. Community-based non-pharmacological interventions for pregnant women with gestational diabetes mellitus: a systematic review. BMC Womens Health 2022; 22:482. [PMID: 36447189 PMCID: PMC9710028 DOI: 10.1186/s12905-022-02038-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 10/31/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Non-pharmacological interventions are the first line of Gestational diabetes mellitus (GDM) management. Community-based interventions are cheaper, more accessible, with higher patient satisfaction. OBJECTIVES To systematically review community-based non-pharmacological interventions and evaluate their effectiveness for GDM. SEARCH STRATEGY Twelve bibliographic databases and reference list of related studies from inception until January 2022. SELECTION CRITERIA All primary studies of community-based non-pharmacological interventions for GDM reported in English which investigated any behavioural or clinical outcome(s). DATA COLLECTION AND ANALYSIS Data were extracted using modified Cochrane's data extraction template. Studies were evaluated using Cochrane Collaboration's risk of bias tool. Narrative synthesis was used to summarise findings. This study is registered with PROSPERO (CRD42021257634). MAIN RESULTS Twenty-seven studies involving 6,242 pregnant women with GDM investigated self-management programmes, medical nutrition/diet therapy, exercise/physical activity, combined diet and exercise, calcium plus vitamin D supplementation, and continuous glucose monitoring. Self-management programmes were more effective than routine care in improving self-efficacy, two-hour postprandial blood glucose, and lifestyle behaviours but were as effective as routine care in improving infant birth weight. Self-management programmes were superior to or as effective as usual care in improving fasting blood glucose, blood glucose control, glycated haemoglobin, macrosomia, and preterm delivery. Medical nutrition/diet therapy was more effective than usual care in improving postprandial blood glucose levels. Postprandial blood glucose levels were better improved by regular supervised exercise plus daily brisk walks or a daily walking intervention than routine obstetric care or no treatment. The effects of exercise/physical activity programmes were mostly inconsistent for other outcomes. Diet and exercise were superior to diet alone in reducing maternal weight gain although there were similar outcomes for other pregnancy and foetal outcomes. Limited or conflicting evidence was found for other outcomes and interventions including calcium and vitamin D supplementation and continuous glucose monitoring intervention. CONCLUSIONS Community-based non-pharmacological interventions are more effective than placebo; and are more or as effective as usual care. Self-management programmes and medical nutrition/diet therapy had the most promising GDM outcomes. FUNDING There was no funding for this study. The study design, data collection, data analysis and interpretation, and writing of this manuscript were not influenced externally by any funder.
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Affiliation(s)
- Chinonso Nwamaka Igwesi-Chidobe
- grid.10757.340000 0001 2108 8257Department of Medical Rehabilitation, Faculty of Health Science and Technology, College of Medicine, University of Nigeria Enugu Campus, Nsukka, Nigeria ,grid.10757.340000 0001 2108 8257Global Population Health (GPH) Research Group, University of Nigeria, Nsukka, Nigeria
| | - Peace Chioma Okechi
- grid.10757.340000 0001 2108 8257Department of Medical Rehabilitation, Faculty of Health Science and Technology, College of Medicine, University of Nigeria Enugu Campus, Nsukka, Nigeria ,grid.10757.340000 0001 2108 8257Global Population Health (GPH) Research Group, University of Nigeria, Nsukka, Nigeria
| | - Grace Nneoma Emmanuel
- grid.10757.340000 0001 2108 8257Department of Medical Rehabilitation, Faculty of Health Science and Technology, College of Medicine, University of Nigeria Enugu Campus, Nsukka, Nigeria ,grid.10757.340000 0001 2108 8257Global Population Health (GPH) Research Group, University of Nigeria, Nsukka, Nigeria
| | - Benjamin C. Ozumba
- grid.10757.340000 0001 2108 8257Department of Obstetrics and Gynaecology, Faculty of Medicine, College of Medicine, University of Nigeria, Nsukka, Nigeria
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Trout KK, Compher CW, Dolin C, Burns C, Quinn R, Durnwald C. Increased Protein with Decreased Carbohydrate Intake Reduces Postprandial Blood Glucose Levels in Women with Gestational Diabetes: The iPRO Study. WOMEN'S HEALTH REPORTS (NEW ROCHELLE, N.Y.) 2022; 3:728-739. [PMID: 36147835 PMCID: PMC9436385 DOI: 10.1089/whr.2022.0012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 06/30/2022] [Indexed: 06/16/2023]
Abstract
Introduction There is an urgent need to establish an evidence base for recommendations regarding proportions of macronutrients for optimized nutritional management of gestational diabetes mellitus (GDM). Our study compared isocaloric diets in women with GDM that differed in protein and carbohydrate content with fats held constant. We hypothesized that the glucose area under the curve (AUC) would be lower with the higher protein/lower carbohydrate diet. Research Design and Methods This study used a random order crossover design within a controlled research unit environment. Nineteen women were randomized to treatment, with 12 participants completing both arms of the study. Blood sampling occurred preprandially and at t = 30, 60, 120, and 180" relative to meals. Inclusion criteria were confirmed diet-controlled GDMA1, singleton gestation, and with no pre-existing medical comorbidities. Mean gestational age at entrance to study = 32 (±1.76) weeks. Mean prepregnant body mass index of participants = 28.7 (±5.3) kg/m2 Participants were randomly assigned initially to either an increased protein/low carbohydrate (iPRO30%/CHO35%) diet or a lower protein/higher carbohydrate (LPRO15%/CHO50%) diet for a 36 hour inpatient stay on the research unit. All meals and snacks were prepared in a metabolic kitchen. After a 3-7 day washout period, participants were randomized to the opposite treatment. Results On day 2 (with confirmed overnight fasting), the average 3-hour pre- through postprandial glucose AUC was lower in iPRO30%/CHO35% treatment arm (17395.20 ± 2493.47 vs. 19172.47 ± 3484.31, p = 0.01). Conclusion This study is the first to demonstrate that a higher protein, lower carbohydrate meal, especially at breakfast, can result in lower postprandial blood glucose values in women with gestational diabetes. A lack of statistically significant differences at other collection time points could have been due to several factors, but most likely due to small sample size. Longer term outcomes of a higher protein diet, including maternal glycemic control, nitrogen balance, and impact on fetal growth outcomes, are needed.
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Affiliation(s)
- Kimberly K. Trout
- Department of Family and Community Health, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Charlene W. Compher
- Departments of Biobehavioral Health Sciences, and University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Cara Dolin
- Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Carrie Burns
- Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ryan Quinn
- Departments of Biobehavioral Health Sciences, and University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Celeste Durnwald
- Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Zhang X, Gong Y, Della Corte K, Yu D, Xue H, Shan S, Tian G, Liang Y, Zhang J, He F, Yang D, Zhou R, Bao W, Buyken AE, Cheng G. Relevance of dietary glycemic index, glycemic load and fiber intake before and during pregnancy for the risk of gestational diabetes mellitus and maternal glucose homeostasis. Clin Nutr 2021; 40:2791-2799. [PMID: 33933745 DOI: 10.1016/j.clnu.2021.03.041] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 03/16/2021] [Accepted: 03/29/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND & AIMS To date, the prevalence of Gestational diabetes mellitus (GDM) in China was 17.5%. Given the substantial relevance of GDM for medium- and long-term health of both mother and offspring and the paucity of existing data on the link between maternal diet and glucose homeostasis during pregnancy in Asian population, additional studies are needed. To examine the relevance of dietary glycemic index (GI), glycemic load (GL) and fiber intake before and during pregnancy for the development of GDM and glucose homeostasis over the course of pregnancy. METHODS Cox proportional hazards analysis and linear mixed effects regressions were performed on data from 9317 women for whom three food frequency questionnaires (pre-pregnancy, 1st and 2nd trimesters) and biochemical measures during pregnancy were available. Investigated outcome variables included GDM risk, fasting plasma glucose (FPG), glycated hemoglobin (HbA1C), and homeostasis model assessment insulin resistance (HOMA-IR) in the 1st, 2nd and 3rd trimesters. RESULTS Women in the highest tertile of dietary GI (or GL) before pregnancy, in the 1st, or the 2nd trimester respectively had a 12% (15%), 25% (23%) or 29% (25%) higher risk of developing GDM than those in the lowest tertile (all p for trend ≤ 0.02). Women with the highest dietary fiber intake before pregnancy, in the 1st or 2nd trimester had a 11%, 17% or 18% lower GDM risk (all p for trend ≤ 0.03). Moreover, increases in GI or GL and decreases in fiber intake over the course of pregnancy (1st to 3rd trimesters) were independently associated with adverse concurrent developments in FPG, HbA1C and HOMA-IR (p ≤ 0.03). CONCLUSIONS Our study indicates that dietary GI, GL and fiber intake before and during pregnancy affects glucose homeostasis of pregnant Chinese women.
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Affiliation(s)
- Xiao Zhang
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Yunhui Gong
- West China Second University Hospital and Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University) of Ministry of Education, Sichuan University, Chengdu, PR China
| | - Karen Della Corte
- Nutrition, Consumption and Health, Faculty of Natural Sciences, Paderborn University, Germany
| | - Dianke Yu
- School of Public Health, Qingdao University, Qingdao, PR China
| | - Hongmei Xue
- College of Public Health, Hebei University, Key Laboratory of Public Health Safety of HeBei University, Baoding, Hebei, China
| | - Shufang Shan
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Guo Tian
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Yi Liang
- Department of Clinical Nutrition, Affiliated Hospital of Guizhou Medical University, Guizhou Medical University, Guiyang, PR China
| | - Jieyi Zhang
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Fang He
- West China School of Public Health and Healthy Food Evaluation Research Center, Sichuan University, Chengdu, PR China
| | - Dagang Yang
- Department of Clinical Nutrition, Affiliated Hospital of Guizhou Medical University, Guizhou Medical University, Guiyang, PR China
| | - Rong Zhou
- West China Second University Hospital and Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University) of Ministry of Education, Sichuan University, Chengdu, PR China
| | - Wei Bao
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA 52246, USA
| | - Anette E Buyken
- Nutrition, Consumption and Health, Faculty of Natural Sciences, Paderborn University, Germany
| | - Guo Cheng
- Laboratory of Molecular Translational Medicine, Center for Translational Medicine, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, PR China.
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Meloncelli N, Wilkinson SA, de Jersey S. Searching for Utopia, the Challenge of Standardized Medical Nutrition Therapy Prescription in Gestational Diabetes Mellitus Management: A Critical Review. Semin Reprod Med 2021; 38:389-397. [PMID: 33429445 DOI: 10.1055/s-0040-1722316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Gestational diabetes mellitus (GDM) is a common pregnancy disorder and the incidence is increasing worldwide. GDM is associated with adverse maternal outcomes which may be reduced with proper management. Lifestyle modification in the form of medical nutrition therapy and physical activity, as well as self-monitoring of blood glucose levels, is the cornerstone of GDM management. Inevitably, the search for the "ultimate" diet prescription has been ongoing. Identifying the amount and type of carbohydrate to maintain blood glucose levels below targets while balancing the nutritional requirements of pregnancy and achieving gestational weight gain within recommendations is challenging. Recent developments in the area of the gut microbiota and its impact on glycemic response add another layer of complexity to the success of medical nutrition therapy. This review critically explores the challenges to dietary prescription for GDM and why utopia may never be found.
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Affiliation(s)
- Nina Meloncelli
- Nutrition and Dietetics, Sunshine Coast University Hospital, Birtinya, Australia.,Centre for Clinical Research and Perinatal Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Shelley A Wilkinson
- School of Human Movements and Nutrition Sciences, Faculty of Health and Behavioural Sciences, The University of Queensland, St Lucia, Queensland, Australia.,Mater Research Institute, The University of Queensland, Brisbane, Queensland, Australia
| | - Susan de Jersey
- Centre for Clinical Research and Perinatal Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Australia.,Department of Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Brisbane, Australia
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11
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Effects of the Dietary Approaches to Stop Hypertension (DASH) on Pregnancy/Neonatal Outcomes and Maternal Glycemic Control: A Systematic Review and Meta-analysis of Randomized Clinical Trials. Complement Ther Med 2020; 54:102551. [PMID: 33183669 DOI: 10.1016/j.ctim.2020.102551] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 08/26/2020] [Accepted: 08/26/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND & OBJECTIVE No systematic review to date has appraised the impact of the Dietary Approaches to Stop Hypertension (DASH) eating plan on maternal glycemic control and pregnancy outcomes. Thus, we conducted a systematic review and meta-analysis of randomized clinical trials (RCTs) to ascertain whether the DASH diet in pregnant women ameliorates their glycemic control and neonatal outcomes when compared to standard diets. METHODS We performed a comprehensive systematic review and meta-analysis of RCTs on PubMed/MEDLINE, Web of Science, SCOPUS, and Embase from the inception until October 2019. RESULTS Six studies met the eligibility criteria and were included in the quantitative meta-analysis. The pregnant women had cardiometabolic disorders such as gestational diabetes, obesity, and hypertension. The meta-analysis suggested a significant effect of DASH diet on fasting plasma levels of glucose (WMD = -6.239 mg/dl; 95% CI: -11.915, -0.563, p = 0.031), but not for the homeostasis model assessment of insulin resistance (WMD = -1.038; 95% CI: -2.704, 0.627, p = 0.22). Following the DASH diet during pregnancy decreased the risk of gestational preeclampsia (RR = 0.667; 95% CI: 0.451, 0.987, p = 0.043), macrosomia (birth weight >4000 g) (RR = 0.294; 95% CI: 0.120, 0.721, p = 0.043), and large for gestational age (RR = 0.452; 95% CI: 0.211, 0.969, p = 0.041). Consuming DASH diet during pregnancy neither increased nor decreased the risk of cesarean section, polyhydramnios, preterm birth (<37 weeks), and small for gestational age. The mean newborn head circumference (cm) (WMD = -0.807; 95% CI: -1.283, -0.331, p = 0.001) and ponderal index (kg/m3) (RR = -0.396; 95% CI: -0.441, -0.350, p = 0.000) in the group receiving the DASH diet were lower than in the control group. CONCLUSION The adherence of pregnant women with cardiometabolic disorders to DASH eating pattern has a significant effect on decreasing fasting plasma glucose levels, ponderal index, incidence of preeclampsia, fetal macrosomia, large for gestational age, and newborn head circumference.
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12
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M. Grant S, J. Glenn A, M. S. Wolever T, G. Josse R, L. O’Connor D, Thompson A, D. Noseworthy R, Seider M, Sobie M, Bhatti G, Cavanagh J, Jones E, B. Darling P. Evaluation of Glycemic Index Education in People Living with Type 2 Diabetes: Participant Satisfaction, Knowledge Uptake, and Application. Nutrients 2020; 12:E2416. [PMID: 32806563 PMCID: PMC7469042 DOI: 10.3390/nu12082416] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 07/30/2020] [Accepted: 08/07/2020] [Indexed: 12/13/2022] Open
Abstract
The glycemic index (GI) has been included in the Canadian clinical practice guidelines for type 2 diabetes (T2D) management since 2003, and even longer in other parts of the world (e.g., Australia). Despite this, dietitians have reported that GI is "too difficult for patients to understand and apply." They have called for diverse GI-utility data and evidence-informed education materials. To address these concerns, we developed and evaluated a GI education workshop and supporting materials, using the Kirkpatrick Model, for a T2D population. Participants (n = 29) with T2D attended a dietitian-facilitated workshop and received education materials. A mixed-form questionnaire (GIQ) and 3-day-diet-record were used to capture patient demographics, satisfaction, knowledge, and application, prior to and immediately after the workshop, 1-week, and 4-weeks post-education. Dietary GI was significantly lower at 1 and 4 weeks post-education (mean ± SEM; both 54 ± 1), compared to pre-education (58 ± 1; p ≤ 0.001). Participants (28/29) were satisfied with the intervention. The GI knowledge score was significantly higher post-education at baseline (83.5 ± 3.4%; p ≤ 0.001), week one (87.5 ± 2.6%; p = 0.035), and week four (87.6 ± 3.8%; p = 0.011) when compared to pre-education (53.6 ± 5.1%). A significant reduction in dietary GI was achieved by participants living with T2D, after completing the workshop, and they were able to acquire and apply GI knowledge in a relatively short period.
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Affiliation(s)
- Shannan M. Grant
- Department of Applied Human Nutrition, Mount Saint Vincent University, 166 Bedford Highway, Halifax, NS B3M 2J6, Canada
- Department of Nutritional Sciences, University of Toronto, 1 King’s College Circle, Toronto, ON M5S 1A8, Canada; (A.J.G.); (T.M.S.W.); (R.G.J.); (D.L.O.); (A.T.); (R.D.N.); (M.S.); (P.B.D.)
- Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s Hospital, 61 Queen Street E, Toronto, ON M5C 2T2, Canada
- Nutrition Department, St Michael’s Hospital, 61 queen St. E, Toronto, ON M5B 1W8, Canada; (M.S.); (G.B.); (J.C.); (E.J.)
| | - Andrea J. Glenn
- Department of Nutritional Sciences, University of Toronto, 1 King’s College Circle, Toronto, ON M5S 1A8, Canada; (A.J.G.); (T.M.S.W.); (R.G.J.); (D.L.O.); (A.T.); (R.D.N.); (M.S.); (P.B.D.)
- Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s Hospital, 61 Queen Street E, Toronto, ON M5C 2T2, Canada
| | - Thomas M. S. Wolever
- Department of Nutritional Sciences, University of Toronto, 1 King’s College Circle, Toronto, ON M5S 1A8, Canada; (A.J.G.); (T.M.S.W.); (R.G.J.); (D.L.O.); (A.T.); (R.D.N.); (M.S.); (P.B.D.)
| | - Robert G. Josse
- Department of Nutritional Sciences, University of Toronto, 1 King’s College Circle, Toronto, ON M5S 1A8, Canada; (A.J.G.); (T.M.S.W.); (R.G.J.); (D.L.O.); (A.T.); (R.D.N.); (M.S.); (P.B.D.)
- Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s Hospital, 61 Queen Street E, Toronto, ON M5C 2T2, Canada
- Division of Endocrinology and Metabolism, St. Michael’s Hospital, 61 Queen St. E, Toronto, ON M5C 2T2, Canada
| | - Deborah L. O’Connor
- Department of Nutritional Sciences, University of Toronto, 1 King’s College Circle, Toronto, ON M5S 1A8, Canada; (A.J.G.); (T.M.S.W.); (R.G.J.); (D.L.O.); (A.T.); (R.D.N.); (M.S.); (P.B.D.)
- Physiology and Experimental Medicine Program, Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G 1X8, Canada
| | - Alexandra Thompson
- Department of Nutritional Sciences, University of Toronto, 1 King’s College Circle, Toronto, ON M5S 1A8, Canada; (A.J.G.); (T.M.S.W.); (R.G.J.); (D.L.O.); (A.T.); (R.D.N.); (M.S.); (P.B.D.)
- Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s Hospital, 61 Queen Street E, Toronto, ON M5C 2T2, Canada
| | - Rebecca D. Noseworthy
- Department of Nutritional Sciences, University of Toronto, 1 King’s College Circle, Toronto, ON M5S 1A8, Canada; (A.J.G.); (T.M.S.W.); (R.G.J.); (D.L.O.); (A.T.); (R.D.N.); (M.S.); (P.B.D.)
- Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s Hospital, 61 Queen Street E, Toronto, ON M5C 2T2, Canada
| | - Maxine Seider
- Department of Nutritional Sciences, University of Toronto, 1 King’s College Circle, Toronto, ON M5S 1A8, Canada; (A.J.G.); (T.M.S.W.); (R.G.J.); (D.L.O.); (A.T.); (R.D.N.); (M.S.); (P.B.D.)
- Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s Hospital, 61 Queen Street E, Toronto, ON M5C 2T2, Canada
| | - Melissa Sobie
- Nutrition Department, St Michael’s Hospital, 61 queen St. E, Toronto, ON M5B 1W8, Canada; (M.S.); (G.B.); (J.C.); (E.J.)
| | - Gurita Bhatti
- Nutrition Department, St Michael’s Hospital, 61 queen St. E, Toronto, ON M5B 1W8, Canada; (M.S.); (G.B.); (J.C.); (E.J.)
| | - Julianne Cavanagh
- Nutrition Department, St Michael’s Hospital, 61 queen St. E, Toronto, ON M5B 1W8, Canada; (M.S.); (G.B.); (J.C.); (E.J.)
| | - Emily Jones
- Nutrition Department, St Michael’s Hospital, 61 queen St. E, Toronto, ON M5B 1W8, Canada; (M.S.); (G.B.); (J.C.); (E.J.)
| | - Pauline B. Darling
- Department of Nutritional Sciences, University of Toronto, 1 King’s College Circle, Toronto, ON M5S 1A8, Canada; (A.J.G.); (T.M.S.W.); (R.G.J.); (D.L.O.); (A.T.); (R.D.N.); (M.S.); (P.B.D.)
- School of Nutrition Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, ON K1N 7K4, Canada
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13
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The Role of Dietary Carbohydrates in Gestational Diabetes. Nutrients 2020; 12:nu12020385. [PMID: 32024026 PMCID: PMC7071246 DOI: 10.3390/nu12020385] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 01/17/2020] [Accepted: 01/27/2020] [Indexed: 12/13/2022] Open
Abstract
Gestational diabetes (GDM) is hyperglycemia that is recognized for the first time during pregnancy. GDM is associated with a wide range of short- and long-term adverse health consequences for both mother and offspring. It is a complex disease with a multifactorial etiology, with disturbances in glucose, lipid, inflammation and gut microbiota. Consequently, its management is complex, requiring patients to self-manage their diet, lifestyle and self-care behaviors in combination with use of insulin. In addition to nutritional recommendations for all pregnant women, special attention to dietary carbohydrate (CHO) amount and type on glucose levels is especially important in GDM. Dietary CHO are diverse, ranging from simple sugars to longer-chain oligo- and poly- saccharides which have diverse effects on blood glucose, microbial fermentation and bowel function. Studies have established that dietary CHO amount and type can impact maternal glucose and nutritional recommendations advise women with GDM to limit total intake or choose complex and low glycemic CHO. However, robust maternal and infant benefits are not consistently shown. Novel approaches which help women with GDM adhere to dietary recommendations such as diabetes-specific meal replacements (which provide a defined and complete nutritional composition with slowly-digested CHO) and continuous glucose monitors (which provide unlimited monitoring of maternal glycemic fluctuations) have shown benefits on both maternal and neonatal outcomes. Continued research is needed to understand and develop tools to facilitate patient adherence to treatment goals, individualize interventions and improve outcomes.
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14
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Lipscombe LL, Delos-Reyes F, Glenn AJ, de Sequeira S, Liang X, Grant S, Thorpe KE, Price JAD. The Avoiding Diabetes After Pregnancy Trial in Moms Program: Feasibility of a Diabetes Prevention Program for Women With Recent Gestational Diabetes Mellitus. Can J Diabetes 2019; 43:613-620. [PMID: 31669188 DOI: 10.1016/j.jcjd.2019.08.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 08/12/2019] [Accepted: 08/29/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Our aim in this study was to evaluate the feasibility of a home-based diabetes prevention program, delivered by interdisciplinary certified diabetes educators (CDEs), and customized for postpartum women with recent gestational diabetes mellitus (GDM). METHODS This pilot randomized trial recruited women with GDM from 24 to 40 weeks gestation from 4 centres, and trained 10 CDEs in behaviour coaching, physical activity (PA) and low glycemic index education. Women were randomized after 3 months postpartum to standard care (1 visit) or 1 of 3 24-week coaching interventions (1 visit and 12 telephone calls): i) PA and diet, ii) PA only or iii) diet only. Feasibility outcomes included recruitment, retention, adherence and satisfaction. RESULTS Of 1,342 eligible patients, 392 were actively invited (29.3%) and 227 (16.9%) consented. Of these, 149 (65.6%) were randomized postpartum, of whom 131 (87.9%) started the program and 105 (70.5%) attended the final assessment. Intervention arm participants completed a median 75% (interquartile range, 50% to 92%) of telephone calls. Visit and call duration were a mean 71.4 (standard deviation, 13.8) and 18.1 (standard deviation, 6.5) minutes, respectively. Participants reported excellent/very good satisfaction 73% of the time, and 87% would recommend the program to others. CONCLUSIONS A home-based diabetes prevention program customized for postpartum women with GDM can be feasibly delivered by CDEs, and it is associated with >70% retention, adherence and satisfaction.
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Affiliation(s)
- Lorraine L Lipscombe
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada.
| | - Faith Delos-Reyes
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - Andrea J Glenn
- Clinical Nutrition and Risk Factor Modification Centre, St Michael's Hospital, Toronto, Ontario, Canada; Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Stephanie de Sequeira
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - Xinyun Liang
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Shannan Grant
- Department of Applied Human Nutrition, Mount St Vincent's University, Halifax, Nova Scotia, Canada; Department of Obstetrics and Gynaecology, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Kevin E Thorpe
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Applied Health Research Centre, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
| | - Jennifer A D Price
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada; Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
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Ojo O, Ojo OO, Wang XH, Adegboye ARA. The Effects of a Low GI Diet on Cardiometabolic and Inflammatory Parameters in Patients with Type 2 and Gestational Diabetes: A Systematic Review and Meta-Analysis of Randomised Controlled Trials. Nutrients 2019; 11:E1584. [PMID: 31336986 PMCID: PMC6683080 DOI: 10.3390/nu11071584] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 06/24/2019] [Accepted: 07/05/2019] [Indexed: 02/07/2023] Open
Abstract
The prevalence of diabetes is increasing globally, and its effect on patients and the healthcare system can be significant. Gestational diabetes mellitus (GDM) and type 2 diabetes are well established risk factors for cardiovascular disease, and strategies for managing these conditions include dietary interventions, such as the use of a low glycemic index (GI) diet. AIMS This review aimed to evaluate the effects of a low GI diet on the cardio-metabolic and inflammatory parameters in patients with type 2 diabetes and women with GDM and assess whether the effects are different in these conditions. METHODS This review was based on the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. Three databases (EMBASE, Pubmed, and PsycINFO) were searched from inception to 20 February 2019 using search terms that included synonyms and Medical Subject Headings (MeSH) in line with the population, intervention, comparator, outcomes, and studies (PICOS) framework. Studies were evaluated for the quality and risk of bias. RESULTS 10 randomised controlled studies were included in the systematic review, while 9 were selected for the meta-analysis. Two distinct areas were identified: the effect of a low GI diet on lipid profile and the effect of a low GI diet on inflammatory parameters. The results of the meta-analysis showed that there were no significant differences (p > 0.05) between the low GI and higher GI diets with respect to total cholesterol, HDL, and LDL cholesterol in patients with type 2 diabetes. However, there was a significant difference (p = 0.027) with respect to triglyceride which increased by a mean of 0.06 mmol/L (0.01, 0.11) in patients with type 2 diabetes on higher GI diet. With respect to the women with GDM, the findings from the systematic review were not consistent in terms of the effect of a low GI diet on the lipid profile. The results of the meta-analysis did not show significant differences (p > 0.05) between low GI and higher GI diets with respect to adiponectin and C-reactive proteins in patients with type 2 diabetes, but a significant difference (p < 0.001) was observed between the two groups in relation to interleukin-6. CONCLUSION This systematic review and meta-analysis have demonstrated that there were no significant differences (p > 0.05) between the low GI and higher GI diets in relation to total cholesterol-HDL and LDL cholesterol-in patients with type 2 diabetes. However, a significant difference (p < 0.05) was observed between the two groups with respect to triglyceride in patients with type 2 diabetes. The results of the effect of a low GI diet on the lipid profile in patients with GDM were not consistent. With respect to the inflammatory parameters, the low GI diet significantly decreased interleukin-6 in patients with type 2 diabetes compared to the higher GI diet. More studies are needed in this area of research.
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Affiliation(s)
- Omorogieva Ojo
- Faculty of Education and Health, Department of Adult Nursing and Paramedic Science, University of Greenwich, London SE9 2UG, UK.
| | - Osarhumwese Osaretin Ojo
- South London and Maudsley NHS Foundation Trust, University Hospital, Lewisham High Street, London SE13 6LH, UK
| | - Xiao-Hua Wang
- The School of Nursing, Soochow University, Suzhou 215006, China
| | - Amanda Rodrigues Amorim Adegboye
- Faculty of Education and Health, Department of Psychology, Social Work & Counselling, University of Greenwich, London SE9 2UG, UK
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Zhang Y, Wang L, Yang W, Niu D, Li C, Wang L, Gu P, Xia Y, Shen Y, Yan J, Zhao Q, Mu K, Yan W. Effectiveness of Low Glycemic Index Diet Consultations Through a Diet Glycemic Assessment App Tool on Maternal and Neonatal Insulin Resistance: A Randomized Controlled Trial. JMIR Mhealth Uhealth 2019; 7:e12081. [PMID: 30998227 PMCID: PMC6503641 DOI: 10.2196/12081] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Revised: 11/08/2018] [Accepted: 02/17/2019] [Indexed: 12/25/2022] Open
Abstract
Background Low glycemic index (LGI) diet has shown to be effective in reducing maternal and neonatal complications in high-risk pregnancies. Objective This trial aimed to examine the effectiveness of individualized LGI diet consultations based on the accurate diet glycemic load (GL) assessment tool on maternal and neonatal insulin resistance levels and diet behavior changes in overweight and obese pregnant women. Methods Overweight and obese pregnant women were recruited before 16 weeks of gestation and randomized to the LGI diet arm or the control arm. All participants received standard dietary education according to the Chinese Dietary Guide for Pregnant Women. In the intervention arm, additional individualized dietary GL assessments were performed using an app and instructions of lowering diet glycemic index (GI) to achieve LGI diet were provided by a clinical dietitian at early, middle, and late gestation. Primary outcomes were serum insulin at late gestation, incidence of gestational diabetes mellitus (GDM) for mothers, and cord blood C-peptide level of neonates. Results In total, 400 subjects were randomized and received different interventions. There were no significant differences in maternal serum insulin levels (13.2 [9.3−13.2] uU/mL vs 12.4 [10.5−12.4] uU/mL), incidence of GDM (45 [22.5%] vs 43 [21.5%]), or cord blood C-peptide levels (mean 0.9ng/mL [SD 0.7] vs mean 0.8ng/mL [SD 0.6]) in the intervention group compared with the controls. The diet GI at late gestation was similar (mean 63.2 [SD 10.4] vs mean 64.3 [SD 10.4]), whereas greater diet fiber intake was observed in the intervention group (mean 11.6 grams [SD 8.0] vs mean 9.0 grams [SD 5.6]; P=.006). Adherence measurements did not significantly differ between 2 groups. Conclusions Individualized LGI diet consultations for overweight and obese pregnant women failed to make a significant difference in maternal or neonatal insulin resistance compared with the standard gestational diet consultation. Trial Registration ClinicalTrials.gov NCT01628835; http://clinicaltrials.gov/ct2/show/NCT01628835 (Archived by WebCite at http://www.webcitation.org/77LHgWP0k)
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Affiliation(s)
- Yi Zhang
- Children's Hospital of Fudan University, Shanghai, China
| | - Liping Wang
- International Peace Maternity & Child Health Hospital of China Welfare Institute, Shanghai, China
| | - Wenhong Yang
- Kunshan Maternity and Child Care Center, Kunshan, China
| | - Dayan Niu
- Children's Hospital of Fudan University, Shanghai, China
| | - Chunying Li
- Kunshan Maternity and Child Care Center, Kunshan, China
| | - Liling Wang
- International Peace Maternity & Child Health Hospital of China Welfare Institute, Shanghai, China
| | - Ping Gu
- Kunshan Maternity and Child Care Center, Kunshan, China
| | - Yingqian Xia
- International Peace Maternity & Child Health Hospital of China Welfare Institute, Shanghai, China
| | - Ying Shen
- International Peace Maternity & Child Health Hospital of China Welfare Institute, Shanghai, China
| | - Juhua Yan
- Kunshan Maternity and Child Care Center, Kunshan, China
| | - Qian Zhao
- Children's Hospital of Fudan University, Shanghai, China
| | - Kai Mu
- Children's Hospital of Fudan University, Shanghai, China
| | - Weili Yan
- Children's Hospital of Fudan University, Shanghai, China
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Zaharudin N, Staerk D, Dragsted LO. Inhibition of α-glucosidase activity by selected edible seaweeds and fucoxanthin. Food Chem 2019; 270:481-486. [PMID: 30174076 DOI: 10.1016/j.foodchem.2018.07.142] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 07/19/2018] [Accepted: 07/21/2018] [Indexed: 11/30/2022]
Abstract
A 5 mg/mL solution of water, methanol and acetone extracts of seaweeds were used for α-glucosidase inhibition assay hyphenated with high performance liquid chromatography-mass spectrometry (HPLC-HRMS). The results showed acetone extracts of Undaria pinnatifida has the strongest inhibitory effect against α-glucosidase activity with IC50 0.08 ± 0.002 mg/mL. The active compound found in Undaria pinnatifida was identified as fucoxanthin. Analytical standard sample of fucoxanthin significantly inhibited α-glucosidase with IC50 value 0.047 ± 0.001 mg/mL. An inhibition kinetics study indicates that fucoxanthin is showing mixed-type inhibition. These results suggest that Undaria pinnatifida has a potential to inhibit α-glucosidase and may be used as a bioactive food ingredient for glycaemic control.
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Affiliation(s)
- Nazikussabah Zaharudin
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen DK-1958, Denmark; Faculty of Industrial Sciences & Technology, Universiti Malaysia Pahang, 26300 Gambang, Pahang, Malaysia.
| | - Dan Staerk
- Department of Drug Design and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, DK-2100 Copenhagen, Denmark
| | - Lars Ove Dragsted
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen DK-1958, Denmark
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Attenuation of maternal weight gain impacts infant birthweight: systematic review and meta-analysis. J Dev Orig Health Dis 2018; 10:387-405. [PMID: 30411697 DOI: 10.1017/s2040174418000879] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Despite many interventions aiming to reduce excessive gestational weight gain (GWG), it is currently unclear the impact on infant anthropometric outcomes. The aim of this review was to evaluate offspring anthropometric outcomes in studies designed to reduce GWG. A systematic search of seven international databases, one clinical trial registry and three Chinese databases was conducted without date limits. Studies were categorised by intervention type: diet, physical activity (PA), lifestyle (diet + PA), other, gestational diabetes mellitus (GDM) (diet, PA, lifestyle, metformin and other). Meta-analyses were reported as weighted mean difference (WMD) for birthweight and birth length, and risk ratio (RR) for small for gestational age (SGA), large for gestational age (LGA), macrosomia and low birth weight (LBW). Collectively, interventions reduced birthweight, risk of macrosomia and LGA by 71 g (WMD: -70.67, 95% CI -101.90 to -39.43, P<0.001), 16% (RR: 0.84, 95% CI 0.73-0.98, P=0.026) and 19% (RR: 0.81, 95% CI 0.69-0.96, P=0.015), respectively. Diet interventions decreased birthweight and LGA by 99 g (WMD -98.80, 95% CI -178.85 to -18.76, P=0.016) and 65% (RR: 0.35, 95% CI 0.17-0.72, P=0.004). PA interventions reduced the risk of macrosomia by 51% (RR: 0.49, 95% CI 0.26-0.92, P=0.036). In women with GDM, diet and lifestyle interventions reduced birthweight by 211 and 296 g, respectively (WMD: -210.93, 95% CI -374.77 to -46.71, P=0.012 and WMD:-295.93, 95% CI -501.76 to -90.10, P=0.005, respectively). Interventions designed to reduce excessive GWG lead to a small reduction in infant birthweight and risk of macrosomia and LGA, without influencing the risk of adverse outcomes including LBW and SGA.
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Hernandez TL, Mande A, Barbour LA. Nutrition therapy within and beyond gestational diabetes. Diabetes Res Clin Pract 2018; 145:39-50. [PMID: 29679625 PMCID: PMC6195478 DOI: 10.1016/j.diabres.2018.04.004] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 04/03/2018] [Indexed: 02/08/2023]
Abstract
With the global rising prevalence of gestational diabetes (GDM), an adaptable, economical approach to nutrition therapy that effectively controls maternal glycemia while promoting normal fetal growth will have far-reaching implications. The conventional focus has been to rigidly limit all types of carbohydrate. While controlling glucose, this approach fosters maternal anxiety and is a primary barrier to adherence. Many mothers substitute fat for carbohydrate, which may unintentionally enhance lipolysis, promote elevated free fatty acids (FFA), and worsen maternal insulin resistance (IR). Nutrition that worsens IR may facilitate nutrient shunting across the placenta, promoting excess fetal fat accretion. Evidence suggests that liberalizing higher quality, nutrient-dense carbohydrates results in controlled fasting/postprandial glucose, lower FFA, improved insulin action, vascular benefits, and may reduce excess infant adiposity. Thus, a less carbohydrate-restricted approach may improve maternal adherence when combined with higher quality carbohydrates, lower fat, appropriate caloric intake, and ethnically acceptable foods. Such a diet can be culturally sensitive, socioeconomically attentive, minimize further weight gain in GDM, with potential relevance for pregnancies complicated by overweight/obesity. Future research is needed to better understand the effect of macronutrient composition on the placenta and gut microbiome, the benefits/risks of nonnutritive sweeteners, and whether precision-nutrition is beneficial in pregnancy.
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Affiliation(s)
- Teri L Hernandez
- Department of Medicine, Division of Endocrinology, Metabolism, and Diabetes, University of Colorado, Anschutz Medical Campus, Aurora, CO, United States; College of Nursing, University of Colorado, Anschutz Medical Campus, Aurora, CO, United States.
| | - Archana Mande
- Colorado Clinical and Translational Science Institute, University of Colorado, Anschutz Medical Campus, Aurora, CO, United States
| | - Linda A Barbour
- Department of Medicine, Division of Endocrinology, Metabolism, and Diabetes, University of Colorado, Anschutz Medical Campus, Aurora, CO, United States; Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of Colorado School of Medicine, Aurora, CO, United States
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20
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Denney JM, Quinn KH. Gestational Diabetes: Underpinning Principles, Surveillance, and Management. Obstet Gynecol Clin North Am 2018; 45:299-314. [PMID: 29747732 DOI: 10.1016/j.ogc.2018.01.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Gestational diabetes mellitus (GDM) is carbohydrate intolerance resulting in hyperglycemia with onset during pregnancy. The article aims to provide clinicians with a working framework to minimize maternal and neonatal morbidity. Landmark historical and recent data are reviewed and presented to provide clinicians with a quick, easy reference for recognition and management of GDM. Data presented tie in insights with underlying pathophysiologic processes leading to GDM. Screening and diagnostic thresholds are discussed along with management upon diagnosis. Good clinical practice regarding screening, diagnosis, and management of GDM effectively reduces risk and improves outcomes of women and fetuses in affected pregnancies.
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Affiliation(s)
- Jeffrey M Denney
- Department of Obstetrics and Gynecology, Section on Maternal-Fetal Medicine, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA.
| | - Kristen H Quinn
- Department of Obstetrics and Gynecology, Section on Maternal-Fetal Medicine, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA
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21
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Sideratou T, Atkinson F, Campbell GJ, Petocz P, Bell-Anderson KS, Brand-Miller J. Glycaemic Index of Maternal Dietary Carbohydrate Differentially Alters Fto and Lep Expression in Offspring in C57BL/6 Mice. Nutrients 2018; 10:E1342. [PMID: 30241328 PMCID: PMC6213875 DOI: 10.3390/nu10101342] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 09/13/2018] [Accepted: 09/17/2018] [Indexed: 12/30/2022] Open
Abstract
Maternal diet and gestational hyperglycaemia have implications for offspring health. Leptin (LEP) and fat mass and obesity-associated (FTO) alleles are known to influence body fat mass in humans, potentially via effects on appetite. We hypothesized that expression of Fto, Lep, and other appetite-related genes (Argp, Npy, Pomc, Cart, Lepr) in the offspring of female mice are influenced by the glycaemic index (GI) of carbohydrates in the maternal diet. C57BL/6 mice were randomly assigned to low or high GI diets and mated with chow-fed males at eight weeks of age. Male pups were weaned at four weeks and randomly divided into two groups, one group following their mother's diet (LL and HH), and one following the standard chow diet (LC and HC) to 20 weeks. Fto expression was 3.8-fold higher in the placenta of mothers fed the high GI diet (p = 0.0001) and 2.5-fold higher in the hypothalamus of 20-week old offspring fed the high GI (HH vs. LL, p < 0.0001). By contrast, leptin gene (Lep) expression in visceral adipose tissue was 4.4-fold higher in four-week old offspring of low GI mothers (LC vs. HC, p < 0.0001) and 3.3-fold higher in visceral adipose tissue of 20-week old animals (LL vs. HH, p < 0.0001). Plasma ghrelin and leptin levels, and hypothalamic appetite genes were also differentially regulated by maternal and offspring diet. These findings provide the first evidence in an animal model that maternal high GI dietary carbohydrates that are digested and absorbed faster may contribute to programming of appetite in offspring.
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Affiliation(s)
- Theodora Sideratou
- School of Life and Environmental Sciences, University of Sydney, Sydney, NSW 2006, Australia.
| | - Fiona Atkinson
- School of Life and Environmental Sciences and Charles Perkins Centre, University of Sydney, Sydney, NSW 2006, Australia.
| | - Grace J Campbell
- School of Life and Environmental Sciences and Charles Perkins Centre, University of Sydney, Sydney, NSW 2006, Australia.
| | - Peter Petocz
- Department of Statistics, Macquarie University, Sydney, NSW 2109, Australia.
| | - Kim S Bell-Anderson
- School of Life and Environmental Sciences and Charles Perkins Centre, University of Sydney, Sydney, NSW 2006, Australia.
| | - Jennie Brand-Miller
- School of Life and Environmental Sciences and Charles Perkins Centre, University of Sydney, Sydney, NSW 2006, Australia.
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22
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Xu J, Ye S. Influence of low-glycemic index diet for gestational diabetes: a meta-analysis of randomized controlled trials. J Matern Fetal Neonatal Med 2018; 33:687-692. [PMID: 30231782 DOI: 10.1080/14767058.2018.1497595] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background: Low-glycemic index (GI) diet might be beneficial for gestational diabetes. However, the results remained controversial. We conducted a systematic review and meta-analysis to explore the influence of low-GI diet on gestational diabetes.Methods: PubMed, EMbase, Web of Science, EBSCO, and Cochrane library databases were systematically searched. Randomized controlled trials (RCTs) assessing the effect of low-GI diet on gestational diabetes were included. Two investigators independently searched articles, extracted data, and assessed the quality of included studies. This meta-analysis was performed using the random-effect model.Results: Six RCTs involving 532 patients were included in the meta-analysis. Overall, compared with a control intervention in gestational diabetes, low-GI diet was found to significantly reduce 2 h postprandial glucose (Std. MD = -0.46; 95% CI = -0.82 to -0.10; p = .01), but demonstrated no substantial influence on fasting plasma glucose (Std. MD = -0.24; 95% CI = -0.72 to 0.24; p = .33), HbA1c (Std. MD = 0.01; 95% CI = -0.29 to 0.31; p = .94), birth weight (Std. MD = -0.17; 95% CI = -0.41 to 0.06; p = .15), macrosomia (Std. MD = 0.45; 95% CI = 0.16 to 1.30; p = .14) and insulin requirement (Std. MD = 0.91; 95% CI = 0.68 to 1.22; p = .55).Conclusions: Compared with control intervention in gestational diabetes, low-GI diet was found to significantly decrease 2 h postprandial glucose, but showed no notable impact on fasting plasma glucose, HbA1c, birth weight, macrosomia, and insulin requirement.
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Affiliation(s)
- Jiang Xu
- Department of Endocrinology, The First Affiliated Hospital of USTC, Anhui Provincial Hospital, Hefei, Anhui, China
| | - Shandong Ye
- Department of Endocrinology, The First Affiliated Hospital of USTC, Anhui Provincial Hospital, Hefei, Anhui, China
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23
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Yamamoto JM, Kellett JE, Balsells M, García-Patterson A, Hadar E, Solà I, Gich I, van der Beek EM, Castañeda-Gutiérrez E, Heinonen S, Hod M, Laitinen K, Olsen SF, Poston L, Rueda R, Rust P, van Lieshout L, Schelkle B, Murphy HR, Corcoy R. 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. Diabetes Care 2018; 41:1346-1361. [PMID: 29934478 DOI: 10.2337/dc18-0102] [Citation(s) in RCA: 131] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Accepted: 03/10/2018] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Medical nutrition therapy is a mainstay of gestational diabetes mellitus (GDM) treatment. However, data are limited regarding the optimal diet for achieving euglycemia and improved perinatal outcomes. This study aims to investigate whether modified dietary interventions are associated with improved glycemia and/or improved birth weight outcomes in women with GDM when compared with control dietary interventions. RESEARCH DESIGN AND METHODS Data from published randomized controlled trials that reported on dietary components, maternal glycemia, and birth weight were gathered from 12 databases. Data were extracted in duplicate using prespecified forms. RESULTS From 2,269 records screened, 18 randomized controlled trials involving 1,151 women were included. Pooled analysis demonstrated that for modified dietary interventions when compared with control subjects, there was a larger decrease in fasting and postprandial glucose (-4.07 mg/dL [95% CI -7.58, -0.57]; P = 0.02 and -7.78 mg/dL [95% CI -12.27, -3.29]; P = 0.0007, respectively) and a lower need for medication treatment (relative risk 0.65 [95% CI 0.47, 0.88]; P = 0.006). For neonatal outcomes, analysis of 16 randomized controlled trials including 841 participants showed that modified dietary interventions were associated with lower infant birth weight (-170.62 g [95% CI -333.64, -7.60]; P = 0.04) and less macrosomia (relative risk 0.49 [95% CI 0.27, 0.88]; P = 0.02). The quality of evidence for these outcomes was low to very low. Baseline differences between groups in postprandial glucose may have influenced glucose-related outcomes. As well, relatively small numbers of study participants limit between-diet comparison. CONCLUSIONS Modified dietary interventions favorably influenced outcomes related to maternal glycemia and birth weight. This indicates that there is room for improvement in usual dietary advice for women with GDM.
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Affiliation(s)
- Jennifer M Yamamoto
- Division of Endocrinology and Metabolism, Department of Medicine, University of Calgary, Calgary, Canada
| | | | - Montserrat Balsells
- Department of Endocrinology and Nutrition, Hospital Mútua de Terrassa, Terrassa, Spain
| | | | - Eran Hadar
- Rabin Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Ivan Solà
- Institute of Biomedical Research, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Iberoamerican Cochrane Centre, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,CIBER Epidemiología y Salud Pública, Instituto de Salud Carlos III, Madrid, Spain
| | - Ignasi Gich
- CIBER Epidemiología y Salud Pública, Instituto de Salud Carlos III, Madrid, Spain.,Department of Epidemiology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Department of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Eline M van der Beek
- Nutricia Research, Utrecht, the Netherlands.,Department of Pediatrics, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | | | - Seppo Heinonen
- Department of Obstetrics and Gynecology, University of Helsinki, Helsinki, Finland.,Helsinki University Hospital, Helsinki, Finland
| | - Moshe Hod
- Rabin Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Kirsi Laitinen
- Institute of Biomedicine, University of Turku, Turku, Finland.,Turku University Hospital, Turku, Finland
| | | | | | - Ricardo Rueda
- Research and Development Department, Abbott Nutrition, Granada, Spain
| | - Petra Rust
- Department of Nutritional Sciences, University of Vienna, Vienna, Austria
| | | | | | - Helen R Murphy
- Norfolk and Norwich University Hospitals, Norfolk, U.K. .,Cambridge University Hospitals NHS Foundation Trust, Cambridge, U.K.,Norwich Medical School, University of East Anglia, Norwich, U.K
| | - Rosa Corcoy
- Department of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain.,CIBER Bioengineering, Biomaterials and Nanotechnology, Instituto de Salud Carlos III, Madrid, Spain.,Department of Endocrinology and Nutrition, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
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24
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Barnes RA, Ross GP, Jalaludin BB, Flack JR. Initial group dietary education compared to individual education in gestational diabetes mellitus management: Do outcomes differ? Diabetes Res Clin Pract 2018; 140:88-96. [PMID: 29605560 DOI: 10.1016/j.diabres.2018.03.039] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 03/14/2018] [Accepted: 03/22/2018] [Indexed: 11/27/2022]
Abstract
AIMS To assess the effectiveness of Initial Group versus Initial Individual GDM dietary education in terms of insulin requirements and pregnancy outcomes. METHODS A retrospective audit of clinical data was conducted where English speaking women who received initial education in a group setting (01-2-2012 to 01-2-2014) (Group), were compared to women who received initial individual education with a dietitian (1-2-2010 to 31-1-2012) (Individual), all followed by one individual dietitian appointment. The same dietary information was provided in both settings. Data collected included: attendance rates, insulin requirements, maternal weight gain, and rates of adverse birth outcomes. Data were compared by t-test or Chi-squared test. Multivariable logistic regression analysis was conducted to determine independent predictors of insulin therapy. RESULTS Of 743 women; (362 Group and 381 Individual), Group women had a lower HbA1c at GDM diagnosis 5.3 ± 0.6% versus 5.5 ± 0.5% (34 ± 6.6 mmol/mol versus 37 ± 5.5 mmol/mol p < 0.0001). There were no other differences in baseline characteristics. More Group women required insulin (42.0% versus 34.6%, p = 0.048). Group education was found to be an independent predictor of insulin therapy (OR = 1.9 [1.29, 2.75] p < 0.001). CONCLUSIONS Despite adjusting for all known potential confounders, unlike Individual education, Group education remained a significant predictor of insulin therapy (but resulted in similar therapeutic and pregnancy outcomes to Individual education).
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Affiliation(s)
- Robyn A Barnes
- Department of Diabetes and Endocrinology, Bankstown-Lidcombe Hospital, 68 Eldridge Rd, Bankstown, NSW 2200, Australia; School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia.
| | - Glynis P Ross
- Department of Diabetes and Endocrinology, Bankstown-Lidcombe Hospital, 68 Eldridge Rd, Bankstown, NSW 2200, Australia; Faculty of Medicine, University of Sydney, Sydney, NSW, Australia.
| | - Bin B Jalaludin
- Healthy People and Places Unit, South Western Sydney Local Health District, Liverpool, Australia; Ingham Institute for Medical Research, University of New South Wales, Liverpool, NSW 2170, Australia.
| | - Jeff R Flack
- Department of Diabetes and Endocrinology, Bankstown-Lidcombe Hospital, 68 Eldridge Rd, Bankstown, NSW 2200, Australia; Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia; School of Medicine, Western Sydney University, Sydney, NSW, Australia.
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25
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Duarte-Gardea MO, Gonzales-Pacheco DM, Reader DM, Thomas AM, Wang SR, Gregory RP, Piemonte TA, Thompson KL, Moloney L. Academy of Nutrition and Dietetics Gestational Diabetes Evidence-Based Nutrition Practice Guideline. J Acad Nutr Diet 2018; 118:1719-1742. [PMID: 29859757 DOI: 10.1016/j.jand.2018.03.014] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 03/20/2018] [Indexed: 12/14/2022]
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26
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Feig DS, Berger H, Donovan L, Godbout A, Kader T, Keely E, Sanghera R. Diabetes and Pregnancy. Can J Diabetes 2018; 42 Suppl 1:S255-S282. [DOI: 10.1016/j.jcjd.2017.10.038] [Citation(s) in RCA: 108] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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27
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Maternal metabolic response to dietary treatment for impaired glucose tolerance and gestational diabetes mellitus. Ir J Med Sci 2018; 187:701-708. [DOI: 10.1007/s11845-018-1744-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 01/10/2018] [Indexed: 12/16/2022]
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28
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Liang Y, Gong Y, Zhang X, Yang D, Zhao D, Quan L, Zhou R, Bao W, Cheng G. Dietary Protein Intake, Meat Consumption, and Dairy Consumption in the Year Preceding Pregnancy and During Pregnancy and Their Associations With the Risk of Gestational Diabetes Mellitus: A Prospective Cohort Study in Southwest China. Front Endocrinol (Lausanne) 2018; 9:596. [PMID: 30364240 PMCID: PMC6193067 DOI: 10.3389/fendo.2018.00596] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 09/19/2018] [Indexed: 12/16/2022] Open
Abstract
Background: Gestational diabetes mellitus (GDM) has become a public health problem in China. Objective: To examine the association of dietary protein intake before and during pregnancy with the risk of GDM. Design: Dietary intake before pregnancy and during the first and second trimesters of pregnancy was assessed using food frequency questionnaires in a prospective cohort of pregnant women. To screen GDM, participants underwent an OGTT test during 24-28 weeks of gestation. Cox proportional hazards were used to estimate RRs and 95% CIs for the associations between tertiles of dietary protein and the source of protein intake in different time windows with GDM status. Results: Higher intake of total protein [RR (95% CI): 1.92 (1.10-3.14), p for trend = 0.04] or animal protein [1.67 (1.19-2.93), p for trend = 0.03] in mid-pregnancy was associated with higher risk of GDM. Vegetable protein intake before or during pregnancy was not related to GDM risk (p for trend > 0.05). Moreover, in the mid-pregnancy, participants with higher meat consumption or dairy consumption had a higher risk of GDM. Conclusion: Our study indicated that higher dietary intakes of total protein and animal protein in mid-pregnancy were associated with an increased risk of GDM among pregnant Chinese women.
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Affiliation(s)
- Yi Liang
- West China School of Public Health and Healthy Food Evaluation Research Center, Sichuan University, Chengdu, China
| | - Yunhui Gong
- Department of Obstetrics and Gynecology, West China Second University Hospital, Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, Sichuan University, Chengdu, China
- Department of Obstetrics and Gynecology, Longquanyi District of Chengdu Maternity and Child Health Care Hospital, Chengdu, China
| | - Xiao Zhang
- West China School of Public Health and Healthy Food Evaluation Research Center, Sichuan University, Chengdu, China
| | - Dagang Yang
- Department of Clinical Nutrition, Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Danqing Zhao
- Department of Obstetrics and Gynecology, Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Liming Quan
- West China School of Public Health and Healthy Food Evaluation Research Center, Sichuan University, Chengdu, China
| | - Rong Zhou
- Department of Obstetrics and Gynecology, West China Second University Hospital, Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, Sichuan University, Chengdu, China
| | - Wei Bao
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA, United States
- *Correspondence: Wei Bao
| | - Guo Cheng
- West China School of Public Health and State Key Laboratory of Biotherapy and Cancer Center, Sichuan University, Chengdu, China
- Guo Cheng
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Ha V, Bonner AJ, Jadoo JK, Beyene J, Anand SS, de Souza RJ. The effects of various diets on glycemic outcomes during pregnancy: A systematic review and network meta-analysis. PLoS One 2017; 12:e0182095. [PMID: 28771519 PMCID: PMC5542432 DOI: 10.1371/journal.pone.0182095] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 07/12/2017] [Indexed: 12/16/2022] Open
Abstract
Aims Evidence to support dietary modifications to improve glycemia during pregnancy is limited, and the benefits of diet beyond limiting gestational weight gain is unclear. Therefore, a systematic review and network meta-analysis of randomized trials was conducted to compare the effects of various common diets, stratified by the addition of gestational weight gain advice, on fasting glucose and insulin, hemoglobin A1c (HbA1c), and homeostatic model assessment for insulin resistance (HOMA-IR) in pregnant women. Methods MEDLINE, EMBASE, Cochrane database, and reference lists of published studies were searched through April 2017. Randomized trials directly comparing two or more diets for ≥2-weeks were eligible. Bayesian network meta-analysis was performed for fasting glucose. Owing to a lack of similar dietary comparisons, a standard pairwise meta-analysis for the other glycemic outcomes was performed. The certainty of the pooled effect estimates was assessed using the GRADE tool. Results Twenty-one trials (1,865 participants) were included. In general, when given alongside gestational weight gain advice, fasting glucose improved in most diets compared to diets that gave gestational weight gain advice only. However, fasting glucose increased in high unsaturated or monounsaturated fatty acids diets. In the absence of gestational weight gain advice, fasting glucose improved in DASH-style diets compared to standard of care. Although most were non-significant, similar trends were observed for these same diets for the other glycemic outcomes. Dietary comparisons ranged from moderate to very low in quality of evidence. Conclusion/Interpretation Alongside with gestational weight gain advice, most diets, with the exception of a high unsaturated or a high monounsaturated fatty acid diet, demonstrated a fasting glucose improvement compared with gestational weight gain advice only. When gestational weight gain advice was not given, the DASH-style diet appeared optimal on fasting glucose. However, a small number of trials were identified and most dietary comparisons were underpowered to detect differences in glycemic outcomes. Further studies that are high in quality and adequately powered are needed to confirm these findings. Registration PROSPERO CRD42015026008
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Affiliation(s)
- Vanessa Ha
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
- Population Genomics Program, Chanchlani Research Centre, McMaster University, Hamilton, Ontario, Canada
| | - Ashley J. Bonner
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
- Population Genomics Program, Chanchlani Research Centre, McMaster University, Hamilton, Ontario, Canada
| | - Jaynendr K. Jadoo
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Joseph Beyene
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
- Population Genomics Program, Chanchlani Research Centre, McMaster University, Hamilton, Ontario, Canada
- The Dalla Lana School of Public Health, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- The Hospital for Sick Children Research Institute, Toronto, ON, Canada
| | - Sonia S. Anand
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
- Population Genomics Program, Chanchlani Research Centre, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
- General Hospital Campus, Hamilton, Ontario, Canada
| | - Russell J. de Souza
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
- Population Genomics Program, Chanchlani Research Centre, McMaster University, Hamilton, Ontario, Canada
- * E-mail:
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30
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Brown J, Alwan NA, West J, Brown S, McKinlay CJD, Farrar D, Crowther CA. Lifestyle interventions for the treatment of women with gestational diabetes. Cochrane Database Syst Rev 2017; 5:CD011970. [PMID: 28472859 PMCID: PMC6481373 DOI: 10.1002/14651858.cd011970.pub2] [Citation(s) in RCA: 97] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Gestational diabetes (GDM) is glucose intolerance, first recognised in pregnancy and usually resolving after birth. GDM is associated with both short- and long-term adverse effects for the mother and her infant. Lifestyle interventions are the primary therapeutic strategy for many women with GDM. OBJECTIVES To evaluate the effects of combined lifestyle interventions with or without pharmacotherapy in treating women with gestational diabetes. SEARCH METHODS We searched the Pregnancy and Childbirth Group's Trials Register (14 May 2016), ClinicalTrials.gov, WHO International Clinical Trials Registry Platform (ICTRP) (14th May 2016) and reference lists of retrieved studies. SELECTION CRITERIA We included only randomised controlled trials comparing a lifestyle intervention with usual care or another intervention for the treatment of pregnant women with GDM. Quasi-randomised trials were excluded. Cross-over trials were not eligible for inclusion. Women with pre-existing type 1 or type 2 diabetes were excluded. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by the Cochrane Collaboration. All selection of studies, data extraction was conducted independently by two review authors. MAIN RESULTS Fifteen trials (in 45 reports) are included in this review (4501 women, 3768 infants). None of the trials were funded by a conditional grant from a pharmaceutical company. The lifestyle interventions included a wide variety of components such as education, diet, exercise and self-monitoring of blood glucose. The control group included usual antenatal care or diet alone. Using GRADE methodology, the quality of the evidence ranged from high to very low quality. The main reasons for downgrading evidence were inconsistency and risk of bias. We summarised the following data from the important outcomes of this review. Lifestyle intervention versus control groupFor the mother:There was no clear evidence of a difference between lifestyle intervention and control groups for the risk of hypertensive disorders of pregnancy (pre-eclampsia) (average risk ratio (RR) 0.70; 95% confidence interval (CI) 0.40 to 1.22; four trials, 2796 women; I2 = 79%, Tau2 = 0.23; low-quality evidence); caesarean section (average RR 0.90; 95% CI 0.78 to 1.05; 10 trials, 3545 women; I2 = 48%, Tau2 = 0.02; low-quality evidence); development of type 2 diabetes (up to a maximum of 10 years follow-up) (RR 0.98, 95% CI 0.54 to 1.76; two trials, 486 women; I2 = 16%; low-quality evidence); perineal trauma/tearing (RR 1.04, 95% CI 0.93 to 1.18; one trial, n = 1000 women; moderate-quality evidence) or induction of labour (average RR 1.20, 95% CI 0.99 to 1.46; four trials, n = 2699 women; I2 = 37%; high-quality evidence).More women in the lifestyle intervention group had met postpartum weight goals one year after birth than in the control group (RR 1.75, 95% CI 1.05 to 2.90; 156 women; one trial, low-quality evidence). Lifestyle interventions were associated with a decrease in the risk of postnatal depression compared with the control group (RR 0.49, 95% CI 0.31 to 0.78; one trial, n = 573 women; low-quality evidence).For the infant/child/adult:Lifestyle interventions were associated with a reduction in the risk of being born large-for-gestational age (LGA) (RR 0.60, 95% CI 0.50 to 0.71; six trials, 2994 infants; I2 = 4%; moderate-quality evidence). Birthweight and the incidence of macrosomia were lower in the lifestyle intervention group.Exposure to the lifestyle intervention was associated with decreased neonatal fat mass compared with the control group (mean difference (MD) -37.30 g, 95% CI -63.97 to -10.63; one trial, 958 infants; low-quality evidence). In childhood, there was no clear evidence of a difference between groups for body mass index (BMI) ≥ 85th percentile (RR 0.91, 95% CI 0.75 to 1.11; three trials, 767 children; I2 = 4%; moderate-quality evidence).There was no clear evidence of a difference between lifestyle intervention and control groups for the risk of perinatal death (RR 0.09, 95% CI 0.01 to 1.70; two trials, 1988 infants; low-quality evidence). Of 1988 infants, only five events were reported in total in the control group and there were no events in the lifestyle group. There was no clear evidence of a difference between lifestyle intervention and control groups for a composite of serious infant outcome/s (average RR 0.57, 95% CI 0.21 to 1.55; two trials, 1930 infants; I2 = 82%, Tau2 = 0.44; very low-quality evidence) or neonatal hypoglycaemia (average RR 0.99, 95% CI 0.65 to 1.52; six trials, 3000 infants; I2 = 48%, Tau2 = 0.12; moderate-quality evidence). Diabetes and adiposity in adulthood and neurosensory disability in later childhoodwere not prespecified or reported as outcomes for any of the trials included in this review. AUTHORS' CONCLUSIONS Lifestyle interventions are the primary therapeutic strategy for women with GDM. Women receiving lifestyle interventions were less likely to have postnatal depression and were more likely to achieve postpartum weight goals. Exposure to lifestyle interventions was associated with a decreased risk of the baby being born LGA and decreased neonatal adiposity. Long-term maternal and childhood/adulthood outcomes were poorly reported.The value of lifestyle interventions in low-and middle-income countries or for different ethnicities remains unclear. The longer-term benefits or harms of lifestyle interventions remains unclear due to limited reporting.The contribution of individual components of lifestyle interventions could not be assessed. Ten per cent of participants also received some form of pharmacological therapy. Lifestyle interventions are useful as the primary therapeutic strategy and most commonly include healthy eating, physical activity and self-monitoring of blood glucose concentrations.Future research could focus on which specific interventions are most useful (as the sole intervention without pharmacological treatment), which health professionals should give them and the optimal format for providing the information. Evaluation of long-term outcomes for the mother and her child should be a priority when planning future trials. There has been no in-depth exploration of the costs 'saved' from reduction in risk of LGA/macrosomia and potential longer-term risks for the infants.
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Affiliation(s)
- Julie Brown
- The University of AucklandLiggins InstitutePark RdGraftonAucklandNew Zealand1142
| | - Nisreen A Alwan
- Faculty of Medicine, University of SouthamptonAcademic Unit of Primary Care and Population SciencesSouthampton General HospitalSouthamptonHampshireUKSO16 6YD
| | - Jane West
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation TrustBradfordUK
| | - Stephen Brown
- Auckland University of TechnologySchool of Interprofessional Health Studies90 Akoranga DriveAucklandNew Zealand0627
| | | | - Diane Farrar
- Bradford Institute for Health ResearchMaternal and Child HealthBradford Royal InfirmaryDuckworth LaneBradfordUKBD9 6RJ
| | - Caroline A Crowther
- The University of AucklandLiggins InstitutePark RdGraftonAucklandNew Zealand1142
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Carolan-Olah M, Duarte-Gardea M, Lechuga J. A systematic review of interventions for Hispanic women with or at risk of Gestational diabetes mellitus (GDM). SEXUAL & REPRODUCTIVE HEALTHCARE 2017; 13:14-22. [PMID: 28844353 DOI: 10.1016/j.srhc.2017.02.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 12/15/2016] [Accepted: 02/21/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND OBJECTIVE Gestational Diabetes Mellitus (GDM) is a serious health concern for pregnant women, with Hispanic women at particular risk for developing the condition. The aim of this review was to critically examine GDM intervention programs for Hispanic women, in the United States of America (US). METHODS English and Spanish electronic databases were searched for relevant studies published between 1995 and 2015. Eligible study designs included randomized controlled trial, pre/post-test and quasi experimental methods. RESULTS Findings indicated that there was a dearth of literature reporting on GDM interventions for Hispanic women and just seven papers met inclusion criteria. These seven studies were included in the review and they reported on interventions for: (1) pregnant women at high risk of developing GDM; (2) pregnant women with GDM. Results suggest that a combination of intensive counselling over a prolonged period of time, together with a low calorie, possibly low glycemic index diet, produces best results. CONCLUSION The review found that intensive nutritional counselling approaches which promote low calorie/low GI diets appear to be most effective in BGL management in this population. Interventions that are delivered in Spanish and culturally tailored may be more acceptable to participants. More research is needed to develop suitable interventions to improve GDM management among Hispanic women.
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Affiliation(s)
- Mary Carolan-Olah
- Victoria University, College of Health and Biomedicine, St Alban's Campus, PO Box 14228, Melbourne 8001, Australia.
| | - Maria Duarte-Gardea
- The University of Texas at El Paso, College of Health Sciences, Department of Public Health Sciences, 500 W University Ave, El Paso, TX 79902, United States.
| | - Julia Lechuga
- The University of Texas at El Paso, College of Health Sciences, Department of Psychology, 500 W University Ave, El Paso, TX 79902, United States.
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Han S, Middleton P, Shepherd E, Van Ryswyk E, Crowther CA. Different types of dietary advice for women with gestational diabetes mellitus. Cochrane Database Syst Rev 2017; 2:CD009275. [PMID: 28236296 PMCID: PMC6464700 DOI: 10.1002/14651858.cd009275.pub3] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Dietary advice is the main strategy for managing gestational diabetes mellitus (GDM). It remains unclear what type of advice is best. OBJECTIVES To assess the effects of different types of dietary advice for women with GDM for improving health outcomes for women and babies. SEARCH METHODS We searched Cochrane Pregnancy and Childbirth's Trials Register (8 March 2016), PSANZ's Trials Registry (22 March 2016) and reference lists of retrieved studies. SELECTION CRITERIA Randomised controlled trials comparing the effects of different types of dietary advice for women with GDM. DATA COLLECTION AND ANALYSIS Two authors independently assessed study eligibility, risk of bias, and extracted data. Evidence quality for two comparisons was assessed using GRADE, for primary outcomes for the mother: hypertensive disorders of pregnancy; caesarean section; type 2 diabetes mellitus; and child: large-for-gestational age; perinatal mortality; neonatal mortality or morbidity composite; neurosensory disability; secondary outcomes for the mother: induction of labour; perineal trauma; postnatal depression; postnatal weight retention or return to pre-pregnancy weight; and child: hypoglycaemia; childhood/adulthood adiposity; childhood/adulthood type 2 diabetes mellitus. MAIN RESULTS In this update, we included 19 trials randomising 1398 women with GDM, at an overall unclear to moderate risk of bias (10 comparisons). For outcomes assessed using GRADE, downgrading was based on study limitations, imprecision and inconsistency. Where no findings are reported below for primary outcomes or pre-specified GRADE outcomes, no data were provided by included trials. Primary outcomes Low-moderate glycaemic index (GI) versus moderate-high GI diet (four trials): no clear differences observed for: large-for-gestational age (risk ratio (RR) 0.71, 95% confidence interval (CI) 0.22 to 2.34; two trials, 89 infants; low-quality evidence); severe hypertension or pre-eclampsia (RR 1.02, 95% CI 0.07 to 15.86; one trial, 95 women; very low-quality evidence); eclampsia (RR 0.34, 95% CI 0.01 to 8.14; one trial, 83 women; very low-quality evidence) or caesarean section (RR 0.66, 95% CI 0.29 to 1.47; one trial, 63 women; low-quality evidence). Energy-restricted versus no energy-restricted diet (three trials): no clear differences seen for: large-for-gestational age (RR 1.17, 95% CI 0.65 to 2.12; one trial, 123 infants; low-quality evidence); perinatal mortality (no events; two trials, 423 infants; low-quality evidence); pre-eclampsia (RR 1.00, 95% CI 0.51 to 1.97; one trial, 117 women; low-quality evidence); or caesarean section (RR 1.12, 95% CI 0.80 to 1.56; two trials, 420 women; low-quality evidence). DASH (Dietary Approaches to Stop Hypertension) diet versus control diet (three trials): no clear differences observed for: pre-eclampsia (RR 1.00, 95% CI 0.31 to 3.26; three trials, 136 women); however there were fewer caesarean sections in the DASH diet group (RR 0.53, 95% CI 0.37 to 0.76; two trials, 86 women). Low-carbohydrate versus high-carbohydrate diet (two trials): no clear differences seen for: large-for-gestational age (RR 0.51, 95% CI 0.13 to 1.95; one trial, 149 infants); perinatal mortality (RR 3.00, 95% CI 0.12 to 72.49; one trial, 150 infants); maternal hypertension (RR 0.40, 95% CI 0.13 to 1.22; one trial, 150 women); or caesarean section (RR 1.29, 95% CI 0.84 to 1.99; two trials, 179 women). High unsaturated fat versus low unsaturated fat diet (two trials): no clear differences observed for: large-for-gestational age (RR 0.54, 95% CI 0.21 to 1.37; one trial, 27 infants); pre-eclampsia (no cases; one trial, 27 women); hypertension in pregnancy (RR 0.54, 95% CI 0.06 to 5.26; one trial, 27 women); caesarean section (RR 1.08, 95% CI 0.07 to 15.50; one trial, 27 women); diabetes at one to two weeks (RR 2.00, 95% CI 0.45 to 8.94; one trial, 24 women) or four to 13 months postpartum (RR 1.00, 95% CI 0.10 to 9.61; one trial, six women). Low-GI versus high-fibre moderate-GI diet (one trial): no clear differences seen for: large-for-gestational age (RR 2.87, 95% CI 0.61 to 13.50; 92 infants); caesarean section (RR 1.91, 95% CI 0.91 to 4.03; 92 women); or type 2 diabetes at three months postpartum (RR 0.76, 95% CI 0.11 to 5.01; 58 women). Diet recommendation plus diet-related behavioural advice versus diet recommendation only (one trial): no clear differences observed for: large-for-gestational age (RR 0.73, 95% CI 0.25 to 2.14; 99 infants); or caesarean section (RR 0.78, 95% CI 0.38 to 1.62; 99 women). Soy protein-enriched versus no soy protein diet (one trial): no clear differences seen for: pre-eclampsia (RR 2.00, 95% CI 0.19 to 21.03; 68 women); or caesarean section (RR 1.00, 95% CI 0.57 to 1.77; 68 women). High-fibre versus standard-fibre diet (one trial): no primary outcomes reported. Ethnic-specific versus standard healthy diet (one trial): no clear differences observed for: large-for-gestational age (RR 0.14, 95% CI 0.01 to 2.45; 20 infants); neonatal composite adverse outcome (no events; 20 infants); gestational hypertension (RR 0.33, 95% CI 0.02 to 7.32; 20 women); or caesarean birth (RR 1.20, 95% CI 0.54 to 2.67; 20 women). Secondary outcomes For secondary outcomes assessed using GRADE no differences were observed: between a low-moderate and moderate-high GI diet for induction of labour (RR 0.88, 95% CI 0.33 to 2.34; one trial, 63 women; low-quality evidence); or an energy-restricted and no energy-restricted diet for induction of labour (RR 1.02, 95% CI 0.68 to 1.53; one trial, 114 women, low-quality evidence) and neonatal hypoglycaemia (average RR 1.06, 95% CI 0.48 to 2.32; two trials, 408 infants; very low-quality evidence).Few other clear differences were observed for reported outcomes. Longer-term health outcomes and health services use and costs were largely not reported. AUTHORS' CONCLUSIONS Evidence from 19 trials assessing different types of dietary advice for women with GDM suggests no clear differences for primary outcomes and secondary outcomes assessed using GRADE, except for a possible reduction in caesarean section for women receiving a DASH diet compared with a control diet. Few differences were observed for secondary outcomes.Current evidence is limited by the small number of trials in each comparison, small sample sizes, and variable methodological quality. More evidence is needed to assess the effects of different types of dietary advice for women with GDM. Future trials should be adequately powered to evaluate short- and long-term outcomes.
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Affiliation(s)
- Shanshan Han
- The University of AdelaideARCH: Australian Research Centre for Health of Women and Babies, Robinson Research Institute, Discipline of Obstetrics and GynaecologyWomen's and Children's Hospital72 King William RoadAdelaideSouth AustraliaAustralia5006
| | - Philippa Middleton
- The University of AdelaideARCH: Australian Research Centre for Health of Women and Babies, Robinson Research Institute, Discipline of Obstetrics and GynaecologyWomen's and Children's Hospital72 King William RoadAdelaideSouth AustraliaAustralia5006
- Healthy Mothers, Babies and Children, South Australian Health and Medical Research InstituteWomen's and Children's Hospital72 King William RoadAdelaideSouth AustraliaAustralia5006
| | - Emily Shepherd
- The University of AdelaideARCH: Australian Research Centre for Health of Women and Babies, Robinson Research Institute, Discipline of Obstetrics and GynaecologyWomen's and Children's Hospital72 King William RoadAdelaideSouth AustraliaAustralia5006
| | - Emer Van Ryswyk
- The University of AdelaideARCH: Australian Research Centre for Health of Women and Babies, Robinson Research Institute, Discipline of Obstetrics and GynaecologyWomen's and Children's Hospital72 King William RoadAdelaideSouth AustraliaAustralia5006
| | - Caroline A Crowther
- The University of AucklandLiggins InstitutePrivate Bag 9201985 Park RoadAucklandNew Zealand
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Ma RCW, Schmidt MI, Tam WH, McIntyre HD, Catalano PM. Clinical management of pregnancy in the obese mother: before conception, during pregnancy, and post partum. Lancet Diabetes Endocrinol 2016; 4:1037-1049. [PMID: 27743977 PMCID: PMC6691730 DOI: 10.1016/s2213-8587(16)30278-9] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 08/15/2016] [Accepted: 08/18/2016] [Indexed: 12/21/2022]
Abstract
The global epidemic of obesity has led to an increasing number of obese women of reproductive age. Obesity is associated with reduced fertility, and pregnancies complicated by maternal obesity are associated with adverse outcomes, including increased risk of gestational diabetes, pre-eclampsia, preterm birth, instrumental and caesarean births, infections, and post-partum haemorrhage. The medical and obstetric management of obese women is focused on identifying, addressing, and preventing some of these associated complications, and is a daunting challenge given the high percentage of patients with obesity and few therapeutic options proven to improve outcomes in this population. The UK's National Institute for Health and Care Excellence guidelines and the American College of Obstetricians and Gynecologists recommend that all pregnant women follow a healthy diet, and consider at least half an hour of moderate physical activity per day during pregnancy. However, although obese women are often directed to seek the advice of a nutritionist and to limit gestational weight gain, guidelines for the management of pregnancy and delivery in this high-risk group are lacking. The post-partum period represents an important opportunity to optimise maternal health before the next pregnancy. As many of the physiological changes of pregnancy associated with maternal obesity are present from early pregnancy onward, reducing maternal obesity before conception is probably the best strategy to decrease the health burden associated with maternal obesity.
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Affiliation(s)
- Ronald Ching Wan Ma
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China.
| | | | - Wing Hung Tam
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Harold David McIntyre
- Mater Clinical School and Mater Research, The University of Queensland, Brisbane, QLD, Australia
| | - Patrick M Catalano
- Center for Reproductive Health, Case Western Reserve University and MetroHealth Medical Center, Cleveland, OH, USA.
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Zhang R, Han S, Chen GC, Li ZN, Silva-Zolezzi I, Parés GV, Wang Y, Qin LQ. Effects of low-glycemic-index diets in pregnancy on maternal and newborn outcomes in pregnant women: a meta-analysis of randomized controlled trials. Eur J Nutr 2016; 57:167-177. [PMID: 27612876 DOI: 10.1007/s00394-016-1306-x] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 08/27/2016] [Indexed: 01/09/2023]
Abstract
PURPOSE Maternal diet with a high glycemic index (GI) is associated with fetal overgrowth and higher infant body adiposity. Effects of low-GI diet on maternal and newborn outcomes have been assessed in both healthy pregnancy and gestational diabetes mellitus, but the results remain inconclusive. This meta-analysis aimed to examine the effects of low-GI diets on maternal and newborn outcomes. METHODS PubMed, Clinical Trials, and Cochrane Library databases were searched for relevant randomized trials up to January 2016. Random- or fixed-effects models were used to calculate combined treatment effects. RESULTS A total of 11 trials involving 1985 women were eligible for analysis. This meta-analysis assessed 7 maternal and 11 newborn outcomes. Of these, gestational weight gain (GWG), fasting blood glucose (FBG), newborn birth weight, ponderal index (PI), proportion of macrosomia, and large for gestational age (LGA) were investigated in more than 8 trials. Compared with control diets, low-GI diets significantly reduced FBG (weight mean differences (WMD) = -0.18 mmol/L, 95 % CI: -0.33, -0.02), 2-h postprandial glucose level (WMD = -0.33 mmol/L, 95 % CI: -0.54, -0.12), and the proportion of LGA (RR = 0.52, 95 % CI: 0.31, 0.89). A lower GWG (WMD = -0.69 kg, 95 % CI: -1.74, 0.36) and birth weight (WMD = -0.10 kg, 95 % CI: -0.23, 0.03) were also observed without significant differences. Heterogeneity was observed in the GWG, FBG, and birth weight analyses. Low-GI diets did not affect other maternal and newborn outcomes. In subgroup and sensitivity analyses, the intervention effects of low GI on GWG and FBG varied. CONCLUSIONS Low-GI diets may have beneficial effects on maternal outcomes for those at risk of developing high glucose levels, without causing adverse effects on newborn outcomes. However, results should be interpreted with caution because of the evidence of heterogeneity and limited number of studies.
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Affiliation(s)
- Ru Zhang
- Department of Nutrition and Food Hygiene, School of Public Health, Soochow University, 199 Renai Road, Dushu Lake Higher Education Town, Suzhou, 215123, China
| | - Shufen Han
- Department of Nutrition and Food Hygiene, School of Public Health, Soochow University, 199 Renai Road, Dushu Lake Higher Education Town, Suzhou, 215123, China
| | - Guo-Chong Chen
- Department of Nutrition and Food Hygiene, School of Public Health, Soochow University, 199 Renai Road, Dushu Lake Higher Education Town, Suzhou, 215123, China
| | - Zeng-Ning Li
- Department of Nutrition, First Hospital of Hebei Medical University, Shijiazhuang, 050031, China
| | - Irma Silva-Zolezzi
- Nutrition and Health Research, Nestlé Research Center, Lausanne, Switzerland
| | | | - Yi Wang
- Nestlé Research Center, Beijing, 100095, China.
| | - Li-Qiang Qin
- Department of Nutrition and Food Hygiene, School of Public Health, Soochow University, 199 Renai Road, Dushu Lake Higher Education Town, Suzhou, 215123, China.
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Wei J, Heng W, Gao J. Effects of Low Glycemic Index Diets on Gestational Diabetes Mellitus: A Meta-Analysis of Randomized Controlled Clinical Trials. Medicine (Baltimore) 2016; 95:e3792. [PMID: 27258511 PMCID: PMC4900719 DOI: 10.1097/md.0000000000003792] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Studies of the effects of low glycemic index (LGI) diets on gestational diabetes mellitus (GDM) have reported conflicting findings.The aim of the study was to evaluate the results of randomized controlled trials (RCTs) that investigated the effects of LGI diets with and without added dietary fiber (DF) on maternal and neonatal outcomes in GDM patients.We searched the MEDLINE, EMBASE, EBSCO, Springer, Ovid, and Cochrane Library databases for studies of the effects of LGI diets in GDM patients. We performed a meta-analysis of the effects of the LGI diets with and without added dietary fiber (DF) on GDM outcomes. Risk ratios (RR) and 95% confidence intervals (CIs) were calculated using random- and fixed-effects models.Five RCTs involving 302 participants were included in our meta-analysis. No statistically significant differences in the risks of cesarean section delivery, large for gestational age, and small for gestational age were observed. The risk of macrosomia in the LGI groups was significantly lower (RR = 0.27; 95% CI: 0.10-0.71; P = 0.008) than that in the control groups. Our subgroup analysis of the effects of DF showed that LGI diets with an increased level of DF, relative to the control diet, reduced the risk of macrosomia beyond that of the LGI diets alone (RR: 0.17 vs 0.47, respectively). The subgroup analysis also showed that LGI diets in which the level of DF was approximately equivalent to that in the control diets significantly reduced the risk of insulin usage (RR = 0.69; 95% CI: 0.52-0.92; P = 0.01).The LGI diets reduced the risk of macrosomia in GDM patients, and LGI diets with added DF reduced the risk of macrosomia further. The LGI diets with levels of DF approximately equivalent to that in the control diets reduced the risk of insulin usage in GDM patients.
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Affiliation(s)
- Jinhua Wei
- From the Department of Obstetrics (JW); Department of Endocrinology (JG), Changzhou Second People's Hospital; and Department of Endocrinology (WH), Changzhou Jintan People's Hospital, Changzhou, China
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Moreno-Castilla C, Mauricio D, Hernandez M. Role of Medical Nutrition Therapy in the Management of Gestational Diabetes Mellitus. Curr Diab Rep 2016; 16:22. [PMID: 26879305 DOI: 10.1007/s11892-016-0717-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Medical nutrition therapy (MNT) plays an important role in the management of gestational diabetes mellitus (GDM), and accordingly, it has a significant impact on women and newborns. The primary objective of MNT is to ensure adequate pregnancy weight gain and fetus growth while maintaining euglycemia and avoiding ketones. However, the optimal diet (energy content, macronutrient distribution, its quality and amount, among others) remains an outstanding question. Overall, the nutritional requirements of GDM are similar for all pregnancies, but special attention is paid to carbohydrates. Despite the classical intervention of restricting carbohydrates, the latest evidence, although limited, seems to favor a low-glycemic index diet. There is general agreement in the literature about caloric restrictions in the case of being overweight or obese. Randomized controlled trials are necessary to investigate the optimal MNT for GDM; this knowledge could yield health benefits and cost savings.
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Affiliation(s)
- Cristina Moreno-Castilla
- Department of Endocrinology & Nutrition, Hospital Universitari Arnau de Vilanova, Rovira Roure, 80, 25198, Lleida, Spain.
| | - Didac Mauricio
- Department of Endocrinology & Nutrition, CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), Hospital Universitari Germans Trias i Pujol, Carretera de Canyet s/n, 08916, Badalona, Spain.
| | - Marta Hernandez
- Department of Endocrinology & Nutrition, Hospital Universitari Arnau de Vilanova, Rovira Roure, 80, 25198, Lleida, Spain.
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Han S, Middleton PF, Tran TS, Crowther CA. Assessing use of a printed lifestyle intervention tool by women with borderline gestational diabetes and their achievement of diet and exercise goals: a descriptive study. BMC Pregnancy Childbirth 2016; 16:44. [PMID: 26934216 PMCID: PMC4774025 DOI: 10.1186/s12884-016-0825-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 02/08/2016] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The purpose of this study is to assess use of a booklet by pregnant women to record and assist dietary and lifestyle changes; to describe diet and exercise goals set during the initial lifestyle discussions; and to assess achievement of goals. METHODS Participants were women with borderline gestational diabetes who received a printed pregnancy record booklet, as part of a randomised trial, to record and set monthly goals for diet and exercise. Outcomes included women's use of the booklets and their achievement of dietary and exercise goals after 1 month. RESULTS Fifty-six women returned their used pregnancy record booklets and were included in this study. These women set a total of 197 dietary goals and 65 exercise goals. In the first month, over 80% of dietary goals that targeted grains, dairy and overall diet were achieved, but only 20-30% of goals about vegetables, and foods high in fat, sugar and/or salt were achieved. After 1 month, women had achieved 86.4% of their exercise goals to maintain their current level of activity, but only 25.0 % exercise goals to increase walking during pregnancy. CONCLUSIONS Women who used pregnancy record booklets reported good achievement rates for goals related to grains, fruits, dairy and overall diet, but they were less likely to be successful in achieving goals to increase intake of vegetables, and limit foods that high in fat, sugar and/or salt. Maintaining an active lifestyle during pregnancy was feasible for women although increases in physical activity were less often achieved. Using a pregnancy record booklet may be helpful in assisting and encouraging behavioural changes, although further investigations of long-term effects and in different populations are warranted.
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Affiliation(s)
- Shanshan Han
- Australian Research Centre for Health of Women and Babies (ARCH), Robinson Research Institute, School of Medicine, Discipline of Obstetrics and Gynaecology, The University of Adelaide, 72 King William Road, North Adelaide, 5006, South Australia, Australia.
| | - Philippa F Middleton
- Australian Research Centre for Health of Women and Babies (ARCH), Robinson Research Institute, School of Medicine, Discipline of Obstetrics and Gynaecology, The University of Adelaide, 72 King William Road, North Adelaide, 5006, South Australia, Australia.
- Women's and Children's Health Research Institute, 72 King William Road, North Adelaide, 5006, South Australia, Australia.
| | - Thach S Tran
- Garvan Institute of Medical Research, 384 Victoria Street, Darlinghurst, 2010, NSW, Australia.
| | - Caroline A Crowther
- Australian Research Centre for Health of Women and Babies (ARCH), Robinson Research Institute, School of Medicine, Discipline of Obstetrics and Gynaecology, The University of Adelaide, 72 King William Road, North Adelaide, 5006, South Australia, Australia.
- Liggins Institute, The University of Auckland, Private Bag 92019 Victoria Street West, West Auckland, 1142, Auckland, New Zealand.
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Markovic TP, Muirhead R, Overs S, Ross GP, Louie JCY, Kizirian N, Denyer G, Petocz P, Hyett J, Brand-Miller JC. Randomized Controlled Trial Investigating the Effects of a Low-Glycemic Index Diet on Pregnancy Outcomes in Women at High Risk of Gestational Diabetes Mellitus: The GI Baby 3 Study. Diabetes Care 2016; 39:31-8. [PMID: 26185283 DOI: 10.2337/dc15-0572] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 06/22/2015] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Dietary interventions can improve pregnancy outcomes in women with gestational diabetes mellitus (GDM). We compared the effect of a low-glycemic index (GI) versus a conventional high-fiber (HF) diet on pregnancy outcomes, birth weight z score, and maternal metabolic profile in women at high risk of GDM. RESEARCH DESIGN AND METHODS One hundred thirty-nine women [mean (SD) age 34.7 (0.4) years and prepregnancy BMI 25.2 (0.5) kg/m(2)] were randomly assigned to a low-GI (LGI) diet (n = 72; target GI ∼50) or a high-fiber, moderate-GI (HF) diet (n = 67; target GI ∼60) at 14-20 weeks' gestation. Diet was assessed by 3-day food records and infant body composition by air-displacement plethysmography, and pregnancy outcomes were assessed from medical records. RESULTS The LGI group achieved a lower GI than the HF group [mean (SD) 50 (5) vs. 58 (5); P < 0.001]. There were no differences in glycosylated hemoglobin, fructosamine, or lipids at 36 weeks or differences in birth weight [LGI 3.4 (0.4) kg vs. HF 3.4 (0.5) kg; P = 0.514], birth weight z score [LGI 0.31 (0.90) vs. HF 0.24 (1.07); P = 0.697], ponderal index [LGI 2.71 (0.22) vs. HF 2.69 (0.23) kg/m(3); P = 0.672], birth weight centile [LGI 46.2 (25.4) vs. HF 41.8 (25.6); P = 0.330], % fat mass [LGI 10 (4) vs. HF 10 (4); P = 0.789], or incidence of GDM. CONCLUSIONS In intensively monitored women at risk for GDM, a low-GI diet and a healthy diet produce similar pregnancy outcomes.
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Affiliation(s)
- Tania P Markovic
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia Department of Endocrinology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Ros Muirhead
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia School of Molecular Bioscience, The University of Sydney, Sydney, NSW, Australia
| | - Shannon Overs
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia School of Molecular Bioscience, The University of Sydney, Sydney, NSW, Australia
| | - Glynis P Ross
- Department of Endocrinology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Jimmy Chun Yu Louie
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia School of Molecular Bioscience, The University of Sydney, Sydney, NSW, Australia
| | - Nathalie Kizirian
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia School of Molecular Bioscience, The University of Sydney, Sydney, NSW, Australia
| | - Gareth Denyer
- Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia School of Molecular Bioscience, The University of Sydney, Sydney, NSW, Australia
| | - Peter Petocz
- Department of Statistics, Macquarie University, Sydney, NSW, Australia
| | - Jon Hyett
- RPA Women and Babies, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Jennie C Brand-Miller
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia School of Molecular Bioscience, The University of Sydney, Sydney, NSW, Australia
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[Prevention of shoulder dystocia risk factors before delivery]. ACTA ACUST UNITED AC 2015; 44:1248-60. [PMID: 26527026 DOI: 10.1016/j.jgyn.2015.09.050] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 09/18/2015] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To determine whether it is possible to prevent the occurrence of risk factors for shoulder dystocia before or during pregnancy. METHODS The PubMed database, the Cochrane Library and the recommendations from the French and foreign obstetrical societies or colleges have been consulted. Studied measures were exercise before or during pregnancy, dietary management, and gestational diabetes management in obese and non-obese patients. RESULTS No study has proven that the correction of these risk factors (except gestational diabetes) would reduce the risk of shoulder dystocia. In the general population, physical exercise is recommended either before or during pregnancy to reduce the risk of gestational diabetes (physical activity before pregnancy) (grade B), fetal macrosomia (grade C) or maternal weight gain during pregnancy (grade C). No dietary regimen is recommended to reduce these issues (grade B). In overweight or obese (body mass index [BMI]>25), physical activity coupled with dietary management is recommended (grade A) because it reduces fetal macrosomia (EL1). In addition, it allows a modest reduction in maternal weight gain during pregnancy (EL2), but did have an effect on the occurrence of gestational diabetes (EL1). In case of gestational diabetes, diabetes care is recommended (diabetic diet, glucose monitoring, insulin if needed) (grade A) as it reduces the risk of macrosomia and shoulder dystocia (EL1). The recommended weight gain during pregnancy is 11.5 kg to 16 kg for normal BMI patients (grade B). Obese patients should be aware of the importance of controlling their weight gain during pregnancy (professional consensus). It is recommended that patients regain their pre-conception weight, and ideally a BMI between 18 and 25 kg/m(2), 6 months postpartum (grade B) to reduce the risk of gestational diabetes and macrosomia in a subsequent pregnancy (EL2). CONCLUSION Physical activity is recommended before and during pregnancy to reduce the occurrence of risk factors for shoulder dystocia. In obese patients, physical activity should be coupled with dietary measures to reduce fetal macrosomia and weight gain during pregnancy.
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A low glycemic index staple diet reduces postprandial glucose values in Asian women with gestational diabetes mellitus. J Investig Med 2015; 62:975-9. [PMID: 25203150 DOI: 10.1097/jim.0000000000000108] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND A low glycemic index (GI) diet is beneficial for glucose control in patients with diabetes mellitus. This study aimed to investigate the influence of a low-GI diet on postprandial glucose levels in women with gestational diabetes mellitus (GDM). METHODS Pregnant women with GDM were randomized to receive a normal diabetic control diet or a low-GI staple diet for 5 days. A low-GI staple food was used to replace rice in lunch and dinner for the low-GI staple diet group, whereas the total energy and carbohydrate levels remained equal in both groups. Fasting and postprandial glucose levels were determined daily. RESULTS A total of 140 pregnant women with GDM were included in the study, including 66 in the low-GI staple diet group and 74 in the normal diabetic diet control group. No differences existed in baseline characteristics between the 2 groups (all P > 0.05). After dietary intervention, glucose levels were significantly reduced in the low-GI staple diet group (all P < 0.01) and the control group (all P < 0.008). Postintervention glucose values after breakfast, lunch, and dinner were significantly reduced in the treatment group compared with those in the control group (all P < 0.05). The percentage changes from baseline of all glucose values were significantly greater in the treatment group than in the control group (all P < 0.05). CONCLUSIONS A low-GI staple diet significantly reduces postprandial glucose levels in women with GDM.
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Viana LV, Gross JL, Azevedo MJ. Dietary intervention in patients with gestational diabetes mellitus: a systematic review and meta-analysis of randomized clinical trials on maternal and newborn outcomes. Diabetes Care 2014; 37:3345-55. [PMID: 25414390 DOI: 10.2337/dc14-1530] [Citation(s) in RCA: 110] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Diet is the cornerstone treatment of patients with gestational diabetes mellitus (GDM), but its role in maternal and newborn outcomes has been scarcely studied. The purpose of this study was to analyze the efficacy of dietary interventions on maternal or newborn outcomes in patients with GDM. RESEARCH DESIGN AND METHODS A systematic review and meta-analysis of randomized clinical trials (RCTs) of dietary intervention in GDM or pregnancy with hyperglycemia was performed. MEDLINE, Embase, ClinicalTrials.gov, Cochrane, and Scopus were searched through to March 2014. The main evaluated maternal outcomes were proportion of patients using insulin and proportion of cesarean delivery; the newborn outcomes were proportion of macrosomia and hypoglycemia and newborn weight. RESULTS From 1,170 studies, nine RCTs, including 884 women aged 31.5 years (28.7-33.2) with 27.4 weeks (24.1-30.3) of gestation, were eligible. We divided the RCTs according to the type of dietary intervention: low glycemic index (GI) (n = 4; 257 patients), total energy restriction (n = 2; 425 patients), low carbohydrates (n = 2; 182 patients), and others (n = 1; 20 patients). Diet with low GI reduced the proportion of patients who used insulin (relative risk 0.767 [95% CI 0.597, 0.986]; P = 0.039) and the newborn birth weight (weight mean differences -161.9 g [95% CI -246.4, -77.4]; P = 0.000) as compared with control diet. Total restriction and low carbohydrate diets did not change either maternal or newborn outcomes. CONCLUSIONS A low GI diet was associated with less frequent insulin use and lower birth weight than control diets, suggesting that it is the most appropriate dietary intervention to be prescribed to patients with GDM.
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Affiliation(s)
- Luciana Verçoza Viana
- Division of Endocrinology, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Jorge Luiz Gross
- Division of Endocrinology, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Mirela Jobim Azevedo
- Division of Endocrinology, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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Dodd JM, Cramp C, Sui Z, Yelland LN, Deussen AR, Grivell RM, Moran LJ, Crowther CA, Turnbull D, McPhee AJ, Wittert G, Owens JA, Robinson JS. The effects of antenatal dietary and lifestyle advice for women who are overweight or obese on maternal diet and physical activity: the LIMIT randomised trial. BMC Med 2014; 12:161. [PMID: 25315237 PMCID: PMC4194375 DOI: 10.1186/s12916-014-0161-y] [Citation(s) in RCA: 113] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Accepted: 08/26/2014] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Overweight and obesity is a significant health concern during pregnancy. Our aim was to investigate the effect of providing antenatal dietary and lifestyle advice to women who are overweight or obese on components of maternal diet and physical activity. METHODS We conducted a randomised controlled trial, in which pregnant women with a body mass index≥25 kg/m2, and singleton gestation between 10(+0) to 20(+0) weeks were recruited and randomised to Lifestyle Advice (involving a comprehensive dietary and lifestyle intervention over their pregnancy) or Standard Care. Within the intervention group, we conducted a nested randomised trial in which a subgroup of women were further randomised to receive access to supervised group walking sessions in addition to the standard information presented during the intervention contacts (the Walking group) or standard information only. The outcome measures were maternal dietary intake, (including food groups, macronutrient and micronutrient intake, diet quality (using the Healthy Eating Index; HEI), dietary glycaemic load, and glycaemic index) and maternal physical activity. Women completed the Harvard Semi-Structured Food Frequency Questionnaire, and the Short Questionnaire to Assess Health-enhancing Physical Activity (SQUASH), at trial entry, 28 and 36 weeks' gestational age, and 4 months postpartum. Analyses were performed on an intention-to-treat basis, using linear mixed effects models with adjustment for the stratification variables. RESULTS Women randomised to Lifestyle Advice demonstrated a statistically significant increase in the number of servings of fruit and vegetables consumed per day, as well as increased consumption of fibre, and reduced percentage energy intake from saturated fats (P<0.05 for all). Maternal HEI was significantly improved at both 28 (73.35±6.62 versus 71.86±7.01; adjusted difference in means 1.58; 95% CI 0.89 to 2.27; P<0.0001) and 36 (72.95±6.82 versus 71.17±7.69; adjusted difference in means 1.77; 95% CI 1.01 to 2.53; P<0.0001) weeks. There were no differences in dietary glycaemic index or glycaemic load. Women randomised to Lifestyle Advice also demonstrated greater total physical activity (adjusted difference in means 359.76 metabolic equivalent task units (MET) minutes/week; 95% CI 74.87 to 644.65; P=0.01) compared with women receiving Standard Care. The supervised walking group was poorly utilised. CONCLUSIONS For women who are overweight or obese, antenatal lifestyle advice improves maternal diet and physical activity during pregnancy. Please see related articles: http://www.biomedcentral.com/1741-7015/12/163 and http://www.biomedcentral.com/1741-7015/12/201. TRIAL REGISTRATION Australian and New Zealand Clinical Trials Registry ( ACTRN12607000161426).
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Affiliation(s)
- Jodie M Dodd
- School of Paediatrics and Reproductive Health, and The Robinson Research Institute, The University of Adelaide, Adelaide, Australia.
- Department of Perinatal Medicine, Women's and Babies Division, The Women's and Children's Hospital, North Adelaide, Australia.
| | - Courtney Cramp
- School of Paediatrics and Reproductive Health, and The Robinson Research Institute, The University of Adelaide, Adelaide, Australia.
| | - Zhixian Sui
- School of Paediatrics and Reproductive Health, and The Robinson Research Institute, The University of Adelaide, Adelaide, Australia.
| | - Lisa N Yelland
- School of Paediatrics and Reproductive Health, and The Robinson Research Institute, The University of Adelaide, Adelaide, Australia.
- Women's and Children's Health Research Institute, North Adelaide, Australia.
- School of Population Health, The University of Adelaide, Adelaide, Australia.
| | - Andrea R Deussen
- School of Paediatrics and Reproductive Health, and The Robinson Research Institute, The University of Adelaide, Adelaide, Australia.
| | - Rosalie M Grivell
- School of Paediatrics and Reproductive Health, and The Robinson Research Institute, The University of Adelaide, Adelaide, Australia.
- Department of Perinatal Medicine, Women's and Babies Division, The Women's and Children's Hospital, North Adelaide, Australia.
| | - Lisa J Moran
- School of Paediatrics and Reproductive Health, and The Robinson Research Institute, The University of Adelaide, Adelaide, Australia.
| | - Caroline A Crowther
- School of Paediatrics and Reproductive Health, and The Robinson Research Institute, The University of Adelaide, Adelaide, Australia.
- Liggins Institute, The University of Auckland, Auckland, New Zealand.
| | - Deborah Turnbull
- School of Psychology, The University of Adelaide, Adelaide, AUSTRALIA.
| | - Andrew J McPhee
- Department of Neonatal Medicine, Women's and Babies Division, The Women's and Children's Hospital, North Adelaide, Australia.
| | - Gary Wittert
- School of Medicine, The University of Adelaide, Adelaide, Australia.
| | - Julie A Owens
- School of Paediatrics and Reproductive Health, and The Robinson Research Institute, The University of Adelaide, Adelaide, Australia.
| | - Jeffrey S Robinson
- School of Paediatrics and Reproductive Health, and The Robinson Research Institute, The University of Adelaide, Adelaide, Australia.
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Intensive low-glycaemic-load dietary intervention for the management of glycaemia and serum lipids among women with gestational diabetes: a randomized control trial. Public Health Nutr 2014; 18:1506-13. [PMID: 25222105 DOI: 10.1017/s1368980014001992] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE The present study aimed to compare the effects of a general dietary intervention and an intervention with low glycaemic load (GL) on glycaemic control, blood lipid metabolism and pregnancy outcomes in women with gestational diabetes mellitus. DESIGN Participants were randomly assigned to two groups, receiving either an individualized general dietary intervention (Control group) or an intensive low-GL intervention (Low-GL group) every two weeks, from 24-26 weeks of gestation to delivery. SETTING The Center of Maternal Primary Care in Guangdong General Hospital, China. SUBJECTS Ninety-five women with gestational diabetes mellitus were enrolled from June 2008 to July 2009. RESULTS After the intervention, both groups significantly decreased their dietary intakes of energy, fat and carbohydrate. The Low-GL group had significantly lower values for GL (122 v. 136) and glycaemic index (50 v. 54) but greater dietary fibre intake (33 v. 29 g/d) than did the Control group (all P<0·01). Significantly greater decreases in fasting plasma glucose (-0·33 v. -0·02 mmol/l, P<0·01) and 2 h postprandial glucose (-2·98 v. -2·51 mmol/l, P<0·01), significantly lower increases in total cholesterol (0·12 v. 0·23 mmol/l) and TAG (0·41 v. 0·56 mmol/l) and a significantly lower decrease in HDL cholesterol (-0·01 v. -0·11 mmol/l) were also observed in the Low-GL group compared with the Control group (all P<0·05). There were no significant differences in body weight gain, birth weight or other maternal-fetal perinatal outcomes between the two groups. CONCLUSIONS The low-GL targeted dietary intervention outperformed the general dietary intervention in glycaemic control and the improvement of blood lipid levels in women with gestational diabetes mellitus.
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Abstract
Elucidating the optimal macronutrient composition for dietary management of gestational diabetes mellitus has enormous potential to improve perinatal outcomes. Diet therapy may result in significant cost savings if effective in deterring the need for expensive medical management within this growing population. In only 6 randomized controlled trials in 250 women, data suggest that a diet higher in complex carbohydrate and fiber, low in simple sugar, and lower in saturated fat may be effective in blunting postprandial hyperglycemia, preventing worsened insulin resistance and excess fetal growth. The use of diet in gestational diabetes mellitus remains an area in grave need for high-quality randomized controlled trials.
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Roskjær AB, Andersen JR, Ronneby H, Damm P, Mathiesen ER. Dietary advices on carbohydrate intake for pregnant women with type 1 diabetes. J Matern Fetal Neonatal Med 2014; 28:229-33. [DOI: 10.3109/14767058.2014.906577] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Moses RG, Casey SA, Quinn EG, Cleary JM, Tapsell LC, Milosavljevic M, Petocz P, Brand-Miller JC. Pregnancy and Glycemic Index Outcomes study: effects of low glycemic index compared with conventional dietary advice on selected pregnancy outcomes. Am J Clin Nutr 2014; 99:517-23. [PMID: 24351875 DOI: 10.3945/ajcn.113.074138] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Eating carbohydrate foods with a high glycemic index (GI) has been postulated to result in fetoplacental overgrowth and higher infant body fat. A diet with a low glycemic index (LGI) has been shown to reduce birth percentiles and the ponderal index (PI). OBJECTIVES We investigated whether offering LGI dietary advice at the first antenatal visit would result in a lower fetal birth weight, birth percentile, and PI than providing healthy eating (HE) advice. This advice had to be presented within the resources of routine antenatal care. DESIGN The Pregnancy and Glycemic Index Outcomes study was a 2-arm, parallel-design, randomized, controlled trial that compared the effects of LGI dietary advice with HE advice on pregnancy outcomes. Eligible volunteers who attended for routine antenatal care at <20 wk of gestation were randomly assigned to either group. RESULTS A total of 691 women were enrolled, and 576 women had final data considered. In the LGI group, the GI was reduced from a mean (± SEM) of 56 ± 0.3 at enrollment to 52 ± 0.3 (P < 0.001) at the final assessment. There were no significant differences in primary outcomes of fetal birth weight, birth percentile, or PI. In a multivariate regression analysis, the glycemic load was the only significant dietary predictor (P = 0.046) of primary outcomes but explained <1% of all variation. CONCLUSION A low-intensity dietary intervention with an LGI diet compared with an HE diet in pregnancy did not result in any significant differences in birth weight, fetal percentile, or PI.
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Affiliation(s)
- Robert G Moses
- Illawarra Shoalhaven Local Health District Wollongong, Wollongong, Australia (RGM, SAC, EGQ, JMC, and MM); the School of Health Sciences, University of Wollongong, Wollongong, Australia (LCT); the Department of Statistics, Macquarie University, Sydney, Australia (PP); and the Boden Institute of Obesity, Nutrition, Exercise and Eating Disorders and School of Molecular Bioscience, University of Sydney, Sydney, Australia (JCB-M)
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Mohd Yusof BN, Firouzi S, Mohd Shariff Z, Mustafa N, Mohamed Ismail NA, Kamaruddin NA. Weighing the evidence of low glycemic index dietary intervention for the management of gestational diabetes mellitus: an Asian perspective. Int J Food Sci Nutr 2014; 65:144-50. [DOI: 10.3109/09637486.2013.845652] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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The effect of DASH diet on pregnancy outcomes in gestational diabetes: a randomized controlled clinical trial. Eur J Clin Nutr 2014; 68:490-5. [PMID: 24424076 DOI: 10.1038/ejcn.2013.296] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Revised: 12/13/2013] [Accepted: 12/19/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND/OBJECTIVES The current study was performed to investigate the effects of the Dietary Approaches to Stop Hypertension (DASH) eating plan on pregnancy outcomes in pregnant women with gestational diabetes mellitus (GDM). SUBJECTS/METHODS This randomized controlled clinical trial was performed among 52 women diagnosed with GDM. Participants were randomly assigned to consume either the control (n=26) or the DASH diet (n=26) for 4 weeks. The control diet was designed to contain 45-55% carbohydrates, 15-20% protein and 25-30% total fat. The DASH diet was rich in fruits, vegetables, whole grains and low-fat dairy products, and contained lower amounts of saturated fats, cholesterol and refined grains with a total of 2400 mg/day sodium. The numbers of women who commenced insulin therapy after dietary intervention, the mode of delivery and prevalence of polyhydramnios were assessed. The length, weight and head circumference of infants were measured during the first 24 h after birth. RESULTS Whereas 46.2% of women in the DASH diet needed to have a cesarean section, this percentage for the control group was 80.8% (P=0.01). The percentage of those who needed to commence insulin therapy after intervention was also significantly different between the two groups (23% for DASH vs 73% for control group, P<0.0001). Infants born to mothers on the DASH diet had significantly lower weight (3222.7 vs 3818.8 g, P<0.0001), head circumference (34.2 vs 35.1 cm, P=0.01) and ponderal index (2.50 vs 2.87 kg/m(3), P<0.0001) compared with those born to mothers on the control diet. CONCLUSIONS In conclusion, consumption of DASH diet for 4 weeks among pregnant women with GDM resulted in improved pregnancy outcomes.
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Lassi ZS, Bhutta ZA. Risk factors and interventions related to maternal and pre-pregnancy obesity, pre-diabetes and diabetes for maternal, fetal and neonatal outcomes: a systematic review. ACTA ACUST UNITED AC 2014. [DOI: 10.1586/17474108.2013.841453] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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McGowan CA, Walsh JM, Byrne J, Curran S, McAuliffe FM. The influence of a low glycemic index dietary intervention on maternal dietary intake, glycemic index and gestational weight gain during pregnancy: a randomized controlled trial. Nutr J 2013; 12:140. [PMID: 24175958 PMCID: PMC4176103 DOI: 10.1186/1475-2891-12-140] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Accepted: 10/26/2013] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Maternal diet is known to impact pregnancy outcome. Following a low glycemic index (GI) diet during pregnancy has been shown to improve maternal glycemia and reduce infant birthweight and may be associated with a higher fibre intake. We assessed the impact of a low GI dietary intervention on maternal GI, nutritional intake and gestational weight gain (GWG) during pregnancy. Compliance and acceptability of the low GI diet was also examined. METHOD Eight hundred women were randomised in early pregnancy to receive low GI and healthy eating dietary advice or to receive standard maternity care. The intervention group received dietary advice at a group education session before 22 weeks gestation. All women completed a 3 day food diary during each trimester of pregnancy. Two hundred and thirty five women from the intervention arm and 285 women from the control arm returned complete 3x3d FDs and were included in the present analysis. RESULTS Maternal GI was significantly reduced in the intervention group at trimester 2 and 3. The numbers of women within the lowest quartile of GI increased from 37% in trimester 1 to 52% in trimester 3 (P < 0.001) among the intervention group. The intervention group had significantly lower energy intake (P < 0.05), higher protein (% TE) (P < 0.01) and higher dietary fibre intake (P < 0.01) post intervention. Consumption of food groups with known high GI values were significantly reduced among the intervention group. Women in the intervention low GI group were less likely to exceed the Institute of Medicine's GWG goals. CONCLUSION A dietary intervention in early pregnancy had a positive influence on maternal GI, food and nutrient intakes and GWG. Following a low GI diet may be particularly beneficial for women at risk of exceeding the GWG goals for pregnancy.
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Affiliation(s)
| | | | | | | | - Fionnuala M McAuliffe
- UCD Obstetrics and Gynaecology, School of Medicine and Medical Science, University College Dublin, National Materntiy Hospital, Dublin 2, Ireland.
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