Inverse relation between fruit and vegetable intake and the risk of gestational diabetes mellitus

Impact of Maternal Micronutrient Intake on Gestational Diabetes Risk: Results from Greece's BORN2020 Prospective Cohort Study

Understanding how maternal micronutrient intake and dietary habits impact gestational diabetes mellitus (GDM) is crucial. Data from 797 pregnant women were prospectively analyzed to assess GDM status with the oral glucose tolerance test (OGTT). Nutritional intake was evaluated using a validated food frequency questionnaire (FFQ) across two periods: Period A, covering 6 months before pregnancy, and Period B, from pregnancy onset to mid-gestation (24 weeks). Micronutrient intakes were compared against the European Food Safety Authority (EFSA) dietary reference values (DRVs) and were used to estimate the mean adequacy ratio (MAR) to assess dietary adequacy. GDM was diagnosed in 14.7% (n = 117) of women with the characteristics of a higher mean maternal age (MA) and pre-pregnancy body mass index (BMI). Out of the 13 vitamins assessed, biotin, folate, niacin, and pantothenic acid were found significantly higher in the GDM group, as did iron, magnesium, manganese, phosphorus, and zinc from the 10 minerals. The results were influenced by the timing of the assessment. Importantly, MAR was higher during pregnancy and was found to increase the risk of GDM by 1% (95%CI: 1, 1.02). A sensitivity analysis revealed that reducing MAR significantly raised the GDM risk by 68% (95%CI: 1.02, 2.79). No association was revealed between adherence to the Mediterranean diet (MD) and GDM risk. These findings highlight areas for further investigation into whether dietary modifications involving these specific micronutrients could effectively influence GDM outcomes.

Effects of an Eating Pattern Including Colorful Fruits and Vegetables on Management of Gestational Diabetes: A Randomized Controlled Trial

Gestational diabetes mellitus (GDM), defined as abnormal glucose tolerance that presents during the second and third trimesters of pregnancy, is a growing issue in the United States and worldwide. If left untreated or poorly controlled, GDM can result in numerous consequences for both the mother and the fetus; thus, it is imperative that different avenues of management for GDM be explored. There is a paucity of studies that examine how lifestyle changes, including dietary and physical activity, affect management of GDM. We examined how counseling on lifestyle changes can affect cardiometabolic risks in women with GDM. We conducted a 12-week randomized controlled trial based on behavioral counseling in which women with GDM (N = 38) were randomized into either a nutrition education (control) (N = 18) group or nutrition intervention (N = 20) group. The nutrition education group were given dietary counseling regarding healthy dietary choices based on USDA guidelines, while the nutrition intervention group were instructed to consume a total of one cup of whole berries and one cup of leafy vegetables daily along with performing postprandial exercise (walking). Blood samples, anthropometric measures, and dietary and physical activity data, recorded in daily food and activity logs, were collected at baseline and at the end of the study and compared between the two groups. Dietary counseling on supplementation with whole berries and leafy vegetables resulted in increased fiber intake, increased antioxidant intake and total serum antioxidant capacity, improved random blood glucose, decreased serum IL-6, and improved HDL cholesterol versus the control group (all p < 0.05). These results highlight that whole berry and leafy vegetable supplementation-based dietary counseling can improve the metabolic pathways involved in gestational diabetes pathogenesis and prognosis. These functional foods must be recommended in the management of pregnancies affected by GDM.

Factors associated with ultra-processed foods consumption in a cohort of Brazilian pregnant women

Nutrition during pregnancy is essential for the health of the pregnant woman, the development of the fetus, and the prevention of complications related to pregnancy and the postpartum period. This study described the factors associated with high consumption of ultra-processed foods among pregnant women. This prospective cohort study was performed from February 2016 to November 2019 in two health units in the city of Rio de Janeiro, Brazil, with data from 344 pregnant women. The first interview was conducted in the prenatal visit at less than 20 gestational weeks, the second at 34 gestational weeks, and the third at two months postpartum. Diet was assessed in the last interview using a food frequency questionnaire, and food items were classified according to NOVA. The percentage of ultra-processed foods consumption was estimated by tertile distribution, and the third tertile represented the highest consumption. Based on the hierarchical analysis model, the associations between ultra-processed foods consumption and sociodemographic, reproductive health, pregestational, behavioral, and pregnancy variables were assessed using a multinomial logistic regression model. Older women had lower ultra-processed foods consumption (OR = 0.33; 95%CI: 0.15-0.71). Few years of schooling (up to 7 years; OR = 5.58; 95%CI: 1.62-19.23), history of a previous childbirth (OR = 2.48; 95%CI: 1.22-5.04), history of two or more previous childbirths (OR = 7.53; 95%CI: 3.02-18.76), and no history of regular physical activity before pregnancy (OR = 2.40; 95%CI: 1.31-4.38) were risk factors. The identification of risk and protection factors allows for the establishment of control measures and encouragement of healthy practices during prenatal care.

Fruit, vegetable, and fruit juice consumption and risk of gestational diabetes mellitus: a systematic review and meta-analysis : List of all authors

BACKGROUND

Fruit, vegetable, and fruit juice intake is associated with the risk of gestational diabetes mellitus (GDM). However, the conclusion is limited and conflicted. The purpose of this systematic review and meta-analysis is to investigate the association between fruit, vegetable, and fruit juice consumption and the risk of GDM.

METHODS

To find relevant studies, we searched PubMed, The Cochrane Library, Web of Science, Embase, ScienceDirect, PsycINFO, CINAHL, Ovid, EBSCO, CBM, CNKI, Wanfang Data, and VIP for the report on prospective cohort studies published from inception to April 8, 2022. Summary relative risks (RR) and 95% confidence intervals (Cis) were estimated using a random-effects model.

RESULTS

A total of 12 studies with 32,794 participants were included in the meta-analysis. Total fruit consumption was associated with a lower risk of GDM (RR = 0.92, 95% CI = 0.86-0.99). Whereas an increasing the consumption of vegetable, including all vegetable (RR = 0.95, 95% CI = 0.87-1.03), starchy vegetable (RR = 1.01, 95% CI = 0.82-1.26), and fruit juice (RR = 0.97, 95% CI = 0.91-1.04) was not associated with a reduction in the risk of GDM. In a dose‒response analysis of eight studies, a 3% reduction in risk of GDM for a 100 g/d increase in fruit consumption (RR = 0.97, 95% CI = 0.96-0.99).

CONCLUSIONS

The findings suggest that higher fruit consumption may reduce the risk of GDM, with a 3% reduction in the risk of GDM for every 100 g/d increase in fruit intake. Higher-quality prospective studies or randomized clinical trials are required to validate the effect of different variations of fruits, vegetables, and fruit juice consumption on the risk of GDM.

The Effect of an eHealth Coaching Program (Smarter Pregnancy) on Attitudes and Practices Toward Periconception Lifestyle Behaviors in Women Attempting Pregnancy: Prospective Study

BACKGROUND

Lifestyle behaviors during the periconception period contribute to achievement of a successful pregnancy. Assessment of attitudes and practices toward these modifiable behaviors can aid in identifying gaps in unhealthy lifestyle behaviors with impact on intervention effectiveness.

OBJECTIVE

This study investigates the effectiveness of coaching by the eHealth program Smarter Pregnancy during the periconception period on improvement of attitudes and practices toward fruit and vegetable intake and smoking in women attempting pregnancy through assisted reproductive technology (ART) or natural conception.

METHODS

Women attempting pregnancy through ART (n=1060) or natural conception (n=631) were selected during the periconception period. The intervention groups, conceived through ART or naturally, received Smarter Pregnancy coaching for 24 weeks, whereas the control group conceived through ART and did not receive coaching. Attitudes and practices at baseline and follow-up periods were obtained from self-administered online questionnaire provided by the program. Attitudes were assessed in women with unhealthy behaviors as their intention to increase their fruit and vegetable intake and to quit smoking using a yes/no question. Outcomes on practices, suggesting effectiveness, included daily fruit (pieces) and vegetable (grams) intake, and if women smoked (yes/no). Changes in attitudes and practices were compared at 12 and 24 weeks with baseline between the ART intervention and ART control groups, and within the intervention groups between ART and natural conception. Changes in practices at 12 and 24 weeks were also compared with baseline between women with negative attitude and positive attitude within the intervention groups: ART and natural conception. Analysis was performed using linear and logistic regression models adjusted for maternal confounders and baseline attitudes and practices.

RESULTS

The ART intervention group showed higher vegetable intake and lower odds for negative attitudes toward vegetable intake after 12 weeks (β_adj=25.72 g, P<.001; adjusted odds ratio [OR_adj] 0.24, P<.001) and 24 weeks of coaching (β_adj=23.84 g, P<.001; OR_adj 0.28, P<.001) compared with ART controls. No statistically significant effect was observed on attitudes and practices toward fruit intake (12 weeks: P=.16 and .08, respectively; 24 weeks: P=.16 and .08, respectively) and smoking behavior (12 weeks: P=.87; 24 weeks: P=.92). No difference was observed for the studied attitudes and practices between the ART intervention and natural conception intervention groups. Women with persistent negative attitude toward fruit and vegetable intake at week 12 showed lower fruit and vegetable intake at week 24 compared with women with positive attitude (β_adj=-.49, P<.001; β_adj=-30.07, P<.001, respectively).

CONCLUSIONS

The eHealth Smarter Pregnancy program may improve vegetable intake-related attitudes and practices in women undergoing ART treatment. Women with no intention to increase fruit and vegetable intake had less improvement in their intakes. Despite small changes, this study demonstrates again that Smarter Pregnancy can be used to improve vegetable intake, which can complemented by blended care that combines face-to-face and online care to also improve fruit intake and smoking behavior.

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

Purpose

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

Methods

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

Results

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

Conclusions

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

Supplementary Information

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

Mid-pregnancy consumption of fruit, vegetable and fruit juice and the risk of gestational diabetes mellitus: A correlation study

OBJECTIVE

To determine the potential association between mid-pregnancy consumption of fruit, vegetable and fruit juice and the risk of gestational diabetes mellitus (GDM).

RESEARCH DESIGN AND METHODS

An observational study with 2987 pregnant women was conducted in China from June 2013 to June 2014. Fruit, vegetable and fruit juice consumption during weeks 13-28 of pregnancy was assessed by using 24 h dietary recall method and food frequency questionnaire. Cox proportional hazard model was used to assess the association between fruit, vegetable and fruit juice consumption (in quartiles) and GDM risks, and One-Way ANOVA was used to compare the incidences of GDM at various levels of fruit, vegetable and fruit juice consumption, adjusted for gestational age, family history of diabetes, physical activity, fiber and meat intake.

RESULTS

Among all the 2987 pregnant women, 405 (13.6%) were diagnosed as GDM for the first time. There was no association between total fruit and vegetable consumption and GDM. Quantity of grape, melon, potatoes and fruit juice consumption were positively associated with the incidence of GDM. In contrast, quantity of apple, orange and vegetables other than potatoes were negatively associated with the incidence of GDM.

CONCLUSIONS

Our findings indicate that appropriate quantity of fruit and vegetable intakes throughout pregnancy may have a beneficial effect on preventing the development of GDM, whereas excess consumption of fruits, potatoes and fruit juices is associated with an increased risk of GDM.

Electrochemical non-enzymatic glucose sensors: recent progress and perspectives

This review summarizes recent advances in the development of electrocatalysts for non-enzymatic glucose detection. The sensing mechanism and influencing factors are discussed, and the perspectives and challenges are also addressed.