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Chiereghin F, Pianazzola S, Mion E, Fumagalli G, Conti M, Vergani M, Gironi I, Di Vieste G, Bertuzzi F, Pintaudi B. Real-world effectiveness of an ethnic diet plan for the management of gestational diabetes in females at high-risk ethnicity: An observational, prospective, case-control study. Diabet Med 2024; 41:e15311. [PMID: 38356191 DOI: 10.1111/dme.15311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 02/05/2024] [Accepted: 02/06/2024] [Indexed: 02/16/2024]
Affiliation(s)
- Francesca Chiereghin
- Department of Human Sciences and Quality of Life Promotion, San Raffaele University, Rome, Italy
| | | | - Elena Mion
- Diabetes Unit, Niguarda Cà Granda Hospital, Milan, Italy
| | | | - Matteo Conti
- Department of Endocrinology, Bicocca University, Milan, Italy
| | - Michela Vergani
- Department of Endocrinology, Bicocca University, Milan, Italy
| | - Ilaria Gironi
- Diabetes Unit, Niguarda Cà Granda Hospital, Milan, Italy
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Bernier E, Plante AS, Lemieux P, Robitaille J, Lemieux S, Desroches S, Bélanger-Gravel A, Maheux-Lacroix S, Weisnagel SJ, Demers S, Camirand Lemyre F, Boulet M, Baillargeon JP, Morisset AS. Promoting healthy eating in early pregnancy in individuals at risk of gestational diabetes mellitus: does it improve glucose homeostasis? A study protocol for a randomized control trial. Front Nutr 2024; 10:1336509. [PMID: 38312142 PMCID: PMC10834641 DOI: 10.3389/fnut.2023.1336509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 12/26/2023] [Indexed: 02/06/2024] Open
Abstract
Background Healthy eating during pregnancy has favorable effects on glycemic control and is associated with a lower risk of gestational diabetes mellitus (GDM). According to Diabetes Canada, there is a need for an effective and acceptable intervention that could improve glucose homeostasis and support pregnant individuals at risk for GDM. Aims This unicentric randomized controlled trial (RCT) aims to evaluate the effects of a nutritional intervention initiated early in pregnancy, on glucose homeostasis in 150 pregnant individuals at risk for GDM, compared to usual care. Methods Population: 150 pregnant individuals ≥18 years old, at ≤14 weeks of pregnancy, and presenting ≥1 risk factor for GDM according to Diabetes Canada guidelines. Intervention: The nutritional intervention initiated in the first trimester is based on the health behavior change theory during pregnancy and on Canada's Food Guide recommendations. It includes (1) four individual counseling sessions with a registered dietitian using motivational interviewing (12, 18, 24, and 30 weeks), with post-interview phone call follow-ups, aiming to develop and achieve S.M.A.R.T. nutritional objectives (specific, measurable, attainable, relevant, and time-bound); (2) 10 informative video clips on healthy eating during pregnancy developed by our team and based on national guidelines, and (3) a virtual support community via a Facebook group. Control: Usual prenatal care. Protocol: This RCT includes three on-site visits (10-14, 24-26, and 34-36 weeks) during which a 2-h oral glucose tolerance test is done and blood samples are taken. At each trimester and 3 months postpartum, participants complete web-based questionnaires, including three validated 24-h dietary recalls to assess their diet quality using the Healthy Eating Food Index 2019. Primary outcome: Difference in the change in fasting blood glucose (from the first to the third trimester) between groups. This study has been approved by the Ethics Committee of the Centre de recherche du CHU de Québec-Université Laval. Discussion This RCT will determine whether a nutritional intervention initiated early in pregnancy can improve glucose homeostasis in individuals at risk for GDM and inform Canadian stakeholders on improving care trajectories and policies for pregnant individuals at risk for GDM. Clinical trial registration https://clinicaltrials.gov/study/NCT05299502, NCT05299502.
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Affiliation(s)
- Emilie Bernier
- École de Nutrition, Université Laval, Québec, QC, Canada
- Centre de Recherche du CHU de Québec-Université Laval, Québec, QC, Canada
- Centre de Recherche Nutrition, Santé et Société (NUTRISS) de l'Institut sur la Nutrition et des Aliments Fonctionnels (INAF), Université Laval, Québec, QC, Canada
| | - Anne-Sophie Plante
- Centre de Recherche du CHU de Québec-Université Laval, Québec, QC, Canada
- Centre de Recherche Nutrition, Santé et Société (NUTRISS) de l'Institut sur la Nutrition et des Aliments Fonctionnels (INAF), Université Laval, Québec, QC, Canada
| | - Patricia Lemieux
- Centre de Recherche du CHU de Québec-Université Laval, Québec, QC, Canada
- Faculté de Médecine, Université Laval, Québec, QC, Canada
| | - Julie Robitaille
- École de Nutrition, Université Laval, Québec, QC, Canada
- Centre de Recherche du CHU de Québec-Université Laval, Québec, QC, Canada
- Centre de Recherche Nutrition, Santé et Société (NUTRISS) de l'Institut sur la Nutrition et des Aliments Fonctionnels (INAF), Université Laval, Québec, QC, Canada
| | - Simone Lemieux
- École de Nutrition, Université Laval, Québec, QC, Canada
- Centre de Recherche Nutrition, Santé et Société (NUTRISS) de l'Institut sur la Nutrition et des Aliments Fonctionnels (INAF), Université Laval, Québec, QC, Canada
| | - Sophie Desroches
- École de Nutrition, Université Laval, Québec, QC, Canada
- Centre de Recherche Nutrition, Santé et Société (NUTRISS) de l'Institut sur la Nutrition et des Aliments Fonctionnels (INAF), Université Laval, Québec, QC, Canada
| | - Ariane Bélanger-Gravel
- Centre de Recherche Nutrition, Santé et Société (NUTRISS) de l'Institut sur la Nutrition et des Aliments Fonctionnels (INAF), Université Laval, Québec, QC, Canada
- Département de Communication, Université Laval, Québec, QC, Canada
- Centre de Recherche de l'Institut Universitaire de Cardiologie de Pneumologie de Québec, Québec, QC, Canada
| | - Sarah Maheux-Lacroix
- Centre de Recherche du CHU de Québec-Université Laval, Québec, QC, Canada
- Faculté de Médecine, Université Laval, Québec, QC, Canada
| | - S John Weisnagel
- Centre de Recherche du CHU de Québec-Université Laval, Québec, QC, Canada
- Faculté de Médecine, Université Laval, Québec, QC, Canada
| | - Suzanne Demers
- Faculté de Médecine, Université Laval, Québec, QC, Canada
| | - Félix Camirand Lemyre
- Département de Mathématiques, Université de Sherbrooke, Sherbrooke, QC, Canada
- Centre de Recherche du CHU de Sherbrooke, Sherbrooke, QC, Canada
| | - Mélanie Boulet
- Centre Intégré Universitaire de Santé et de Service Sociaux de l'Estrie-CHU de Sherbrooke, Sherbrooke, QC, Canada
| | - Jean-Patrice Baillargeon
- Centre de Recherche du CHU de Sherbrooke, Sherbrooke, QC, Canada
- Département de Médecine, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Anne-Sophie Morisset
- École de Nutrition, Université Laval, Québec, QC, Canada
- Centre de Recherche du CHU de Québec-Université Laval, Québec, QC, Canada
- Centre de Recherche Nutrition, Santé et Société (NUTRISS) de l'Institut sur la Nutrition et des Aliments Fonctionnels (INAF), Université Laval, Québec, QC, Canada
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Wang S, Ma L, Ji J, Huo R, Dong S, Bai Y, Hua L, Lei J, Tian S, Wang M, Yu Y. Protective effect of soy isolate protein against streptozotocin induced gestational diabetes mellitus via TLR4/MyD88/NF-κB signaling pathway. Biomed Pharmacother 2023; 168:115688. [PMID: 37890205 DOI: 10.1016/j.biopha.2023.115688] [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: 07/23/2023] [Revised: 10/04/2023] [Accepted: 10/09/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) is a serious complication of pregnancy that is characterized by high blood sugar levels that occur due to insulin resistance and dysfunction in glucose metabolism during pregnancy. It usually develops in the second or third trimester of pregnancy and affects about 7 % of all pregnancies worldwide. In this experimental study, we scrutinized the GDM protective effect of soy isolate protein against streptozotocin (STZ) induced GDM in rats and explore the underlying mechanism. MATERIAL AND METHODS Sprague-Dawley (SD) rats were used in this experimental study. A 55 mg/kg intraperitoneal injection of streptozotocin (STZ) was administered to induce diabetes in female rats, followed by oral administration of soy isolate protein for 18 days. Body weight, glucose levels, and insulin were measured at different time intervals (0, 9, and 18 days). Lipid profiles, antioxidant levels, inflammatory cytokines, apoptosis parameters, and mRNA expression were also assessed. Pancreatic and liver tissues were collected for histopathological examination during the experimental study. RESULTS Soy isolate protein significantly (P < 0.001) reduced the glucose level and enhanced the insulin level and body weight. Soy isolate protein remarkably decreased the placental weight and increased the fetal weight. Soy isolate protein significantly (P < 0.001) decreased the HbA1c, hepatic glycogen, serum C-peptide and increased the level of free fatty acid. Soy isolate protein significantly (P < 0.001) altered the level of lipid, antioxidant and inflammatory cytokines. Soy isolate protein significantly (P < 0.001) improved the level of adiponectin, visfatin and suppressed the level of leptin and ICAM-1. Soy isolate protein significantly (P < 0.001) altered the mRNA expression and also restored the alteration of histopathology. CONCLUSION Based on the result, soy isolate protein exhibited the GDM protective effect against the STZ induced GDM in rats via alteration of TLR4/MyD88/NF-κB signaling pathway.
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Affiliation(s)
- Shuijing Wang
- School of Public Health, Xi'an Jiaotong University, Xi'an, Shaanxi 710061, China; Shaanxi SANZ Pharmaceutical Co., Ltd, Xi'an, Shaanxi 710086, China
| | - Liangkun Ma
- Department of Obstetrics and Gynecology, National Clinical Research Center for Obstetric & Gynecologic Diseases, PUMC Hospital, CAMS and PUMC, Beijing100730, China
| | - Jing Ji
- Northwest Women's and Children's Hospital, Xi'an, Shaanxi 710061, China
| | - Ruichao Huo
- Pingyao Agriculture and Rural Bureau, Pingyao, Shanxi 031100, China
| | - Shan Dong
- Nutritional Department, Maternal and Child Health Care Hospital of HaiDian District, Beijing 100000, China
| | - Yunfeng Bai
- School of Public Health, Shaanxi University of Chinese Medicine, Xianyang 712046, China
| | - Linlin Hua
- Department of Advanced Medical Research, The Second Affiliated Hospital of Zhengzhou University, Jingba road, Jinshui district, Zhengzhou 450014, China
| | - Jiao Lei
- Shaanxi SANZ Pharmaceutical Co., Ltd, Xi'an, Shaanxi 710086, China
| | - Sasa Tian
- Shaanxi SANZ Pharmaceutical Co., Ltd, Xi'an, Shaanxi 710086, China
| | - Manning Wang
- Shaanxi SANZ Pharmaceutical Co., Ltd, Xi'an, Shaanxi 710086, China
| | - Yan Yu
- School of Public Health, Xi'an Jiaotong University, Xi'an, Shaanxi 710061, China.
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Tan J, Huo L, Qian X, Wang X. Effect of individualised nutritional intervention on the postpartum nutritional status of patients with gestational diabetes mellitus and the growth and development of their offspring: a quasi-experimental study. J OBSTET GYNAECOL 2023; 43:2171280. [PMID: 36708518 DOI: 10.1080/01443615.2023.2171280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
This study explored the effect of individualised nutritional intervention on the postpartum nutritional status of patients with the growth and development of their offspring. This study included pregnant women with gestational diabetes mellitus (GDM) at Hangzhou Women's Hospital in 2019. At 42 days after childbirth, the HbA1c (95% CI: 0.44-0.56%, p < 0.001), the FPG (95% CI: 0.01-0.26 mmol/L, p < 0.05), 2HPG (95% CI: -0.01-0.73 mmol/L, p < 0.05) and TCH (95% CI: -0.34-0.00 mmol/L, p < 0.05) level of the control group were 0.14, 0.36, and 0.17 mmol/L higher than in the intervention group. There were no differences in TG and HGB between the two groups (all p > 0.05). There were significant differences in the number of macrosomia and neonatal weight between the two groups (both p < 0.05). Differences in WHZ after childbirth were not statistically significant between the two groups (all p > 0.05). Individualised nutritional intervention could improve blood glucose levels 42 days after childbirth and reduce macrosomia incidence in pregnant women with GDM.Impact statementWhat is already known on this subject? Individualised nutrition intervention can improve blood glucose status and complications during pregnancy, thus improving pregnancy outcomes.What the results of this study add? Individual nutrition intervention improved the blood glucose and nutritional status of patients at 42 days postpartum, but there was no difference in the growth and development indicators of their offspring at 0-24 months.What the implications are of these findings for clinical practice and/or further research? Improve nutritional intervention programs for gestational diabetes, improve blood glucose during pregnancy and postpartum, to improve pregnancy outcomes and reduce the occurrence of type 2 diabetes and other metabolic diseases; Extend the monitoring range of the growth and development of the offspring of gestational diabetes, find the problems and timely carry out the nutritional intervention, to improve the development of the offspring.
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Affiliation(s)
- Jie Tan
- Department of Nutrition, Hangzhou Women's Hospital, Hangzhou, China
| | - Liangliang Huo
- Institute of Infectious Disease, Hangzhou City Center for Disease Control and Prevention, Hangzhou, China
| | - Xia Qian
- Department of Child Health, Hangzhou Women's Hospital, Hangzhou, China
| | - Xiaohua Wang
- Department of Nutrition, Hangzhou Women's Hospital, Hangzhou, China
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Chen J, Yang Y, Yu N, Sun W, Yang Y, Zhao M. Relationship between gut microbiome characteristics and the effect of nutritional therapy on glycemic control in pregnant women with gestational diabetes mellitus. PLoS One 2022; 17:e0267045. [PMID: 35427393 PMCID: PMC9012359 DOI: 10.1371/journal.pone.0267045] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 03/31/2022] [Indexed: 12/15/2022] Open
Abstract
The purpose of this study was to explore the relationship between the characteristics of gut microbiome and the effect of medical nutrition therapy (MNT) on glycemic control in pregnant women with gestational diabetes mellitus (GDM). Seventy-four pregnant women newly diagnosed with GDM received MNT for one-week. The effect of glycemic control was evaluated by fasting and 2-hour postprandial blood glucose; and stool samples of pregnant women were collected to detect the gut microbiome before and after MNT. We used a nested case-control study design, with pregnant women with GDM who did not meet glycemic standards after MNT as the ineffective group and those with an age difference of ≤5 years, matched for pre-pregnancy body mass index (BMI) 1:1, and meeting glycemic control criteria as the effective group. Comparison of the gut microbiome characteristics before MNT showed that the ineffective group was enriched in Desulfovibrio, Aeromonadales, Leuconostocaceae, Weissella, Prevotella, Bacillales_Incertae Sedis XI, Gemella and Bacillales, while the effective group was enriched in Roseburia, Clostridium, Bifidobacterium, Bifidobacteriales, Bifidobacteriaceae, Holdemania and Proteus. After treatment, the effective group was enriched in Bifidobacterium and Actinomycete, while the ineffective group was enriched in Holdemania, Proteus, Carnobacteriaceae and Granulicatella. In conclusion, the decrease in the abundance of characteristic gut microbiome positively correlated with blood glucose may be a factor influencing the poor hypoglycemic effect of MNT in pregnant women with GDM. Abundance of more characteristic gut microbiome negatively correlated with blood glucose could help control blood glucose in pregnant women with GDM.
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Affiliation(s)
- Jing Chen
- School of Nursing, Anhui Medical University, Hefei, Anhui Province, The people’s Republic of China
| | - Yuying Yang
- Division of Life Sciences and Medicine, Department of Nursing, Hefei Ion Medical Center, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, Anhui Province, The people’s Republic of China
| | - Ningning Yu
- School of Nursing, Anhui Medical University, Hefei, Anhui Province, The people’s Republic of China
| | - Wanxiao Sun
- School of Nursing, Anhui Medical University, Hefei, Anhui Province, The people’s Republic of China
| | - Yuanyuan Yang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, The people’s Republic of China
| | - Mei Zhao
- School of Nursing, Anhui Medical University, Hefei, Anhui Province, The people’s Republic of China
- * E-mail:
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An explainable machine learning-based clinical decision support system for prediction of gestational diabetes mellitus. Sci Rep 2022; 12:1170. [PMID: 35064173 PMCID: PMC8782851 DOI: 10.1038/s41598-022-05112-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 01/06/2022] [Indexed: 12/19/2022] Open
Abstract
Gestational Diabetes Mellitus (GDM), a common pregnancy complication associated with many maternal and neonatal consequences, is increased in mothers with overweight and obesity. Interventions initiated early in pregnancy can reduce the rate of GDM in these women, however, untargeted interventions can be costly and time-consuming. We have developed an explainable machine learning-based clinical decision support system (CDSS) to identify at-risk women in need of targeted pregnancy intervention. Maternal characteristics and blood biomarkers at baseline from the PEARS study were used. After appropriate data preparation, synthetic minority oversampling technique and feature selection, five machine learning algorithms were applied with five-fold cross-validated grid search optimising the balanced accuracy. Our models were explained with Shapley additive explanations to increase the trustworthiness and acceptability of the system. We developed multiple models for different use cases: theoretical (AUC-PR 0.485, AUC-ROC 0.792), GDM screening during a normal antenatal visit (AUC-PR 0.208, AUC-ROC 0.659), and remote GDM risk assessment (AUC-PR 0.199, AUC-ROC 0.656). Our models have been implemented as a web server that is publicly available for academic use. Our explainable CDSS demonstrates the potential to assist clinicians in screening at risk patients who may benefit from early pregnancy GDM prevention strategies.
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