Lifestyle intervention in early pregnancy can prevent gestational diabetes in high-risk pregnant women in the UAE: a randomized controlled trial

Effects of dietary fiber on maternal health in pregnant women with metabolic syndrome risk: a randomized controlled trial

Metabolic Syndrome (MetS) during pregnancy can lead to complications such as gestational diabetes mellitus (GDM) and hypertensive disorders. In this study, we sought to examine the influence of dietary fiber, from both food sources and soluble fiber supplementation, on the metabolic health and overall pregnancy outcomes of women at high risk of MetS. We conducted a randomized controlled trial involving 376 women between 11 and 13 weeks of gestation. To evaluate dietary fiber intake, we performed an exhaustive dietary component analysis using a food frequency questionnaire. Additionally, the participants in the intervention group received daily soluble fiber supplements until delivery. All participants underwent nutritional consultations and metabolic health assessments at three distinct stages of pregnancy (GW 11-13, GW 24-26, and GW 32-34). Our findings revealed a significant correlation between insufficient dietary fiber intake and an increased risk of GDM, even after adjusting for variables such as maternal age and pre-pregnancy BMI. We also noted that a high total dietary fiber intake was associated with reduced changes in triglyceride levels. In addition, the intervention group showed lower need for constipation medication, and soluble fiber supplementation may offer potential benefits for GDM patients. Importantly, our study verified the safety of long-term soluble fiber supplementation during pregnancy. Our results underscore the importance of adequate fiber intake, particularly from dietary sources, for the metabolic health of pregnant women. Moreover, our findings suggest that early fiber supplementation may benefit pregnant women experiencing constipation or those diagnosed with GDM.

Gestational Metabolic Risk: A Narrative Review of Pregnancy-Related Complications and of the Effectiveness of Dietary, Exercise and Lifestyle Interventions during Pregnancy on Reducing Gestational Weight Gain and Preventing Gestational Diabetes Mellitus

Objective: This study is a Narrative Review that aims at investigating the implications of obesity, excessive gestational weight gain (GWG) and gestational diabetes mellitus (GDM). Additionally, this Review seeks to explore the effectiveness of nutrition, and/or exercise interventions during pregnancy on reducing GWG and preventing GDM. Materials and Methods: The search in literature included studies that identified obesity, GWG, GDM and associated risks during pregnancy. Also, SR and MA focusing on interventions including diet, or physical activity (PA), or combined (i.e., lifestyle interventions) and their impact on metabolic risk during pregnancy, were identified through searches in PubMed, Cochrane Database of Systematic Reviews (CDSRs), and Scopus. Results: The study findings suggest that lifestyle interventions during pregnancy may be effective in reducing excessive GWG. Regarding the prevention of GDM, results from studies evaluating lifestyle interventions vary. However, significant and less controversial results were reported from studies assessing the efficacy of exercise interventions, particularly in high-risk pregnant women. Conclusions: Lifestyle interventions during pregnancy may reduce excessive GWG. Exercise during pregnancy may prevent GDM, especially in high-risk pregnant women. Future research is warranted to tailor lifestyle interventions for optimal effectiveness during pregnancy.

Mapping Lifestyle Interventions for Gestational Diabetes Prevention: A Scoping Review

PURPOSE OF REVIEW

The purpose of this study was to conduct a scoping review to map intervention, sample, and physiologic measurement characteristics of lifestyle interventions for gestational diabetes mellitus (GDM) prevention.

RECENT FINDINGS

A total of 19 studies met selection criteria from 405 articles screened (PubMed, Web of Science). No studies were US-based (47% multi-site), and all were delivered in clinical settings. The most targeted nutrition components were low carbohydrate intake (sugar rich foods/added sugars, low glycemic index), low fat intake (mainly low-fat meat, dairy, and saturated fat), and increased fruits and vegetables. Many studies promoted 150 min/week moderate-intensity physical activity. Only two studies provided supervised physical activity sessions. Dietitians and nurses were the most common implementers. Samples were characterized as adults with obesity (mean age 31 yr, BMI 31 kg/m2). Asian populations were predominantly studied. Four studies used theoretical frameworks (75% of which used Social Cognitive Theory). GDM diagnostic criteria set forth by the American Diabetes Association were the most widely used. Insulin sensitivity was commonly assessed via fasting indices. There was a lack of multi-disciplinary, multi-level, and theory-based lifestyle interventions for reducing GDM risk. Addressing these gaps and prioritizing high-risk populations in the US with measurement of traditional and novel biomarkers will advance the field.

Future clinical prospects of C-peptide testing in the early diagnosis of gestational diabetes

Gestational diabetes is typically diagnosed in the late second or third trimester of pregnancy. It is one of the most common metabolic disorders among expectant mothers, with potential serious short- and long-term complications for both maternal and offspring health. C-peptide is secreted from pancreatic beta-cells into circulation in equimolar amounts with insulin. It is a useful biomarker to estimate the beta-cell function because it undergoes negligible hepatic clearance and consequently it has a longer half-life compared to insulin. Pregnancy induces increased insulin resistance due to physiological changes in hormonal and metabolic homeostasis. Inadequate compensation by islet beta-cells results in hyperglycemia. The standard oral glucose tolerance test at 24-28 wk of gestation sets the diagnosis. Accumulated evidence from prospective studies indicates a link between early pregnancy C-peptide levels and the risk of subsequent gestational diabetes. Elevated C-peptide levels and surrogate glycemic indices at the beginning of pregnancy could prompt appropriate strategies for secondary prevention.

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

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.

Interventions in preconception and pregnant women at risk of gestational diabetes; a systematic review and meta-analysis of randomised controlled trials

BACKGROUND

Women at risk of gestational diabetes mellitus (GDM) need preventative interventions.

OBJECTIVE

To evaluate targeted interventions before and during pregnancy for women identified as being at risk of developing GDM.

METHODS

Systematic review and meta-analysis conducted following PRISMA guidelines. MEDLINE, EMBASE and the Cochrane Library in addition to reference and citation lists were searched to identify eligible randomised controlled trials (RCTs) utilising risk stratification during the preconception period or in the first/early second trimester. Screening and data extraction were carried out by the authors independently. Quality assessment was conducted based on the Cochrane risk-of-bias tool. Random effects meta-analysis and narrative synthesis were performed.

RESULTS

Eighty-four RCTs were included: two during preconception and 82 in pregnancy, with a pooled sample of 22,568 women. Interventions were behavioural (n = 54), dietary supplementation (n = 19) and pharmacological (n = 11). Predictive factors for risk assessment varied; only one study utilised a validated prediction model. Gestational diabetes was reduced in diet and physical activity interventions (risk difference - 0.03, 95% CI 0.06, - 0.01; I2 58.69%), inositol (risk difference - 0.19, 95% CI 0.33, - 0.06; I2 92.19%), and vitamin D supplements (risk difference - 0.16, 95% CI 0.25, - 0.06; I2 32.27%). Subgroup analysis showed that diet and physical activity interventions were beneficial in women with ≥ 2 GDM risk factors (risk difference - 0.16, 95% CI 0.25, - 0.07; I2 11.23%) while inositol supplementation was effective in women with overweight or obesity (risk difference - 0.17, 95% CI 0.22, - 0.11; I2 0.01%). Effectiveness of all other interventions were not statistically significant.

CONCLUSIONS

This review provides evidence that interventions targeted at women at risk of GDM may be an effective strategy for prevention. Further studies using validated prediction tools or multiple risk factors to target high-risk women for intervention before and during pregnancy are warranted.

The impact of health coaching on the prevention of gestational diabetes in overweight/obese pregnant women: a quasi-experimental study

BACKGROUND

Previous studies have demonstrated that excessive gestational weight gain (GWG) increases the risk of gestational diabetes mellitus (GDM). This study aimed to determine the effect of using health coaching on the prevention of GDM in overweight pregnant women.

METHODS

In this quasi-experimental study, 64 eligible overweight women at 12-14 gestational weeks were randomly divided into 2 groups: the coaching group and the control group (usual care group). The intervention group received 8 weeks of the phone coaching program, which integrated GWG and physical activity to reduce the incidence of GDM. The Pregnancy Physical Activity Questionnaire (PPAQ) was used to assess physical activity during pregnancy. The occurrence of gestational diabetes was determined based on the 75-g 2-hour oral glucose tolerance test (OGTT) at 24-28 weeks of gestation. The primary outcome was the incidence of GDM, and the secondary outcomes included physical activity, GWG, and neonatal and maternal birth outcomes.

RESULTS

The incidence of GDM in the control and intervention groups was 24.1% and 22.6%, respectively. The relative risk (RR) was 0.93 (95% CI, 0.37-2.34; P = 0.887). The post survey results indicated that GWG decreased more considerably in the coaching than in the control group between pre-trial (T0) and post-trial (T1), (MD; -2.49 with 95% CI, -4.38 to -0.60; P < 0.011). Moreover, the total GWG (between pre-pregnancy and birth) diminished more remarkably in the coaching than in the control group, (MD; -2.83 with 95% CI, -5.08 to -0.58; P < 0.014). However, the score of self-efficacy and concern about PPAQ Metabolic Equivalent of Task (METs) did not differ between the coaching and control groups.

CONCLUSIONS

The findings and implications of this research could significantly contribute to maternal health and gestational diabetes prevention. Additional support from a midwife coach resulted in better GWG. More studies are needed to assess the impact of health coaching as a component of usual care and its long-term effect on maternal and neonatal outcomes.

Effectiveness of Lifestyle Interventions during Pregnancy on Preventing Gestational Diabetes Mellitus in High-Risk Women: A Systematic Review and Meta-Analyses of Published RCTs

BACKGROUND

Until now, it is uncertain whether lifestyle interventions during pregnancy can prevent gestational diabetes mellites (GDM) in high-risk pregnant women.

OBJECTIVE

This study aims at investigating the effectiveness of dietary interventions and/or exercise interventions during pregnancy for preventing GDM in high-risk pregnant women.

MATERIALS AND METHODS

Eligible randomized controlled trials (RCTs) were selected after a search in CENTRAL, Scopus, and PubMed. Synthesis was performed for the outcome of GDM in women with any identified GDM risk factor. Separate meta-analyses (MA) were performed to assess the efficacy of either nutrition or physical activity (PA) interventions or both combined compared with standard prenatal care for preventing GDM. Subgroup and sensitivity analyses, as well as meta-regressions against OR, were performed to assess potentional heterogeneity. Overall quality, the quality of RCTs, and publication bias were also evaluated.

RESULTS

A total of 13,524 participants comprising high-risk pregnant women in 41 eligible RCTs were analyzed for GDM. Women receiving only a nutrition intervention during pregnancy were less likely to experience GDM compared with women following standard prenatal care. Among 3109 high-risk pregnant women undergoing only dietary intervention for preventing GDM, 553 (17.8%) developed GDM; however, the result of the MA was marginally not significant (OR 0.73, 95%CI 0.51, 1.03; p-value 0.07), (Q 21.29, p-value 0.01; I2 58% (95%CI 10, 78%)). Subgroup analyses demonstrated an effect for studies that were conducted in Great Britain (OR 0.65, 95%CI 0.49, 0.81; p-value 0.003), and in Spain (OR 0.50, 95%CI 0.27, 0.94; p-value 0.03), for studies with forms of the Mediterranean diet as the intervention's component (OR 0.61; 95%CI 0.46, 0.81; p-value 0.0005), and for studies including a motivation arm in the intervention (OR 0.71, 95%CI 0.58, 0.87; p-value 0.0008). Among 2742 high-risk pregnant women being analyzed for GDM outcome after receiving only an exercise intervention, 461 (16.8%) were diagnosed with GDM. Women after receiving PA intervention were less likely to develop GDM (OR 0.64, 95%CI 0.51, 0.80; p-value < 0.0001), (Q 11.27, p-value 0.51; I2 0% (95%CI 0, 99%)). Finally, 1308 (17%) cases of GDM were diagnosed among 7673 high-risk pregnant women undergoing both diet and PA intervention. Women in the group of mixed lifestyle intervention had a significant reduction in incidence of GDM (OR 0.70, 95%CI 0.55, 0.90; p-value 0.005), (Q 50.32, p-value < 0.0001, I2 66%, (95% CI 44, 79%)).

CONCLUSIONS

The results of this study support the efficacy of lifestyle interventions during pregnancy for preventing GDM in high-risk women if an exercise component is included in the intervention arm, either alone, or combined with diet. A combined lifestyle intervention including physical exercise and a Mediterranean diet accompanied by motivation support may be considered the most effective way to prevent GDM among high-risk women during pregnancy. Future research is needed to strengthen these findings.

Pregnancy Cholesterol Metabolism Markers and the Risk of Gestational Diabetes Mellitus: A Nested Case-Control Study

This study aims to determine the association of pregnancy cholesterol metabolism markers with gestational diabetes mellitus (GDM) risk. We performed a nested case-control study in the Tongji Birth Cohort. GDM was diagnosed according to the 75 g 2 h oral glucose tolerance test (OGTT) at 24-28 gestational weeks. Nine cholesterol metabolism markers were detected using gas chromatography-mass spectrometry. Conditional logistic regression models were conducted. A total of 444 pregnant women were matched in a 1:2 ratio. The cholestanolTC and β-sitosterolTC in cholesterol absorption markers presented negative associations with the risks of GDM (adjusted OR: 0.77, 95% CI: 0.61-0.96; adjusted OR: 0.80, 95% CI: 0.64-1.00). The desmosterolTC in cholesterol synthesis markers were positively associated with the risks of GDM (adjusted OR: 1.25, 95% CI: 1.00-1.56), similar in the ratios of cholesterol synthesis to absorption markers. After adjustment for insulin or HOMA-IR, these effects were reduced. In conclusion, higher cholesterol synthesis and lower cholesterol absorption marker levels in the first pregnancy are associated with a higher risk of GDM, and insulin resistance may play a vital role in this association.

UAE Women's Knowledge and Attitudes towards Physical Activity during Pregnancy

The benefits of being physically active during pregnancy are widely acknowledged. It is important for the prevention of chronic diseases and the promotion of good health for mothers and children. However, physical activity by women in the UAE is notoriously low and reduced further during pregnancy. The same can be said regarding research about the knowledge and understanding of the benefits and risks associated with exercise as a predictor of behavior. We aimed to assess knowledge and attitudes towards physical activity during pregnancy amongst Emirati women. A cross-sectional digital survey was designed to assess knowledge and attitudes and distributed to women, aged 18-40 years, using non-randomized, purposeful snowball sampling. A total of 1538 women were recruited. Most participants were aged 20-29 years (53.5%), were Emiratis (88.9%), and had no history of chronic disease (68.6%). The participants self-reported very low levels of PA (75.5%) and had a below-average level of knowledge overall (40.6 ± 20). Younger ages (p < 0.001), lower educational levels (p = 0.004), being employed (p = 0.014), and having a history of chronic disease (p = 0.016) were significantly associated with lower mean knowledge scores, while being married (p = 0.003) was significantly associated with higher scores. The participants also exhibited a positive attitude towards physical activity during pregnancy by selecting answers that they supported it. To encourage physical activity, women living in the UAE could benefit from clear advice about safe physical activity during pregnancy.