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Hyperglycemia in Pregnancy and Nutrition

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A special issue of Nutrients (ISSN 2072-6643). This special issue belongs to the section "Nutrition and Diabetes".

Deadline for manuscript submissions: closed (30 January 2023) | Viewed by 20026

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Dr. David Simmons

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Guest Editor

Campbelltown Hospital Endocrinology Department, Macarthur Clinical School, Western Sydney University, Sydney, NSW, Australia
Interests: diagnosis and management of GDM; management of diabetes in pregnancy; prevention of GDM and type 2 diabetes; diabetes integrated care; diabetes epidemiology; barriers to diabetes care
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Special Issue Information

Dear Colleagues,

Hyperglycemia in pregnancy, including gestational diabetes mellitus (GDM) and known pregestational diabetes (type 1 diabetes, type 2 diabetes, and rare forms of diabetes), is associated with a range of pregnancy complications that can often be avoided with glucose and weight management. Diet, exercise, and optimization of gestational weight gain are the cornerstone of management for all forms of diabetes with or without pharmacotherapy and yet often remain a significant challenge for women during pregnancy. Similarly, although nutritional interventions are often promoted for the prevention of GDM, evidence of major effectiveness for reducing GDM incidence is limited. Finally, preventing progression to type 2 diabetes after GDM remains elusive, often due to wider life impacts. Determining how best to implement nutritional interventions and which nutritional interventions to promote are also topics of ongoing investigations.

In this Special Issue, we seek submissions involving all aspects of diet and diet therapy relating to the prevention and management of any form of hyperglycemia in pregnancy, including GDM, and including those relating to breastfeeding. This includes programs for the prevention of progression to type 2 diabetes after GDM involving dietary intervention. Reports on relevant clinical trials and nutrition-related health outcomes are encouraged.

Dr. David Simmons
Guest Editor

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Keywords

gestational diabetes mellitus
type 1 diabetes in pregnancy
type 2 diabetes in pregnancy
nutrition
diet treatment
carbohydrates
lifestyle
prevention
glucose
obesity

Published Papers (7 papers)

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13 pages, 1073 KiB

Open AccessArticle

Fasting Glucose Level on the Oral Glucose Tolerance Test Is Associated with the Need for Pharmacotherapy in Gestational Diabetes Mellitus

by Natassia Rodrigo, Deborah Randall, Farah Abu Al-Hial, Kathleen L. M. Pak, Alexander Junmo Kim and Sarah J. Glastras

Nutrients 2023, 15(5), 1226; https://doi.org/10.3390/nu15051226 - 28 Feb 2023

Cited by 2 | Viewed by 2002

Abstract

Gestational diabetes mellitus (GDM) has a rapidly increasing prevalence, which poses challenges to obstetric care and service provision, with known serious long-term impacts on the metabolic health of the mother and the affected offspring. The aim of this study was to evaluate the association between glucose levels on the 75 g oral glucose tolerance test and GDM treatment and outcomes. We performed a retrospective cohort study of women with GDM attending a tertiary Australian hospital obstetric clinic between 2013 and 2017, investigating the relationship between the 75 g oral glucose tolerance test (OGTT) glucose values, and obstetric (timing of delivery, caesarean section, preterm birth, preeclampsia), and neonatal (hypoglycaemia, jaundice, respiratory distress and NICU admission) outcomes. This time frame encompassed a change in diagnostic criteria for gestational diabetes, due to changes in international consensus guidelines. Our results showed that, based on the diagnostic 75 g OGTT, fasting hyperglycaemia, either alone or in combination with elevated 1 or 2 h glucose levels, was associated with the need for pharmacotherapy with either metformin and/or insulin (p < 0.0001; HR 4.02, 95% CI 2.88–5.61), as compared to women with isolated hyperglycaemia at the 1 or 2 h post-glucose load timepoints. Fasting hyperglycaemia on the OGTT was more likely in women with higher BMI (p < 0.0001). There was an increased risk of early term birth in women with mixed fasting and post-glucose hyperglycaemia (adjusted HR 1.72, 95% CI 1.09–2.71). There were no significant differences in rates of neonatal complications such as macrosomia or NICU admission. Fasting hyperglycaemia, either alone or in combination with post-glucose elevations on the OGTT, is a strong indicator of the need for pharmacotherapy in pregnant women with GDM, with significant ramifications for obstetric interventions and their timing. Full article

(This article belongs to the Special Issue Hyperglycemia in Pregnancy and Nutrition)

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15 pages, 672 KiB

Open AccessArticle

Vitamin D3 Supplementation in Overweight/Obese Pregnant Women: No Effects on the Maternal or Fetal Lipid Profile and Body Fat Distribution—A Secondary Analysis of the Multicentric, Randomized, Controlled Vitamin D and Lifestyle for Gestational Diabetes Prevention Trial (DALI)

by Jürgen Harreiter, Lilian C. Mendoza, David Simmons, Gernot Desoye, Roland Devlieger, Sander Galjaard, Peter Damm, Elisabeth R. Mathiesen, Dorte M. Jensen, Lise Lotte T. Andersen, Fidelma Dunne, Annunziata Lapolla, Maria G. Dalfra, Alessandra Bertolotto, Ewa Wender-Ozegowska, Agnieszka Zawiejska, David Hill, Judith G. M. Jelsma, Frank J. Snoek, Christof Worda, Dagmar Bancher-Todesca, Mireille N. M. van Poppel, Rosa Corcoy, Alexandra Kautzky-Willer and on behalf of the DALI Core Investigator Group Show full author list Hide full author list

Nutrients 2022, 14(18), 3781; https://doi.org/10.3390/nu14183781 - 14 Sep 2022

Cited by 5 | Viewed by 3160

Abstract

Vitamin D deficiency is a common finding in overweight/obese pregnant women and is associated with increased risk for adverse pregnancy outcome. Both maternal vitamin D deficiency and maternal obesity contribute to metabolic derangements in pregnancy. We aimed to assess the effects of vitamin D3 supplementation in pregnancy versus placebo on maternal and fetal lipids. Main inclusion criteria were: women <20 weeks’ gestation, BMI ≥ 29 kg/m². Eligible women (n = 154) were randomized to receive vitamin D3 (1600 IU/day) or placebo. Assessments were performed <20, 24–28 and 35–37 weeks and at birth. Linear regression models were used to assess effects of vitamin D on maternal and cord blood lipids. In the vitamin D group significantly higher total 25-OHD and 25-OHD3 levels were found in maternal and cord blood compared with placebo. Adjusted regression models did not reveal any differences in triglycerides, LDL-C, HDL-C, free fatty acids, ketone bodies or leptin between groups. Neonatal sum of skinfolds was comparable between the two groups, but correlated positively with cord blood 25-OH-D3 (r = 0.34, p = 0.012). Vitamin D supplementation in pregnancy increases maternal and cord blood vitamin D significantly resulting in high rates of vitamin D sufficiency. Maternal and cord blood lipid parameters were unaffected by Vitamin D3 supplementation. Full article

(This article belongs to the Special Issue Hyperglycemia in Pregnancy and Nutrition)

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10 pages, 519 KiB

Open AccessArticle

Diet-Treated Gestational Diabetes Mellitus Is an Underestimated Risk Factor for Adverse Pregnancy Outcomes: A Swedish Population-Based Cohort Study

by Inga Rós Valgeirsdóttir, Ulf Hanson, Erik Schwarcz, David Simmons and Helena Backman

Nutrients 2022, 14(16), 3364; https://doi.org/10.3390/nu14163364 - 16 Aug 2022

Cited by 2 | Viewed by 2174

Abstract

In Sweden, diet-treated gestational diabetes mellitus (GDM) pregnancies have been managed as low risk. The aim was to evaluate the risk of adverse perinatal outcomes among women with diet-treated GDM compared with the background population and with insulin-treated GDM. This is a population-based cohort study using national register data between 1998 and 2012, before new GDM management guidelines and diagnostic criteria in Sweden were introduced. Singleton pregnancies (n = 1,455,580) without pregestational diabetes were included. Among 14,242 (1.0%) women diagnosed with GDM, 8851 (62.1%) were treated with diet and 5391 (37.9%) with insulin. In logistic regression analysis, the risk was significantly increased in both diet- and insulin-treated groups (vs. background) for large-for-gestational-age newborns, preeclampsia, cesarean section, birth trauma and preterm delivery. The risk was higher in the insulin-treated group (vs. diet) for most outcomes, but perinatal mortality rates neither differed between treatment groups nor compared to the background population. Diet as a treatment for GDM did not normalize pregnancy outcomes. Pregnancies with diet-treated GDM should therefore not be considered as low risk. Whether changes in surveillance and treatment improve outcomes needs to be evaluated. Full article

(This article belongs to the Special Issue Hyperglycemia in Pregnancy and Nutrition)

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13 pages, 997 KiB

Open AccessFeature PaperArticle

Gestational Diabetes Mellitus and High Triglyceride Levels Mediate the Association between Pre-Pregnancy Overweight/Obesity and Macrosomia: A Prospective Cohort Study in Central China

by Xinli Song, Letao Chen, Senmao Zhang, Yiping Liu, Jianhui Wei, Tingting Wang and Jiabi Qin

Nutrients 2022, 14(16), 3347; https://doi.org/10.3390/nu14163347 - 16 Aug 2022

Cited by 7 | Viewed by 2524

Abstract

The purpose of this study is to investigate whether the link between pre-pregnancy overweight/obesity and risk of macrosomia is mediated by both gestational diabetes mellitus (GDM) and high maternal triglyceride (mTG) levels. This prospective study finally included 29,415 singleton term pregnancies. The outcome of interest was macrosomia (≥4000 g). High mTG levels were denoted as values ≥90th percentile. GDM was diagnosed using a standard 75 g 2 h oral glucose tolerance test. The mediation analysis was conducted using log-binomial regression while controlling for maternal age, education, parity, gestational weight gain, gestational hypertension, smoking, drinking and infant sex. Overall, 15.9% of pregnant women were diagnosed with GDM, and 4.3% were macrosomia. Mediation analysis suggested that overweight had a total effect of 0.009 (95% CI, 0.006–0.013) on macrosomia, with a direct effect of 0.008 (95% CI, 0.004–0.012) and an indirect effect of 0.001 (95% CI, 0.001–0.002), with an estimated proportion of 11.1% mediated by GDM and high mTG levels together. Furthermore, we also discovered a total effect of obesity on macrosomia of 0.038 (95% CI, 0.030–0.047), consisting of a direct effect of 0.037 (95% CI, 0.028–0.045) and an indirect effect of 0.002 (95% CI, 0.001–0.002), with an estimated proportion of 5.3% mediated by GDM and high mTG levels combined. Both GDM and high mTG levels enhanced the risk of macrosomia independently and served as significant mediators in the relationship between pre-pregnancy overweight/obesity and macrosomia. Full article

(This article belongs to the Special Issue Hyperglycemia in Pregnancy and Nutrition)

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Review

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16 pages, 349 KiB

Open AccessReview

Dietary Advice to Support Glycaemic Control and Weight Management in Women with Type 1 Diabetes during Pregnancy and Breastfeeding

by Lene Ringholm, Sidse Kjærhus Nørgaard, Ane Rytter, Peter Damm and Elisabeth Reinhardt Mathiesen

Nutrients 2022, 14(22), 4867; https://doi.org/10.3390/nu14224867 - 17 Nov 2022

Cited by 7 | Viewed by 2768

Abstract

In women with type 1 diabetes, the risk of adverse pregnancy outcomes, including congenital anomalies, preeclampsia, preterm delivery, foetal overgrowth and perinatal death is 2–4-fold increased compared to the background population. This review provides the present evidence supporting recommendations for the diet during pregnancy and breastfeeding in women with type 1 diabetes. The amount of carbohydrate consumed in a meal is the main dietary factor affecting the postprandial glucose response. Excessive gestational weight gain is emerging as another important risk factor for foetal overgrowth. Dietary advice to promote optimized glycaemic control and appropriate gestational weight gain is therefore important for normal foetal growth and pregnancy outcome. Dietary management should include advice to secure sufficient intake of micro- and macronutrients with a focus on limiting postprandial glucose excursions, preventing hypoglycaemia and promoting appropriate gestational weight gain and weight loss after delivery. Irrespective of pre-pregnancy BMI, a total daily intake of a minimum of 175 g of carbohydrate, mainly from low-glycaemic-index sources such as bread, whole grain, fruits, rice, potatoes, dairy products and pasta, is recommended during pregnancy. These food items are often available at a lower cost than ultra-processed foods, so this dietary advice is likely to be feasible also in women with low socioeconomic status. Individual counselling aiming at consistent timing of three main meals and 2–4 snacks daily, with focus on carbohydrate amount with pragmatic carbohydrate counting, is probably of value to prevent both hypoglycaemia and hyperglycaemia. The recommended gestational weight gain is dependent on maternal pre-pregnancy BMI and is lower when BMI is above 25 kg/m². Daily folic acid supplementation should be initiated before conception and taken during the first 12 gestational weeks to minimize the risk of foetal malformations. Women with type 1 diabetes are encouraged to breastfeed. A total daily intake of a minimum of 210 g of carbohydrate is recommended in the breastfeeding period for all women irrespective of pre-pregnancy BMI to maintain acceptable glycaemic control while avoiding ketoacidosis and hypoglycaemia. During breastfeeding insulin requirements are reported approximately 20% lower than before pregnancy. Women should be encouraged to avoid weight retention after pregnancy in order to reduce the risk of overweight and obesity later in life. In conclusion, pregnant women with type 1 diabetes are recommended to follow the general dietary recommendations for pregnant and breastfeeding women with special emphasis on using carbohydrate counting to secure sufficient intake of carbohydrates and to avoid excessive gestational weight gain and weight retention after pregnancy. Full article

(This article belongs to the Special Issue Hyperglycemia in Pregnancy and Nutrition)

21 pages, 567 KiB

Open AccessReview

Probiotics in the Prevention and Treatment of Gestational Diabetes Mellitus (GDM): A Review

by Klaudia Kamińska, Dominika Stenclik, Wiktoria Błażejewska, Paweł Bogdański and Małgorzata Moszak

Nutrients 2022, 14(20), 4303; https://doi.org/10.3390/nu14204303 - 14 Oct 2022

Cited by 14 | Viewed by 4388

Abstract

Gestational diabetes mellitus (GDM)is one of the most common perinatal pathologies, with a prevalence of 5–20% depending on the population or diagnostic standards. It is diagnosed when glucose intolerance is first detected during pregnancy. In the pathogenesis of GDM, genetic, environmental, and pregnancy-related factors (excessive fat storage and increased adipokine and cytokine secretion) play important roles. A growing amount of scientific data has indicated the role of gut microbiota (GM) dysbiosis in the development of glucose intolerance during pregnancy. Previous studies have indicated that, in comparison to healthy pregnant women, GDM individuals have a greater abundance of bacteria belonging to the genera Ruminococcus, Eubacterium, and Prevotella and a lower number of bacteria belonging to the genera Bacteroides, Parabacteroides, Roseburia, Dialister, and Akkermansia. Recently, many studies have focused on treating GDM with methods targeting GM. Several previous studies have analyzed the effect of probiotics on the course of GDM, but their data are inconclusive. In view of this state, the aim of the study was to collect and comprehensively discuss current knowledge regarding the role of probiotic supplementation in preventing and treating GDM. According to the analyzed data, probiotics have a positive influence on glycemic control and are a promising tool for lowering the frequency of GDM. However, further studies must be conducted to determine the optimal model of probiotic therapy (strain, dose, time of intervention, etc.) in pregnant women with GDM. Full article

(This article belongs to the Special Issue Hyperglycemia in Pregnancy and Nutrition)

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Other

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12 pages, 2041 KiB

Open AccessSystematic Review

Association of Selenium Levels with Gestational Diabetes Mellitus: An Updated Systematic Review and Meta-Analysis

by Hamdan Z. Hamdan, Sumaia Zaki Hamdan and Ishag Adam

Nutrients 2022, 14(19), 3941; https://doi.org/10.3390/nu14193941 - 23 Sep 2022

Cited by 5 | Viewed by 1993

Abstract

Several studies have investigated the association between selenium levels and gestational diabetes mellitus (GDM); however, their results are not conclusive. This systematic review and meta-analysis aimed to update and draw conclusions regarding the evidence from published studies that investigated selenium levels in relation to GDM. PubMed, Google Scholar, Cochrane Library and ScienceDirect were searched for studies related to selenium and GDM, published from the inception of each database through to July 2022. The meta-analysis was conducted by measuring the standardized mean difference (SMD) between the selenium levels of women with GDM and those pregnant without GDM (control group). Stratified meta-analysis, meta-regression analysis and reporting bias were applied. The “meta” package in the open-access software R was used to analyze all of the data. A total of 12 studies, including 940 pregnant women with GDM and 1749 controls met this study’s inclusion criteria. The selenium levels were significantly lower in women with GDM compared with the control group (SMD = −0.66; 95% confidence interval (CI): (−1.04, −0.28); p ≤ 0.001). Due to significant heterogeneity (I² = 94%, Cochrane Q = 186.7; p ≤ 0.0001), the random-effects model was followed. The stratified meta-analysis showed that the selenium levels were lower in the cases compared with the normal controls in the third trimester (SMD = −1.85 (−3.03, −0.66); p ≤ 0.01). The same trend was observed in the studies published before the year 2014 (SMD = −0.99 (−1.70, −0.28); p ≤0.01) and those published in or after 2014 (SMD = −0.45 (−0.90, 0.00); p = 0.05). None of the investigated covariates in the meta-regression analysis (each study’s geographic location, trimester of selenium quantification, World Bank economic classification, method of selenium determination, study design, study quality score, publication year and study’s sample size) were significantly associated with the selenium SMD. The current evidence indicates that selenium levels are lower among women with GDM in comparison to those without GDM; however, after the correction of the reporting bias, the result was no longer significant. Further studies with more prospective designs are needed to confirm this evidence and explain the function of selenium in GDM throughout pregnancy. Full article

(This article belongs to the Special Issue Hyperglycemia in Pregnancy and Nutrition)

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