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Special Issue "Nutrition and Gestational Diabetes"

A special issue of Nutrients (ISSN 2072-6643).

Deadline for manuscript submissions: closed (1 January 2019)

Special Issue Editor

Guest Editor
Prof. Dr. David Simmons

School of Medicine, Western Sydney University, Sydney, Australia
Website | E-Mail
Phone: +61-(02)-4634-4899
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

Special Issue Information

Dear Colleagues,

Gestational diabetes mellitus (GDM) is a common medical disorder of pregnancy associated with adverse outcomes for the mother and infant. Often defined as carbohydrate intolerance that is first detected in pregnancy, it is considered a heterogenous condition including pre-existing undiagnosed type 2 and monogenic diabetes, lesser degrees of pre-existing glucose intolerance and genuine incident GDM. The impact of GDM, beyond the proportion of babies that are large for gestational age, is through increased rates of maternal complications such as pre-eclampsia, perineal trauma and cesarean section, while the neonates suffer increased rates of stillbirth, neonatal trauma, respiratory distress, hypoglycaemia and jaundice. Long term morbidity includes type 2 diabetes and cardiovascular disease in the women and type 2 diabetes, metabolic syndrome and obesity in the offspring. While much of GDM has a genetic and likely epigenetic aetiology, it is clear that an ‘unhealthy’ lifestyle is the key causal factor among most women, wither directly or through obesity. This includes physical activity, sedentary behaviours, sleep patterns and of course, the most complex is nutrition. Nutrition includes the diet before, during and after pregnancy for prevention and treatment of GDM/diabetes. The aim of this special issue is to tease out the contributions and usefulness of different nutrients, foods, eating patterns and styles, along with insights into the underlying genetic, physiological and behavioural mechanisms, and potential for modern technology in the prevention and management of GDM and its long term morbidity.

Prof. David Simmons
Guest Editors

Manuscript Submission Information

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Keywords

  • Gestational Diabetes
  • Nutrition
  • Carbohydrate
  • Fat
  • Prevention

Published Papers (9 papers)

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Research

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Open AccessArticle Dietary Patterns during Pregnancy Are Associated with the Risk of Gestational Diabetes Mellitus: Evidence from a Chinese Prospective Birth Cohort Study
Nutrients 2019, 11(2), 405; https://doi.org/10.3390/nu11020405
Received: 20 December 2018 / Revised: 31 January 2019 / Accepted: 1 February 2019 / Published: 15 February 2019
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Abstract
Dietary patterns during pregnancy have been shown to influence the development of gestational diabetes mellitus (GDM). However, evidence from Asian populations is limited and inconsistent. We conducted a prospective cohort study in China to assess the relationship between dietary patterns and GDM. We [...] Read more.
Dietary patterns during pregnancy have been shown to influence the development of gestational diabetes mellitus (GDM). However, evidence from Asian populations is limited and inconsistent. We conducted a prospective cohort study in China to assess the relationship between dietary patterns and GDM. We administered three-day food diaries (TFD) and food frequency questionnaires (FFQ) at the second trimester. GDM was diagnosed with a 75 g 2-h oral glucose tolerance test at 24–28 weeks of gestation. We identified dietary patterns using principal components analysis and used multivariable logistic regression to investigate associations of dietary patterns with GDM. Of the 1014 participants, 23.5% were diagnosed with GDM. Both the TFD and FFQ identified a “traditional pattern”, consisting of high vegetable, fruit, and rice intake, which was associated with a lower GDM risk (odds ratio (OR) for quartile 4 versus quartile 1: 0.40, 95% CI: 0.23–0.71 for traditional pattern (TFD); OR: 0.44, CI: 0.27–0.70 for traditional pattern (FFQ)). The protective associations were more pronounced among women ≥35 years old. A whole grain–seafood TFD pattern was associated with higher risk of GDM (OR: 1.73, 95% CI: 1.10–2.74). These findings may provide evidence for making dietary guidelines among pregnant women in Chinese populations to prevent GDM. Full article
(This article belongs to the Special Issue Nutrition and Gestational Diabetes)
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Open AccessArticle Mediators of Lifestyle Behaviour Changes in Obese Pregnant Women. Secondary Analyses from the DALI Lifestyle Randomised Controlled Trial
Nutrients 2019, 11(2), 311; https://doi.org/10.3390/nu11020311
Received: 31 December 2018 / Revised: 24 January 2019 / Accepted: 28 January 2019 / Published: 1 February 2019
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Abstract
A better understanding of what drives behaviour change in obese pregnant overweight women is needed to improve the effectiveness of lifestyle interventions in this group at risk for gestational diabetes (GDM). Therefore, we assessed which factors mediated behaviour change in the Vitamin D [...] Read more.
A better understanding of what drives behaviour change in obese pregnant overweight women is needed to improve the effectiveness of lifestyle interventions in this group at risk for gestational diabetes (GDM). Therefore, we assessed which factors mediated behaviour change in the Vitamin D and Lifestyle Intervention for GDM Prevention (DALI) Lifestyle Study. A total of 436 women, with pre-pregnancy body mass index ≥29 kg/m2, ≤19 + 6 weeks of gestation and without GDM, were randomised for counselling based on motivational interviewing (MI) on healthy eating and physical activity, healthy eating alone, physical activity alone, or to a usual care group. Lifestyle was measured at baseline, and at 24–28 and 35–37 weeks of gestation. Outcome expectancy, risk perception, task self-efficacy and social support were measured at those same time points and considered as possible mediators of intervention effects on lifestyle. All three interventions resulted in increased positive outcome expectancy for GDM reduction, perceived risk to the baby and increased task self-efficacy. The latter mediated intervention effects on physical activity and reduced sugared drink consumption. In conclusion, our MI intervention was successful in increasing task self-efficacy, which was related to improved health behaviours. Full article
(This article belongs to the Special Issue Nutrition and Gestational Diabetes)
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Open AccessArticle A High Adherence to Six Food Targets of the Mediterranean Diet in the Late First Trimester is Associated with a Reduction in the Risk of Materno-Foetal Outcomes: The St. Carlos Gestational Diabetes Mellitus Prevention Study
Nutrients 2019, 11(1), 66; https://doi.org/10.3390/nu11010066
Received: 24 November 2018 / Revised: 17 December 2018 / Accepted: 27 December 2018 / Published: 31 December 2018
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Abstract
A prenatal diet affects materno-foetal outcomes. This is a post hoc analysis of the St. Carlos gestational diabetes mellitus (GDM) Prevention Study. It aims to evaluate the effect of a late first-trimester (>12 gestational weeks) degree of adherence to a MedDiet pattern—based on [...] Read more.
A prenatal diet affects materno-foetal outcomes. This is a post hoc analysis of the St. Carlos gestational diabetes mellitus (GDM) Prevention Study. It aims to evaluate the effect of a late first-trimester (>12 gestational weeks) degree of adherence to a MedDiet pattern—based on six food targets—on a composite of materno-foetal outcomes (CMFCs). The CMFCs were defined as having emergency C-section, perineal trauma, pregnancy-induced hypertension and preeclampsia, prematurity, large-for-gestational-age, and/or small-for-gestational-age. A total of 874 women were stratified into three groups according to late first-trimester compliance with six food targets: >12 servings/week of vegetables, >12 servings/week of fruits, <2 servings/week of juice, >3 servings/week of nuts, >6 days/week consumption of extra virgin olive oil (EVOO), and ≥40 mL/day of EVOO. High adherence was defined as complying with 5–6 targets; moderate adherence 2–4 targets; low adherence 0–1 targets. There was a linear association between high, moderate, and low adherence, and a lower risk of GDM, CMFCs, urinary tract infections (UTI), prematurity, and small-for-gestational-age (SGA) newborns (all p < 0.05). The odds ratios (95% CI) for GDM and CMFCs in women with a high adherence were 0.35((0.18–0.67), p = 0.002) and 0.23((0.11–0.48), p < 0.001), respectively. Late first-trimester high adherence to the predefined six food targets is associated with a reduction in the risk of GDM, CMFCs, UTI, prematurity, and SGA new-borns. Full article
(This article belongs to the Special Issue Nutrition and Gestational Diabetes)
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Open AccessArticle Mid-Pregnancy Fructosamine Measurement—Predictive Value for Gestational Diabetes and Association with Postpartum Glycemic Indices
Nutrients 2018, 10(12), 2003; https://doi.org/10.3390/nu10122003
Received: 6 November 2018 / Revised: 2 December 2018 / Accepted: 17 December 2018 / Published: 18 December 2018
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Abstract
Screening for gestational diabetes mellitus (GDM) during pregnancy is cumbersome. Measurement of plasma fructosamine may help simplify the first step of detecting GDM. We aimed to assess the predictive value of mid-pregnancy fructosamine for GDM, and its association with postpartum glycemic indices. Among [...] Read more.
Screening for gestational diabetes mellitus (GDM) during pregnancy is cumbersome. Measurement of plasma fructosamine may help simplify the first step of detecting GDM. We aimed to assess the predictive value of mid-pregnancy fructosamine for GDM, and its association with postpartum glycemic indices. Among 1488 women from Project Viva (mean ± SD: 32.1 ± 5.0 years old; pre-pregnancy body mass index 24.7 ± 5.3 kg/m2), we measured second trimester fructosamine and assessed gestational glucose tolerance with a 50 g glucose challenge test (GCT) followed, if abnormal, by a 100 g oral glucose tolerance test (OGTT). Approximately 3 years postpartum (median 3.2 years; SD 0.4 years), we measured maternal glycated hemoglobin (n = 450) and estimated insulin resistance (HOMA-IR; n = 132) from fasting blood samples. Higher glucose levels 1 h post 50 g GCT were associated with higher fructosamine levels (Pearson’s r = 0.06; p = 0.02). However, fructosamine ≥222 µmol/L (median) had a sensitivity of 54.8% and specificity of 48.6% to detect GDM (area under the receiver operating characteristic curve = 0.52); other fructosamine thresholds did not show better predictive characteristics. Fructosamine was also weakly associated with 3-year postpartum glycated hemoglobin (per 1 SD increment: adjusted β = 0.03 95% CI [0.00, 0.05] %) and HOMA-IR (per 1 SD increment: adjusted % difference 15.7, 95% CI [3.7, 29.0] %). Second trimester fructosamine is a poor predictor of gestational glucose tolerance and postpartum glycemic indices. Full article
(This article belongs to the Special Issue Nutrition and Gestational Diabetes)
Open AccessFeature PaperArticle Dietary Intakes and Dietary Quality during Pregnancy in Women with and without Gestational Diabetes Mellitus - A Norwegian Longitudinal Study
Nutrients 2018, 10(11), 1811; https://doi.org/10.3390/nu10111811
Received: 8 October 2018 / Revised: 1 November 2018 / Accepted: 16 November 2018 / Published: 20 November 2018
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Abstract
Gestational diabetes mellitus (GDM) is associated with maternal diet, however, findings are inconsistent. The aims of the present study were to assess whether intakes of foods and beverages during pregnancy differed between women who developed GDM and non-GDM women, and to compare dietary [...] Read more.
Gestational diabetes mellitus (GDM) is associated with maternal diet, however, findings are inconsistent. The aims of the present study were to assess whether intakes of foods and beverages during pregnancy differed between women who developed GDM and non-GDM women, and to compare dietary intakes with dietary recommendations of pregnancy. This is a longitudinal study using participants of a randomized controlled trial. Women with complete measurements of a 75 g oral glucose tolerance test (OGTT) at 18–22 and 32–36 weeks gestation were included in the cohort (n = 702). Women were diagnosed for GDM according to the simplified International Association of Diabetes and Pregnancy Study Group criteria at 32–36 weeks (GDM women: n = 40; non-GDM women: n = 662). Dietary data (food frequency questionnaire) was collected at both time points and compared between GDM and non-GDM women. Variability in OGTT values was assessed in a general linear model. Marginal differences between GDM and non-GDM women in intakes of food groups were found. No associations were found between dietary variables and OGTT values. Not all dietary recommendations were followed in the cohort, with frequently reported alcohol consumption giving largest cause for concern. This study did not find dietary differences that could help explain why 40 women developed GDM. Full article
(This article belongs to the Special Issue Nutrition and Gestational Diabetes)
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Open AccessArticle Association between Gestational Weight Gain, Gestational Diabetes Risk, and Obstetric Outcomes: A Randomized Controlled Trial Post Hoc Analysis
Nutrients 2018, 10(11), 1568; https://doi.org/10.3390/nu10111568
Received: 27 September 2018 / Revised: 18 October 2018 / Accepted: 19 October 2018 / Published: 23 October 2018
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Abstract
Excess gestational weight gain (GWG) is associated with the development of gestational diabetes mellitus (GDM). Lifestyle trials have not achieved much GWG limitation, and have largely failed to prevent GDM. We compared the effect of substantial GWG limitation on maternal GDM risk. Pregnant [...] Read more.
Excess gestational weight gain (GWG) is associated with the development of gestational diabetes mellitus (GDM). Lifestyle trials have not achieved much GWG limitation, and have largely failed to prevent GDM. We compared the effect of substantial GWG limitation on maternal GDM risk. Pregnant women with a body mass index (BMI) ≥29 kg/m2 <20 weeks gestation without GDM (n = 436) were randomized, in a multicenter trial, to usual care (UC), healthy eating (HE), physical activity (PA), or HE and PA lifestyle interventions. GWG over the median was associated with higher homeostasis model assessment insulin resistance (HOMA-IR) and insulin secretion (Stumvoll phases 1 and 2), a higher fasting plasma glucose (FPG) at 24–28 weeks (4.66 ± 0.43 vs. 4.61 ± 0.40 mmol/L, p < 0.01), and a higher rate of caesarean section (38% vs. 27% p < 0.05). The GWG over the median at 35–37 weeks was associated with a higher rate of macrosomia (25% vs. 16%, p < 0.05). A post hoc comparison among women from the five sites with a GWG difference >3 kg showed no significance difference in glycaemia or insulin resistance between HE and PA, and UC. We conclude that preventing even substantial increases in GWG after the first trimester has little effect on maternal glycaemia. We recommend randomized controlled trials of effective lifestyle interventions, starting in or before the first trimester. Full article
(This article belongs to the Special Issue Nutrition and Gestational Diabetes)
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Open AccessArticle Fish Intake in Pregnancy and Offspring Metabolic Parameters at Age 9–16—Does Gestational Diabetes Modify the Risk?
Nutrients 2018, 10(10), 1534; https://doi.org/10.3390/nu10101534
Received: 14 September 2018 / Revised: 9 October 2018 / Accepted: 15 October 2018 / Published: 17 October 2018
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Abstract
Oily fish, an important source of marine n-3 long-chain polyunsaturated fatty acids (LCPUFA), has shown to reduce cardiometabolic risk in adults. Whether maternal fish intake affects offspring metabolic health is less established, especially among high-risk pregnancies. We aimed to examine the association of [...] Read more.
Oily fish, an important source of marine n-3 long-chain polyunsaturated fatty acids (LCPUFA), has shown to reduce cardiometabolic risk in adults. Whether maternal fish intake affects offspring metabolic health is less established, especially among high-risk pregnancies. We aimed to examine the association of fish intake in pregnancy with offspring metabolic health who were either exposed or unexposed to gestational diabetes mellitus (GDM). Our study included 1234 mother-offspring dyads (608 with a GDM index pregnancy and 626 control dyads) nested within the Danish National Birth Cohort, which is a prebirth cohort. Maternal seafood and marine n-3 LCPUFA consumption was quantified by a food frequency questionnaire (gestational week 25) and a sub-sample with interview data (weeks 12 and 30). The offspring were clinically examined at 9–16 years, including a Dual energy X-ray Absorptiometry (DXA) scan and a fasting blood sample. We calculated multivariable effect estimates and 95% confidence intervals (CI) for anthropometric, adiposity, and metabolic parameters. The median (IQR) intake of total seafood was 23(24) g/day. We found largely no association for total seafood and marine n-3 LCPUFA with offspring metabolic parameters in either group. Using interview data, GDM-exposed women reporting no fish in week 12 and 30 (versus intake >2 times/week) had offspring with a higher Body Mass Index (BMI) (ratio of geometric means (RGM): 1.28, 95% CI: 1.06, 1.55), waist circumference (RGM: 1.22, 95% CI: 1.05, 1.40), triglycerides (RGM: 1.77, 95% CI: 1.03, 3.03), and homeostatic model assessment of insulin resistance HOMA-IR (RGM: 2.16, 95% CI: 1.17, 3.97). We found no associations of n-3 LCPUFA and seafood intake with offspring metabolic outcomes. However, GDM-exposed women who consistently reported eating no fish had offspring with a poorer metabolic profile. Fish intake in pregnancy may mitigate some adverse effects of intrauterine hyperglycemia, however, these findings need replication in better powered studies. Full article
(This article belongs to the Special Issue Nutrition and Gestational Diabetes)
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Review

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Open AccessReview Diet-Gut Microbiota Interactions and Gestational Diabetes Mellitus (GDM)
Nutrients 2019, 11(2), 330; https://doi.org/10.3390/nu11020330
Received: 27 December 2018 / Revised: 30 January 2019 / Accepted: 31 January 2019 / Published: 3 February 2019
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Abstract
Medical nutritional therapy is the first-line approach in managing gestational diabetes mellitus (GDM). Diet is also a powerful modulator of the gut microbiota, whose impact on insulin resistance and the inflammatory response in the host are well known. Changes in the gut microbiota [...] Read more.
Medical nutritional therapy is the first-line approach in managing gestational diabetes mellitus (GDM). Diet is also a powerful modulator of the gut microbiota, whose impact on insulin resistance and the inflammatory response in the host are well known. Changes in the gut microbiota composition have been described in pregnancies either before the onset of GDM or after its diagnosis. The possible modulation of the gut microbiota by dietary interventions in pregnancy is a topic of emerging interest, in consideration of the potential effects on maternal and consequently neonatal health. To date, very few data from observational studies are available about the associations between diet and the gut microbiota in pregnancy complicated by GDM. In this review, we analyzed the available data and discussed the current knowledge about diet manipulation in order to shape the gut microbiota in pregnancy. Full article
(This article belongs to the Special Issue Nutrition and Gestational Diabetes)
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Open AccessReview Screening and Management of Gestational Diabetes Mellitus after Bariatric Surgery
Nutrients 2018, 10(10), 1479; https://doi.org/10.3390/nu10101479
Received: 3 September 2018 / Revised: 18 September 2018 / Accepted: 9 October 2018 / Published: 11 October 2018
Cited by 1 | PDF Full-text (446 KB) | HTML Full-text | XML Full-text
Abstract
Gestational diabetes mellitus (GDM) is a frequent medical complication during pregnancy. This is partly due to the increasing prevalence of obesity in women of childbearing age. Since bariatric surgery is currently the most successful way to achieve maintained weight loss, increasing numbers of [...] Read more.
Gestational diabetes mellitus (GDM) is a frequent medical complication during pregnancy. This is partly due to the increasing prevalence of obesity in women of childbearing age. Since bariatric surgery is currently the most successful way to achieve maintained weight loss, increasing numbers of obese women of childbearing age receive bariatric surgery. Bariatric surgery performed before pregnancy significantly reduces the risk to develop GDM but the risk is generally still higher compared to normal weight pregnant women. Women after bariatric surgery therefore still require screening for GDM. However, screening for GDM is challenging in pregnant women after bariatric surgery. The standard screening tests such as an oral glucose tolerance test are often not well tolerated and wide variations in glucose excursions make the diagnosis difficult. Capillary blood glucose measurements may currently be the most acceptable alternative for screening in pregnancy after bariatric surgery. In addition, pregnant women after bariatric surgery have an increased risk for small neonates and need careful nutritional and foetal monitoring. In this review, we address the risk to develop GDM after bariatric surgery, the challenges to screen for GDM and the management of women with GDM after bariatric surgery. Full article
(This article belongs to the Special Issue Nutrition and Gestational Diabetes)
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