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Diet, Exercise and Gestational Diabetes Mellitus

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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 (20 March 2022) | Viewed by 22376

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Dr. Trine Tegdan Moholdt

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Guest Editor

Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
Interests: exercise; nutrition; pregnancy; metabolic health

Special Issue Information

Dear Colleagues,

Obesity during pregnancy is associated with the development of adverse outcomes, including gestational diabetes mellitus (GDM). GDM increases the risk of both complications during pregnancy and the future susceptibility for future impaired glycaemic control and cardiovascular disease for both mother and child.

Diet modification and increased physical activity are the first-line strategy for prevention and treatment of GDM, yet there is inconclusive evidence for which type of diet and exercise is most beneficial and how lifestyle interventions can be optimised to prevent and treat GDM.

This Special Issue will collate recent high-quality research in the field of GDM, focussing on diet- and/or exercise. Both original research articles and reviews spanning from prevention to treatment of GDM are welcome.

Dr. Trine Tegdan Moholdt
Guest Editor

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Keywords

Pregnancy
Exercise
Diet
Gestational Diabetes

Published Papers (6 papers)

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Editorial

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3 pages, 212 KiB

Open AccessEditorial

Diet, Exercise and Gestational Diabetes Mellitus

by Trine Moholdt

Nutrients 2023, 15(10), 2251; https://0-doi-org.brum.beds.ac.uk/10.3390/nu15102251 - 10 May 2023

Cited by 1 | Viewed by 1917

Abstract

Gestational diabetes mellitus (GDM) is defined as hyperglycaemia with blood glucose values above normal, but below those diagnostic of diabetes, and is the most common metabolic disease in pregnancy [...] Full article

(This article belongs to the Special Issue Diet, Exercise and Gestational Diabetes Mellitus)

Research

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10 pages, 285 KiB

Open AccessArticle

Role of Beta Cell Function and Insulin Resistance in the Development of Gestational Diabetes Mellitus

by Jonas Ellerbrock, Benthe Spaanderman, Joris van Drongelen, Eva Mulder, Veronica Lopes van Balen, Veronique Schiffer, Laura Jorissen, Robert-Jan Alers, Jeanine Leenen, Chahinda Ghossein-Doha and Marc Spaanderman

Nutrients 2022, 14(12), 2444; https://0-doi-org.brum.beds.ac.uk/10.3390/nu14122444 - 13 Jun 2022

Cited by 12 | Viewed by 2033

Abstract

Background: Gestational diabetes mellitus (GDM) is a pregnancy complication characterized by second trimester hyperglycemia. Untreated, GDM is related to an increased risk for adverse pregnancy outcomes. Both beta cell dysfunction and insulin resistance underlie impaired glucose tolerance. Understanding the dominant mechanism predisposing to GDM may be important to provide effective treatment in order to improve perinatal outcomes. We hypothesize that insulin resistance rather that beta cell dysfunction predisposes to GDM. Methods: A 75g oral glucose tolerance test (OGTT) was performed on 2112 second-trimester pregnant women to determine the relationship between insulin resistance (HOMA-IR), beta cell function (HOMA-β), and the prevalence of abnormal glucose handling. Results: High insulin resistance raised the risk of GDM (relative risk (RR) 6.1, 95% confidence interval (CI) (4.4–8.5)), as did beta cell dysfunction (RR 3.8, 95% CI (2.7–5.4)). High insulin resistance, but not beta cell function, enhances the necessity for additional glucose lowering medication on top of a low carbohydrate diet in women diagnosed with GDM. Conclusions: Both high insulin resistance and beta cell dysfunction increase the risk of GDM. As increased insulin resistance, rather than beta cell function, is related to an insufficient response to a low carbohydrate diet, we speculate that insulin sensitizers rather than insulin therapy may be the most targeted therapeutic modality in diet-insensitive GDM. Full article

(This article belongs to the Special Issue Diet, Exercise and Gestational Diabetes Mellitus)

11 pages, 824 KiB

Open AccessArticle

Pre-Pregnancy Body Mass Index and Risk of Macrosomia and Large for Gestational Age Births with Gestational Diabetes Mellitus as a Mediator: A Prospective Cohort Study in Central China

by Xinli Song, Jing Shu, Senmao Zhang, Letao Chen, Jingyi Diao, Jinqi Li, Yihuan Li, Jianhui Wei, Yiping Liu, Mengting Sun, Tingting Wang and Jiabi Qin

Nutrients 2022, 14(5), 1072; https://0-doi-org.brum.beds.ac.uk/10.3390/nu14051072 - 03 Mar 2022

Cited by 17 | Viewed by 5837

Abstract

This study aimed to examine the risk of macrosomia and large for gestational age (LGA) births in relation to maternal pre-pregnancy body mass index (BMI) status mediated through gestational diabetes mellitus (GDM). This prospective study included 34,104 singleton pregnancies at 8–14 weeks of gestation. The interesting outcomes were macrosomia (≥4000 g) and LGA (≥90th percentile). Mediation analyses were conducted using log-binomial regression adjusted for age, education, parity, fetal sex, and gestational weight gain. The proportion mediated was estimated based on the risk difference scale, and the E-value was utilized to assess potential confounders. Overall, 15.9% of women had GDM, and there were 4.0% macrosomia and 9.9% LGA births. The proportion mediated by GDM on macrosomia was up to 40% among obese women, and the estimate of the total effect was 6.18 (95% CI: 5.26–7.26), of the natural direct effect was 4.10 (95% CI: 3.35–4.99), and of the natural indirect effect was 1.51 (95% CI: 1.31–1.76). Likewise, among overweight women, the proportion mediated by GDM on macrosomia was up to 40%. Furthermore, consistent findings were evident for the outcome of LGA births. Pre-pregnancy overweight/obesity increased the risk of macrosomia and LGA births independently and partly mediated by GDM. Full article

(This article belongs to the Special Issue Diet, Exercise and Gestational Diabetes Mellitus)

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13 pages, 427 KiB

Open AccessArticle

Dietary Intake in Early Pregnancy and Glycemia in Late Pregnancy among Women with Obesity

by Kirsti Krohn Garnæs, Trude Elvebakk, Øyvind Salvesen, Signe Nilssen Stafne, Siv Mørkved, Kjell Åsmund Salvesen and Trine Moholdt

Nutrients 2022, 14(1), 105; https://0-doi-org.brum.beds.ac.uk/10.3390/nu14010105 - 27 Dec 2021

Cited by 5 | Viewed by 2662

Abstract

Women with obesity have increased risk for hyperglycemia during pregnancy, with negative health consequences for mother and child. We aimed to investigate adherence to nutritional recommendations in early pregnancy and to examine associations between early pregnancy dietary intake and late pregnancy glycemia among women with obesity. We included 120 women with pre-pregnancy body mass index (BMI) ≥30 kg/m² who participated in one of two randomized controlled trials. The participants completed a food frequency questionnaire in early pregnancy (gestational weeks 12–22). Fasting and 120 min glucose tolerance after ingestion of 75 g glucose were assessed in late pregnancy (gestational weeks 32–37). About 90% of the participants reported early pregnancy diary intake within the recommendations. Average intakes of vitamin D, iron, and folate were below recommended levels. High intakes of dairy products and protein in early pregnancy were associated with lower fasting glucose in late pregnancy, whereas high intake of bread was associated with lower 120 min glucose. There were no clear associations between single dietary variables and gestational diabetes mellitus (GDM) diagnosis in late pregnancy. In conclusion, some early pregnancy dietary variables were associated with late pregnancy glycemia. Potential causality of these findings should be investigated in future studies. Full article

(This article belongs to the Special Issue Diet, Exercise and Gestational Diabetes Mellitus)

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13 pages, 525 KiB

Open AccessArticle

Intensive Medical Nutrition Therapy Alone or with Added Metformin to Prevent Gestational Diabetes Mellitus among High-Risk Mexican Women: A Randomized Clinical Trial

by Otilia Perichart-Perera, Jennifer Mier-Cabrera, Claudia Montserrat Flores-Robles, Nayeli Martínez-Cruz, Lidia Arce-Sánchez, Itzel Nallely Alvarado-Maldonado, Araceli Montoya-Estrada, José Romo-Yañez, Ameyalli Mariana Rodríguez-Cano, Guadalupe Estrada-Gutierrez, Salvador Espino y Sosa, Mario Guzmán-Huerta, Rodrigo Ayala-Yañez and Enrique Reyes-Muñoz

Nutrients 2022, 14(1), 62; https://0-doi-org.brum.beds.ac.uk/10.3390/nu14010062 - 24 Dec 2021

Cited by 4 | Viewed by 4483

Abstract

The aim of this study was to examine the efficacy of intensive medical nutrition therapy (MNT) plus metformin in preventing gestational diabetes mellitus (GDM) among high-risk Mexican women. An open-label randomized clinical trial was conducted. Inclusion criteria were pregnant women with three or more GDM risk factors: Latino ethnic group, maternal age >35 years, body mass index >25 kg/m², insulin resistance, and a history of previous GDM, prediabetes, a macrosomic neonate, polycystic ovarian syndrome, or a first-degree relative with type 2 diabetes. Women before 15 weeks of gestation were assigned to group 1 (n = 45): intensive MNT-plus metformin (850 mg twice/day) or group 2 (n = 45): intensive MNT without metformin. Intensive MNT included individual dietary counseling, with ≤50% of total energy from high carbohydrates. The primary outcome was the GDM incidence according to the International Association of Diabetes Pregnancy Study Groups criteria. There were no significant differences in baseline characteristics and adverse perinatal outcomes between the groups. The GDM incidence was n = 11 (24.4%) in the MNT plus metformin group versus n = 7 (15.5%) in the MNT without metformin group: p = 0.42 (RR: 1.57 [95% CI: 0.67–3.68]). There is no benefit in adding metformin to intensive MNT to prevent GDM among high-risk Mexican women. Clinical trials registration: NCT01675310. Full article

(This article belongs to the Special Issue Diet, Exercise and Gestational Diabetes Mellitus)

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Review

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17 pages, 2058 KiB

Open AccessFeature PaperReview

Preventing Gestational Diabetes Mellitus by Improving Healthy Diet and/or Physical Activity during Pregnancy: An Umbrella Review

by Malak Kouiti, Cristian Hernández-Muñiz, Ibtissam Youlyouz-Marfak, Inmaculada Salcedo-Bellido, Juan Mozas-Moreno and José Juan Jiménez-Moleón

Nutrients 2022, 14(10), 2066; https://0-doi-org.brum.beds.ac.uk/10.3390/nu14102066 - 14 May 2022

Cited by 7 | Viewed by 4449

Abstract

Several epidemiological studies have analyzed the effects of lifestyle modification on reducing the risk of gestational diabetes mellitus (GDM); however, their results remain inconsistent. This umbrella review aims to evaluate the effects of diet and/or physical activity interventions during pregnancy on preventing GDM. Systematic reviews and meta-analysis of randomized clinical trials reporting preventive effects of diet and/or physical activity in reducing the incidence of GDM were included from PubMed, Web of Science, Scopus and Cochrane library. Two authors independently assessed the overlapping and quality of the 35 selected reviews using AMSTAR 2. The results, although variable, tend to defend the protective role of diet and physical activity interventions separately and independently of each other in the prevention of GDM. However, the results for the combined interventions show a possible protective effect; however, it is not entirely clear because most of the analyzed meta-analyses tend to approach 1, and heterogeneity cannot be ruled out. Establishing conclusions about the most efficient type of intervention and a dose–effect relationship was not feasible given the low quality of systematic reviews (83% low to critically low) and the variability in reporting interventions. Therefore, more studies with better quality and definition of the interventions are required. The protocol was previously registered in PROSPERO as CRD42021237895. Full article

(This article belongs to the Special Issue Diet, Exercise and Gestational Diabetes Mellitus)

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