Article Text
Abstract
Objectives To assess whether Mediterranean Diet (MedDiet)-based medical nutrition therapy facilitates near-normoglycemia in women with gestational diabetes mellitus (GDMw) and observe the effects on adverse pregnancy outcomes.
Research design and methods This is a secondary analysis of the St Carlos GDM Prevention Study, conducted between January and December 2015 in Hospital Clínico San Carlos (Madrid, Spain). One thousand consecutive women with normoglycemia were included before 12 gestational weeks (GWs), with 874 included in the final analysis. Of these, 177 women were diagnosed with gestational diabetes mellitus (GDM) and 697 had normal glucose tolerance. All GDMw received MedDiet-based medical nutrition therapy with a recommended daily extra virgin olive oil intake ≥40 mL and a daily handful of nuts. The primary goal was comparison of hemoglobin A1c (HbA1c) levels at 36–38 GWs in GDMw and women with normal glucose tolerance (NGTw).
Results GDMw as compared with NGTw had higher HbA1c levels at 24–28 GWs (5.1%±0.3% (32±0.9 mmol/mol) vs 4.9%±0.3% (30±0.9 mmol/mol), p=0.001). At 36–38 GWs values were similar between the groups. Similarly, fasting serum insulin and homeostatic model assessment insulin resitance (HOMA-IR) were higher in GDMw at 24–28 GWs (p=0.001) but became similar at 36–38 GWs. 26.6% of GDMw required insulin for glycemic control. GDMw compared with NGTw had higher rates of insufficient weight gain (39.5% vs 22.0%, p=0.001), small for gestational age (6.8% vs 2.6%, p=0.009), and neonatal intensive care unit admission (5.6% vs 1.7%, p=0.006). The rates of macrosomia, large for gestational age, pregnancy-induced hypertensive disorders, prematurity and cesarean sections were comparable with NGTw.
Conclusions Using a MedDiet-based medical nutrition therapy as part of GDM management is associated with achievement of near-normoglycemia, subsequently making most pregnancy outcomes similar to those of NGTw.
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Footnotes
CA-B and NGdlT contributed equally.
Presented at The main results of this secondary analysis were presented at the American Diabetes Association’s 78th Scientific Sessions, June 22–26, 2018, in Orlando, Florida.
Contributors Conceptualization: ALC-P, NGdlT, AD, EB, MAH, MJT, MC and MAR. Data curation and formal analysis: ALC-P, CA-B, NGdlT, AD, MF, LdV, JV, CF, IJ, NI, MJT, IR, IM, MCM, AB and MAR. Funding acquisition: ALC-P. Investigation: ALC-P, CA-B, NGdlT, AD, MF, EB, LdV, JV, CF, IJ, MAH, NI, MJT, IR, MPM, MCM, AB, MC and MAR. Methodology: ALC-P, CA-B, NGdlT, AD, MF, EB, LdV, JV, CF, IJ, MAH, NI, MJT, IR, MPM, MCM, AB, MC and MAR. Supervision: ALC-P, MF, MC and MAR. Validation and visualization: ALC-P and MF. Drafting and writing and review and editing of the original article: ALC-P, CA-B, NGdlT, AD and IR. All authors were involved in the critical revision of the manuscript for important intellectual content, material support and study supervision. All authors have seen and agreed with the content of the last version of the manuscript. ALC-P is the guarantor of this work and as such had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Funding Fundación para Estudios Endocrinometabolicos, IdISSC Hospital Clínico San Carlos, Universidad Complutense of Madrid, Medicina Department, the Instituto de Salud Carlos III of Spain under grant number PI14/01563 and Fondo Europeo de Desarrollo Regional (FEDER). The design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, and approval of the manuscript; and decision to submit the manuscript for publication are the responsibilities of the authors alone and independent of the funders.
Competing interests None declared.
Patient consent Obtained.
Ethics approval The study was approved by the Ethics Committee of Hospital Clínico San Carlos and conducted according to the Helsinki Declaration.
Provenance and peer review Not commissioned; externally peer reviewed.
Data statement Data may be requested from the corresponding author.