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Gestational Diabetes: Nutritional Aspects of Cause, Consequences, and Treatment

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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 April 2023) | Viewed by 18893

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Dr. Clive J. Petry

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School of Clinical Medicine, Wellcome-MRC Institute of Metabolic Science, University of Cambridge, Cambridge CB2 0QQ, UK
Interests: diabetes; metabolism; hypertension; growth; development; imprinted genes; biomarkers; nutritional therapies
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Dear Colleagues,

Gestational diabetes (GDM), defined as glucose intolerance first detected in pregnancy, has a rising prevalence such that it is thought to affect up to one in six pregnancies worldwide. Nutrition plays a key role in it, whether as part of an ‘unhealthy’ diet that contributes to its cause or as changes in dietary intake which act as the frontline treatment for GDM (supplemented with exercise and, sometimes, pharmacological intervention). Dietary changes can therefore alter the risk of developing GDM in the first place, and once it has emerged in pregnancy, the risk of developing GDM-related complications such as macrosomia, respiratory distress, hypoglycemia, and jaundice in the neonate, and pre-eclampsia, as well as leading to an increased need for caesarean section and placental abruption in the mother. In this Special Issue, we aim to highlight the role of nutrition in both the etiology of GDM, whether directly or indirectly through weight gain and obesity, and in its role as a GDM treatment to lower hyperglycemia and the risk of these complications.

Dr. Clive J. Petry
Guest Editor

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Keywords

diabetes
pregnancy
insulin resistance/secretion
obesity
macronutrients
micronutrients
glycemic index
fiber
epidemiology
etiology
treatment
pathogenesis

Published Papers (6 papers)

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Research

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12 pages, 289 KiB

Open AccessArticle

Maternal Lutein Intake during Pregnancies with or without Gestational Diabetes Mellitus and Cognitive Development of Children at 2 Years of Age: A Prospective Observational Study

by Isma’il Kadam, Chauntelle Nebie, Mudar Dalloul, Joan Hittelman, Lawrence Fordjour, Lori Hoepner, Itamar D. Futterman, Howard Minkoff and Xinyin Jiang

Nutrients 2024, 16(2), 328; https://doi.org/10.3390/nu16020328 - 22 Jan 2024

Viewed by 1634

Abstract

Lutein and its isomer zeaxanthin serve as antioxidants and preserve cognitive function during aging. However, whether lutein/zeaxanthin (L + Z) exposure early in life improves cognitive development of children is rarely explored. It is also unknown whether gestational diabetes mellitus (GDM), characterized by heightened oxidative stress, affects lutein metabolism. This prospective longitudinal cohort study examined the differences in L + Z intake and metabolism, as well as the association between maternal L + Z intake and children’s cognitive development in GDM versus non-GDM pregnancies. Seventy-six pregnant women (n = 40 with GDM) were recruited between 25 and 33 weeks of gestation and dietary intakes were recorded. At delivery, cord blood was collected, and 2 years later, the Bayley III developmental test was conducted on a subset of children (n = 38). The results suggest that GDM reduced cord blood lutein levels at birth; L + Z intake during pregnancy was associated with better cognitive (β = 0.003, p = 0.001) and language (β = 0.002, p = 0.038) scoring of children at 2 years regardless of GDM status. In conclusion, maternal L + Z intake was positively associated with children’s developmental scores, regardless of GDM. More studies are needed to confirm such associations. Full article

(This article belongs to the Special Issue Gestational Diabetes: Nutritional Aspects of Cause, Consequences, and Treatment)

12 pages, 639 KiB

Open AccessArticle

Ethnic Disparities and Obesity Risk Factors in Pregnant Women: A Retrospective Observational Cohort Study

by Míriam Orós, Júlia Siscart, Daniel Perejón, Maria Catalina Serna, Pere Godoy and Blanca Salinas-Roca

Nutrients 2023, 15(4), 926; https://doi.org/10.3390/nu15040926 - 12 Feb 2023

Viewed by 1801

Abstract

(1) Background: This article focuses on the prevalence of overweight and obesity in pregnancy in different ethnic groups and assesses the existence of associated comorbidities. (2) Materials and Methods: A retrospective observational cohort study of 16803 pregnant women was carried out between 2012 and 2018 in the health region of Lleida (72% of the total). The relationship between overweight and obesity and different variables was analyzed by calculating the adjusted odds ratio (aOR) and 95% confidence intervals with multivariate logistic regression models. (3) Results: The prevalence of obesity in pregnant women rose from 11.1% in 2012 to 13.4% in 2018, and there was an age-related weight gain. A high incidence of overweight and obesity was recorded in pregnant women from ethnic groups: Maghrebi, sub-Saharan African and Latin America populations presented ORs of 4.08, 3.18 and 1.59, respectively. Hypertension was the variable most affected by body mass index (BMI) > 25 (OR = 3.39) followed by gestational diabetes mellitus (OR = 2.35). Depression was also associated with obesity. (4) Conclusions: The BMI of pregnant women is influenced by individual, ethnic and clinical factors. Mental health conditions such as depression are associated with BMI. Full article

(This article belongs to the Special Issue Gestational Diabetes: Nutritional Aspects of Cause, Consequences, and Treatment)

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11 pages, 940 KiB

Open AccessArticle

Vitamin D Deficiency Is Significantly Associated with Retinopathy in Type 2 Diabetes Mellitus: A Case-Control Study

by José M. Castillo-Otí, Ana I. Galván-Manso, María R. Callejas-Herrero, Luís A. Vara-González, Fernando Salas-Herrera and Pedro Muñoz-Cacho

Nutrients 2022, 14(1), 84; https://doi.org/10.3390/nu14010084 - 25 Dec 2021

Cited by 8 | Viewed by 3339

Abstract

Aim: Results from meta-analyses point to an association between vitamin D deficiency and the onset of diabetic retinopathy (DR). The objectives of the present study were to evaluate the association of vitamin D for the development of DR and to determine the levels of vitamin D associated with a greater risk of DR. Methods: Between November 2013 and February 2015, we performed a case-control study based on a sample of patients with diabetes in Spain. The study population comprised all patients who had at least one evaluable electroretinogram and recorded levels of 25(OH)D. We collected a series of analytical data: 25(OH)D, 1,25(OH)2D, iPTH, calcium, albumin, and HbA1c. Glycemic control was evaluated on the basis of the mean HbA1c values for the period 2009–2014. A logistic regression analysis was performed to identify the variables associated with DR. Results: The final study sample comprised 385 patients, of which 30 (7.8%) had DR. Significant differences were found between patients with and without DR for age (69.54 vs. 73.43), HbA1c (6.68% vs. 7.29%), years since diagnosis of diabetes (10.9 vs. 14.17), level of 25(OH)D (20.80 vs. 15.50 ng/mL), level of 1,25(OH)2D (35.0 vs. 24.5 pg/mL), treatment with insulin (14.9% vs. 56.7%), hypertension (77.7% vs. 100%), cardiovascular events (33.2% vs. 53.3%), and kidney failure (22.0% vs. 43.3%). In the multivariate analysis, the factors identified as independent risk factors for DR were treatment of diabetes (p = 0.001) and 25(OH)D (p = 0.025). The high risk of DR in patients receiving insulin (OR 17.01) was also noteworthy. Conclusions: Levels of 25(OH)D and treatment of diabetes were significantly associated with DR after adjusting for other risk factors. Combined levels of 25(OH)D < 16 ng/mL and levels of 1,25(OH)2D < 29 pg/mL are the variables that best predict the risk of having DR with respect to vitamin D deficiency. The risk factor with the strongest association was the treatment of type 2 diabetes mellitus. This was particularly true for patients receiving insulin, who had a greater risk of DR than those receiving insulin analogues. However, further studies are necessary before a causal relationship can be established. Full article

(This article belongs to the Special Issue Gestational Diabetes: Nutritional Aspects of Cause, Consequences, and Treatment)

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11 pages, 261 KiB

Open AccessArticle

Associations between Maternal Iron Supplementation in Pregnancy and Changes in Offspring Size at Birth Reflect Those of Multiple Micronutrient Supplementation

by Clive J. Petry, Ken K. Ong, Ieuan A. Hughes and David B. Dunger

Nutrients 2021, 13(7), 2480; https://doi.org/10.3390/nu13072480 - 20 Jul 2021

Cited by 8 | Viewed by 2803

Abstract

It was previously observed that in a population of a high-income country, dietary multiple micronutrient supplementation in pregnancy was associated with an increased risk of gestational diabetes (GDM) and increased offspring size at birth. In this follow-up study, we investigated whether similar changes are observed with dietary iron supplementation. For this we used the prospective Cambridge Baby Growth Study with records of maternal GDM status, nutrient supplementation, and extensive offspring birth size measurements. Maternal iron supplementation in pregnancy was associated with GDM development (risk ratio 1.67 (1.01–2.77), p = 0.048, n = 677) as well as offspring size and adiposity (n = 844–868) at birth in terms of weight (β’ = 0.078 (0.024–0.133); p = 0.005), head circumference (β’ = 0.060 (0.012–0.107); p = 0.02), body mass index (β’ = 0.067 (0.014–0.119); p = 0.01), and various skinfold thicknesses (β’ = 0.067–0.094; p = 0.03–0.003). In a subset of participants for whom GDM statuses were available, all these associations were attenuated by adjusting for GDM. Iron supplementation also attenuated the associations between multiple micronutrient supplementation and these same measures. These results suggest that iron supplementation may mediate the effects associated with multiple micronutrient supplementation in pregnancy in a high-income country, possibly through the increased risk of developing GDM. Full article

(This article belongs to the Special Issue Gestational Diabetes: Nutritional Aspects of Cause, Consequences, and Treatment)

Review

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23 pages, 1416 KiB

Open AccessReview

The Association of Specific Dietary Patterns with Cardiometabolic Outcomes in Women with a History of Gestational Diabetes Mellitus: A Scoping Review

by Hannah O’Hara, Josh Taylor and Jayne V. Woodside

Nutrients 2023, 15(7), 1613; https://doi.org/10.3390/nu15071613 - 27 Mar 2023

Cited by 1 | Viewed by 2036

Abstract

Gestational diabetes mellitus is associated with a significantly increased risk of later type 2 diabetes (T2DM) and cardiovascular disease (CVD). Post-natal interventions aim to reduce this risk by addressing diet and lifestyle factors and frequently focus on restricting energy or macronutrient intake. With increased interest in the role of complete dietary patterns in the prevention of cardiometabolic disease, we sought to evaluate what is known about the role of dietary patterns in reducing cardiometabolic risk in women with previous GDM. A systematic search was conducted to identify studies relating to dietary pattern and cardiometabolic parameters in women with a history of GDM. The search criteria returned 6014 individual studies. In total, 71 full texts were reviewed, with 24 studies included in the final review. Eleven individual dietary patterns were identified, with the Alternative Health Eating Index (AHEI), Mediterranean diet (MD), and low glycaemic index (GI) as the most commonly featured dietary patterns. Relevant reported outcomes included incident T2DM and glucose tolerance parameters, as well as several cardiovascular risk factors. Dietary patterns which have previously been extensively demonstrated to reduce the risk of cardiovascular and metabolic disorders in the general population, including AHEI, MD, and DASH, were found to be associated with a reduction in the incidence of T2DM, hypertension, and additional risk factors for cardiometabolic disease in women with a history of GDM. Notable gaps in the literature were identified, including the relationship between dietary patterns and incident CVD, as well as the relationship between a low GI diet and the development of T2DM in this population. Full article

(This article belongs to the Special Issue Gestational Diabetes: Nutritional Aspects of Cause, Consequences, and Treatment)

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14 pages, 454 KiB

Open AccessReview

Iron Supplementation in Pregnancy and Risk of Gestational Diabetes: A Narrative Review

by Clive J. Petry

Nutrients 2022, 14(22), 4791; https://doi.org/10.3390/nu14224791 - 12 Nov 2022

Cited by 10 | Viewed by 5833

Abstract

Pregnant women frequently supplement their diets with iron to treat any cryptic anemia, on the assumption that if anemia is not present, there will be no negative consequences. However, in women who are already iron-replete, it has been suggested that this can lead to iron overload and an increased risk of certain pregnancy complications. One such complication is gestational diabetes. Fourteen clinical trials, case–control or cohort studies (found using Pubmed/Scopus/Web of Science) have investigated links between iron supplementation in pregnancy and risk of gestational diabetes, several of them finding significant associations with increased risk. Potential mechanisms include increased oxidative stress leading to insulin resistance and inadequate compensatory insulin secretion. Current evidence suggests that dietary supplementation with iron in pregnancy may increase a pregnant woman’s chance of developing gestational diabetes, although available evidence is somewhat contradictory, and the magnitude of any increased risk appears relatively small. Meta-analyses have suggested the presence of significant heterogeneity in results between studies, urging a degree of caution in interpreting these results. It is currently suggested that advice to pregnant women about whether to supplement their diets with iron or not should consider both their current iron status and their other established risk factors for gestational diabetes. Full article

(This article belongs to the Special Issue Gestational Diabetes: Nutritional Aspects of Cause, Consequences, and Treatment)

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