Abstract
Gestational diabetes mellitus (GDM) is a common pregnancy complication that has short- and long-term health implications for both the mother and child. While lifestyle modifications, insulin therapy, and oral agents such as metformin are effective, they can be difficult to adhere to, and there remain concerns over long-term effects of oral agents on the infant. Further, GDM has no proven preventive strategies, which could be more effective than treatment postdiagnosis. Nutritional supplements are an appealing, potentially safer, and better tolerated alternative to pharmaceuticals to treat and/or prevent GDM. Here, we review the existing evidence for nutritional supplementation for treatment and prevention of GDM. There is limited evidence that myo-inositol, vitamins D and B6, magnesium, selenium, zinc, fatty acids, and probiotics might be beneficial for the prevention or treatment of GDM. There are very few studies for each nutrient, and the existing studies tend to have few participants. Where multiple studies of a nutrient exist, often those studies were conducted within the same country, limiting the generalizability of the findings, or alternatively there was no consensus across findings. There is limited evidence that nutritional supplementation of myo-inositol, vitamins D and B6, magnesium, selenium, zinc, fatty acids, and probiotics could improve glycemic control or prevent GDM. Our understanding is constrained by the small number of studies, small sample sizes in most studies, and by lack of consistency across findings. Further large, high-quality, randomized controlled trials are required to determine the efficacy of nutritional supplements to treat or prevent GDM.
Highlights
Gestational diabetes mellitus (GDM) is defined as hyperglycemia that is diagnosed during pregnancy and is not clearly overt diabetes that existed prior to pregnancy
The growing burden of obesity and its relationship with type 2 diabetes mellitus (T2DM) has prompted a surge in diabetes-related research, which has demonstrated that hyperglycemia during pregnancy is related to adverse pregnancy outcomes [2]
This study reported that inositol supplementation reduced gestational weight gain in the obese model, and improved glucose tolerance, blood pressure and hyperleptinemia in the metabolic syndrome model [79]
Summary
During the course of normal pregnancy, a surge of local and placental hormones (including oestrogen, progesterone, cortisol, leptin, placental growth hormone and placental lactogen) contribute toward a state of mild insulin resistance [14]. Blood glucose is slightly elevated, and glucose is transported across the placenta to the developing fetus. This mild insulin resistance promotes endogenous glucose production and breakdown of adipose tissue, resulting in a further increase in plasma glucose and free fatty acid (FFA) concentrations [15]. While the exact mechanisms are poorly understood, the majority of cases (~80%) manifest as a result of β cell dysfunction on a background of chronic insulin resistance, to which the normal insulin resistance of pregnancy is partially additive [18]. GDM can be the result of failures within the β cells themselves, in mediators of insulin signaling, or both. Diet and nutrition are important modifying factors, as described below
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