Prevention Of Gestational Diabetes Mellitus Research Articles

Optimizing perinatal wellbeing in pregnancy with obesity: a clinical trial with a multi-component nutrition intervention for prevention of gestational diabetes and infant growth and neurodevelopment impairment.

Pregnancy complicated by obesity represents an increased risk of unfavorable perinatal outcomes such as gestational diabetes mellitus (GDM), hypertensive disorders in pregnancy, preterm birth, and impaired fetal growth, among others. Obesity is associated with deficiencies of micronutrients, and pregnant women with obesity may have higher needs. The intrauterine environment in pregnancies complicated with obesity is characterized by inflammation and oxidative stress, where maternal nutrition and metabolic status have significant influence and are critical in maternal health and in fetal programming of health in the offspring later in life. Comprehensive lifestyle interventions, including intensive nutrition care, are associated with a lower risk of adverse perinatal outcomes. Routine supplementation during pregnancy includes folic acid and iron; other nutrient supplementation is recommended for high-risk women or women in low-middle income countries. This study is an open label randomized clinical trial of parallel groups (UMIN Clinical Trials Registry: UMIN000052753, https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000060194) to evaluate the effect of an intensive nutrition therapy and nutrient supplementation intervention (folic acid, iron, vitamin D, omega 3 fatty acids, myo-inositol and micronutrients) in pregnant women with obesity on the prevention of GDM, other perinatal outcomes, maternal and newborn nutritional status, and infant growth, adiposity, and neurodevelopment compared to usual care. Given the absence of established nutritional guidelines for managing obesity during pregnancy, there is a pressing need to develop and implement new nutritional programs to enhance perinatal outcomes.

Assessment of the Level of Knowledge About Risk Factors, Prevention, and Treatment of Gestational Diabetes Mellitus in a Community Sample From Saudi Arabia.

Introduction Gestational diabetes mellitus (GDM) is a common disease affecting pregnant females, and it carries a major risk of short and long-term health problems for both mothers and their offspring. Multiple factors like advanced maternal age, obesity, and unhealthy lifestyle can increase the risk of GDM. The current guidelines recommend screening all pregnant females for risk factors during the first trimester with subsequent testing of the blood glucose level at 24 weeks gestation. Lack of awareness about GDM is a main contributing factor in the delay in screening and diagnosis of GDM with subsequent fetal and maternal complications. This study aims to identify the level of knowledge about GDM among the adult population in the Kingdom of Saudi Arabia (KSA). Material and methods A descriptive cross-sectional questionnaire-based study was conductedto identify the level of knowledge about risk factors, prevention, and treatment of GDM in a community sample from Saudi Arabia. A self-administered electronic questionnaire was designed, tested for validity and reliability, and distributed through social media platforms. It consisted of 18 questions asking about the socio-demographic characteristics, the type of hospital in which the participant receives their medical care, whether the participant heard about GDM or not, and if they knowsomeone with GDM, in addition to questions to assess the level of knowledge about risk factors, complications, prevention, and treatment of GDM. The total score of knowledge was calculated. The multivariate regression analysis test was employed to analyze the relationship between various demographic variables and the level of knowledge about GDM among the study population. A p-value of 0.05 or less was considered statistically significant. Results A total of 539 (100%) participants completed the questionnaire: 263 (48.8%) of them were in the age category (18-25 years), 440 (81.6%) of them were females, 307 (57%) had a bachelor's degree, 275 (51%) were single, 454 (84.2%) had heard about GDM, and 258 (47.9%) of them have or know someone with GDM. The total score of knowledge revealed excellent, good, fair, and poor levels among 334 (62%), 140 (26%), 49 (9%), and 16 (3%) of participants, respectively. The multivariable linear regression model revealed that participants who received health care from governmental hospitals heard about GDMand had or knew someone with GDM were positively associated with a higher level of knowledge. Conclusions The findings revealed that among participants, 62% showed excellent knowledge about GDM, although, the other 38% had non-optimal levels of knowledge. Awareness campaigns are recommended to improve the level of knowledge about this disease, its risk factors, treatment, and complications.

Early age at menarche and the risk of gestational diabetes mellitus: a cohort study.

To evaluate whether there is an association between age at menarche (AAM) and the risk of gestational diabetes mellitus (GDM). A retrospective cohort study was conducted, including 5390 pregnant women who were screened for GDM at Alexandra Hospital in Athens, Greece over a 15-year period (2000-2014). Maternal age, pre-pregnancy body mass index (BMI), height, family history of type 2 diabetes mellitus, parity, educational and smoking status, and AAM were recorded. The results were expressed as odds ratios (OR) with a 95% confidence interval (95% CI). Pregnant women with GDM experienced earlier menarche compared to normoglycemic women (12.9 ± 1.5 vs 13.1 ± 1.6, p < 0.001, respectively). The OR for a woman with AAM <12 years to develop GDM was 1.08 (95% CI 1.03-1.14), while the OR to be obese was 1.70 (95% CI 1.50-1.90). The multivariate logistic regression analysis showed that AAM is a risk factor for GDM. However, that effect was lost after adjusting for BMI. Early AAM may be associated with an increased risk of GDM. Therefore, it can be used to identify high-risk women and implement preconception interventions for GDM prevention. Future studies should be conducted to confirm these findings.

IDF23-0289 An Intereventional Study for Prevention of Gestational Diabetes Mellitus and its Sequelae by Administering Metformin

IDF23-0289 An Intereventional Study for Prevention of Gestational Diabetes Mellitus and its Sequelae by Administering Metformin

The association between interpregnancy interval and gestational diabetes mellitus: A nationwide register-based study in Finland.

Previous results on the association between interpregnancy interval (IPI) and gestational diabetes mellitus (GDM) have been contradictory. Hence, the aim of this study was to examine the association between IPI and GDM using high-quality nationwide register data. All women with first and second pregnancies during our study period from the National Medical Birth Register during 2004-2018 were considered. A logistic regression model was used to assess the association between the length of the IPI and development of the GDM in the second pregnancy. Women were divided into three groups based on the length of the IPI: short IPI (0-11 months), normal IPI (12-47 months), and long IPI (48+ months). Adjusted odds ratios (aOR) with 95% CI were compared between the groups. A total of 47 078 women were included in the study. We found no evidence of difference when women with short IPI were compared with women with normal IPI (aOR 0.99, 95% CI 0.93-1.05). Women with long IPI had increased odds for the development of GDM when compared with women with normal IPI (aOR 1.28, 95% CI 1.19-1.38). In the logistic regression model for continuous IPI, the total odds for the development of GDM increased as the IPI increased (aOR 1.05 per year, 95% CI 1.03-1.06). The odds for the development of GDM increased as the IPI increased. This study's results serve as a clarion call for proactive measures in GDM prevention. Moreover, they advocate for intensified investigation into the underlying factors contributing to GDM among women with extended IPI. It is imperative that these insights inform both clinical practice and further research agendas, as we strive to safeguard maternal health and well-being.

Mapping Lifestyle Interventions for Gestational Diabetes Prevention: A Scoping Review.

The purpose of this study was to conduct a scoping review to map intervention, sample, and physiologic measurement characteristics of lifestyle interventions for gestational diabetes mellitus (GDM) prevention. A total of 19 studies met selection criteria from 405 articles screened (PubMed, Web of Science). No studies were US-based (47% multi-site), and all were delivered in clinical settings. The most targeted nutrition components were low carbohydrate intake (sugar rich foods/added sugars, low glycemic index), low fat intake (mainly low-fat meat, dairy, and saturated fat), and increased fruits and vegetables. Many studies promoted 150min/week moderate-intensity physical activity. Only two studies provided supervised physical activity sessions. Dietitians and nurses were the most common implementers. Samples were characterized as adults with obesity (mean age 31yr, BMI 31kg/m2). Asian populations were predominantly studied. Four studies used theoretical frameworks (75% of which used Social Cognitive Theory). GDM diagnostic criteria set forth by the American Diabetes Association were the most widely used. Insulin sensitivity was commonly assessed via fasting indices. There was a lack of multi-disciplinary, multi-level, and theory-based lifestyle interventions for reducing GDM risk. Addressing these gaps and prioritizing high-risk populations in the US with measurement of traditional and novel biomarkers will advance the field.

Investigating the causal impact of polycystic ovary syndrome on gestational diabetes mellitus: a two-sample Mendelian randomization study.

Determining the causal relationship between polycystic ovary syndrome (PCOS) and gestational diabetes mellitus (GDM) holds significant implications for GDM prevention and treatment. Despite numerous observational studies suggesting an association between PCOS and GDM, it remains unclear whether a definitive causal relationship exists between these two conditions and which specific features of PCOS contribute to increased incidence of GDM. The causal relationship between polycystic ovary syndrome (PCOS), its characteristic indices, and gestational diabetes mellitus (GDM) was investigated using a two-sample Mendelian randomization study based on publicly available statistics from genome-wide association studies (GWAS). The inverse-variance weighted method was employed as the primary analytical approach to examine the association between PCOS, its characteristic indices, and GDM. MR Egger intercept was used to assess pleiotropy, while Q values and their corresponding P values were utilized to evaluate heterogeneity. It is important to note that this study adopts a two-sample MR design where PCOS and its characteristic indices are considered as exposures, while GDM is treated as an outcome. The study results indicate that there is no causal relationship between PCOS and GDM (all methods P > 0.05, 95% CI of OR values passed 1). The IVW OR value was 1.007 with a 95% CI of 0.906 to 1.119 and a P value of 0.904. Moreover, the MR Egger Q value was 8.141 with a P value of 0.701, while the IVW Q value was also 8.141 with a P value of 0.774, indicating no significant heterogeneity. Additionally, the MR Egger intercept was 0.0004, which was close to zero with a P value of 0.988, suggesting no pleiotropy. However, the study did find a causal relationship between several other factors such as testosterone, high-density lipoprotein, sex hormone-binding globulin, body mass index, waist-hip ratio, apolipoprotein A-I, number of children, diabetes illnesses of mother, father and siblings, hemoglobin A1c, fasting insulin, fasting blood glucose, years of schooling, and GDM based on the IVW method. We observed no association between genetically predicted PCOS and the risk of GDM, implying that PCOS itself does not confer an increased susceptibility to GDM. The presence of other PCOS-related factors such as testosterone, high-density lipoprotein, and sex hormone-binding globulin may elucidate the link between PCOS and GDM. Based on these findings, efforts aimed at preventing GDM in individuals with PCOS should prioritize those exhibiting high-risk features rather than encompassing all women with PCOS.

Development and acceptability of a gestational diabetes mellitus prevention system (Better pregnancy) based on a user-centered approach: A clinical feasibility study.

Gestational diabetes mellitus (GDM) can increase the risk of adverse outcomes for both mothers and infants. Preventive interventions can effectively assist pregnant women suffering from GDM. At present, pregnant women are unaware of the importance of preventing GDM, and they possess a low level of self-management ability. Recently, mHealth technology has been used worldwide. Therefore, developing a mobile health app for GDM prevention could potentially help pregnant women reduce the risk of GDM. To design and develop a mobile application, evaluate its acceptance, and understand the users'using experience and suggestions, thus providing a valid tool to assist pregnant women at risk of GDM in enhancing their self-management ability and preventing GDM. An evidence-based GDM prevent app (Better pregnancy) was developed using user-centered design methods, following the health belief model, and incorporating GDM risk prediction. A convenient sampling method was employed from June to August 2022 to select 102 pregnant women at risk of GDM for the pilot study. After a week, the app's acceptability was evaluated using an application acceptance questionnaire, and we updated the app based on the feedback from the women. We used SPSS 26.0 for data analysis. The application offers various functionalities, including GDM risk prediction, health management plan, behavior management, health information, personalized guidance and consultation, peer support, family support, and other functions. In total, 102 pregnant women consented to participate in the study, achieving a retention rate of 98%; however, 2% (n = 2) withdrew. The Better pregnancy app's average acceptability score is 4.07 out of 5. Additionally, participants offered several suggestions aimed at enhancing the application. The Better pregnancy app developed in this study can serve as an auxiliary management tool for the prevention of GDM, providing a foundation for subsequent randomized controlled trials.

Effects of mHealth-Based Lifestyle Interventions on Gestational Diabetes Mellitus in Pregnant Women With Overweight and Obesity: Systematic Review and Meta-Analysis.

The increasing incidence of gestational diabetes mellitus (GDM) is a global health problem that is more likely to occur in pregnant women with overweight or obesity. Adhering to a healthy lifestyle is associated with a reduced risk of GDM. With the development of IT, mobile health (mHealth) interventions have become widely available in health care. However, there are no definitive conclusions on the effectiveness of mHealth-based lifestyle interventions in preventing GDM. This study aims to evaluate the impact of mHealth-based lifestyle interventions on GDM and other pregnancy outcomes in pregnant women with overweight or obesity. A systematic literature search was conducted in 5 English databases (MEDLINE, Embase, Web of Science, CENTRAL, and CINAHL) and 4 Chinese databases (CBM, CNKI, Vip, and Wanfang) to identify randomized controlled trials (RCTs) on the effectiveness of mHealth-based interventions for GDM from inception to January 10, 2023. In total, 2 authors independently screened the studies and extracted the data. The quality of the included studies was examined using the Cochrane risk-of-bias tool. Data synthesis was conducted using Review Manager (version 5.4; The Cochrane Collaboration). A total of 16 RCTs with 7351 participants were included in this study. The included studies were published between 2014 and 2021 and were conducted in China, the United States, Australia, New Zealand, the United Kingdom, Ireland, and Norway. The sample sizes of the studies ranged from 75 to 2202, and the duration of the mHealth-based lifestyle interventions ranged from 4 to 28 weeks. Compared with usual care, mHealth-based lifestyle interventions significantly reduced the incidence of GDM (odds ratio [OR] 0.74, 95% CI 0.56-0.96; P=.03; I2=65%), preterm birth (OR 0.65, 95% CI 0.48-0.87; P=.004; I2=25%), macrosomia (OR 0.59, 95% CI 0.40-0.87; P=.008; I2=59%), and gestational weight gain (mean difference=-1.12 kg, 95% CI -1.44 to -0.80; P<.001; I2=43%). The subgroup analysis showed that interventions delivered via apps (OR 0.55, 95% CI 0.37-0.83; P=.004; I2=44%), provided by obstetricians (OR 0.69, 95% CI 0.51-0.93; P=.02; I2=60%), and targeted at Asian populations (OR 0.44, 95% CI 0.34-0.58; P<.001; I2=0%) and that used the International Association of Diabetes and Pregnancy Study Groups diagnostic criteria (OR 0.58, 95% CI 0.39-0.86; P=.007; I2=69%) showed a statistically significant reduction in the risk of GDM. mHealth-based lifestyle interventions had a favorable impact on the prevention of GDM in pregnant women with overweight and obesity. Future studies need to further explore the potential of mHealth-based interventions for GDM through better design and more rigorous large-scale RCTs. PROSPERO International Prospective Register of Systematic Reviews CRD42021286995; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=286995.

Genetics and epigenetics of gestational diabetes mellitus

Gestational diabetes mellitus (GDM) is one of the most common complications of pregnancy. Its prevalence is increasing every year with increasing obesity, sedentary lifestyle, poor or unhealthy diet and increasing age of pregnant women. GDM is known to be accompanied by multiple short- and long-term complications for both mother and child. Research in genetics and epigenetics has provided new insights into the pathophysiology of GDM, which provides an opportunity to develop new strategies to improve the diagnosis, prevention and treatment of GDM and its complications.This review describes the role of genetic and epigenetic factors on the risks of developing GDM and its complications. The review also discusses the similarities in the genetic changes underlying type 2 diabetes mellitus and GDM, indicating a multifactorial pathogenesis of GDM.

Interaction and Metabolic Pathways: Elucidating the Role of Gut Microbiota in Gestational Diabetes Mellitus Pathogenesis.

Gestational diabetes mellitus (GDM) is a complex metabolic condition during pregnancy with an intricate link to gut microbiota alterations. Throughout gestation, notable shifts in the gut microbial component occur. GDM is marked by significant dysbiosis, with a decline in beneficial taxa like Bifidobacterium and Lactobacillus and a surge in opportunistic taxa such as Enterococcus. These changes, detectable in the first trimester, hint as the potential early markers for GDM risk. Alongside these taxa shifts, microbial metabolic outputs, especially short-chain fatty acids and bile acids, are perturbed in GDM. These metabolites play pivotal roles in host glucose regulation, insulin responsiveness, and inflammation modulation, which are the key pathways disrupted in GDM. Moreover, maternal GDM status influences neonatal gut microbiota, indicating potential intergenerational health implications. With the advance of multi-omics approaches, a deeper understanding of the nuanced microbiota-host interactions via metabolites in GDM is emerging. The reviewed knowledge offers avenues for targeted microbiota-based interventions, holding promise for innovative strategies in GDM diagnosis, management, and prevention.

New perspective on first-trimester serum uric acid level in predicting the risk of gestational diabetes mellitus

This study aimed to investigate the correlation between serum uric acid (UA) and gestational diabetes mellitus (GDM) during the first trimester and provide a new perspective for the prevention and treatment of GDM. Based on the diagnostic criteria of gestational diabetes of the International Association of Diabetes and Pregnancy Study Groups, 1744 and 4256 patients were enrolled in the GDM and normal glucose tolerance (NGT) groups. Four groups were constituted based on the quartile of first-trimester serum UA (UA) level, and the differences in each indicator between groups were compared. Logistic regression was used to analyze the effects of UA level on GDM risk. The rate of GDM in the UA quartile changed from low to high. Significant differences were also observed in fasting plasma glucose level, 1 h post glucose and 2 h post glucose levels, in all the groups (P < 0.05), which increased with the UA level. UA level were independent risk factors for GDM. The best threshold of GDM predicted by the first-trimester UA level was 226.55 μmol/L. The first-trimester UA level in patients with GDM was relatively higher and was an independent risk factor for GDM.

Getting a "SMART START" to gestational diabetes mellitus education: a mixed-methods pilot evaluation of a knowledge translation tool in primary care.

South Asian people living in Canada face higher rates of gestational diabetes mellitus (GDM) compared to national trends. The objective of this study was to design and pilot test a knowledge translation (KT) tool to support GDM prevention counselling in primary care. This study is a mixed-methods pilot evaluation of the "SMART START" KT tool involving 2 family physicians in separate practices and 20 pregnant South Asians in Ontario, Canada. We conducted the quantitative and qualitative components in parallel, developing a joint display to illustrate the converging and diverging elements. Between January and July 2020, 20 South Asian pregnant people were enrolled in this study. A high level of acceptability was received from patients and practitioners for timing, content, format, language, and interest in the interventions delivered. Quantitative findings revealed gaps in patient knowledge and behaviour in the following areas: GDM risk factors, the impact of GDM on the unborn baby, weight gain recommendations, diet, physical activity practices, and tracking of weight gain. From the qualitative component, we found that physicians valued and were keen to engage in GDM prevention counselling. Patients also expressed personal perceptions of healthy active living during pregnancy, experiences, and preferences with gathering and searching for information, and key preventative behaviours. Building on this knowledge can contribute to the design and implementation of other research opportunities or test new hypotheses as they relate to GDM prevention among South Asian communities.

The association between prepregnancy dietary fatty acids and risk of gestational diabetes mellitus: A prospective cohort study

Background & aimsEpidemiologic studies have examined the association between dietary fatty acids and type 2 diabetes risk in general populations. Evidence regarding their associations with gestational diabetes mellitus (GDM) risk remains limited. This study aimed to evaluate prepregnancy fatty acids intake in relation to GDM risk. Methods3,725 pregnant women from the Xi’an Birth Cohort Study who were free of previous GDM or pre-existing chronic diseases were included. Dietary intake of total fat and individual fatty acids (including saturated fatty acids [SFA], monounsaturated fatty acids [MUFA], polyunsaturated fatty acids [PUFA], and trans fatty acids) during the year preceding pregnancy was assessed by a validated food-frequency questionnaire before 16 weeks of gestation. GDM was confirmed based on the 75-g oral glucose tolerance test. Log-binomial or modified Poisson regression models were applied to estimate the relative risks (RRs) and 95% confidence intervals (95%CIs) of GDM for fatty acids intake. Generalized linear regression was adopted for blood glucose levels with fatty acids intake. Results644 (17.3%) incident GDM cases were confirmed in our study. Participants in the highest intake of total fat substituting for carbohydrates had a 33% reduced risk of GDM than those in the lowest intake (RR:0.67;95%CI:0.55,0.81). For individual fatty acids, only PUFA intake was associated with a lower risk of GDM, with RR comparing extreme tertiles of 0.61 (95%CI:0.49,0.76). Each 2% increase in energy from total fat and PUFA replacing carbohydrates decreased the risk of GDM by 6% (95%CI:3%,9%) and 15% (95%CI:9%,21%), respectively. Similar inverse associations with intake of total fat and PUFA were observed for blood glucose levels. Further analyses of SFA substitution showed that replacement of 2% energy from SFA with PUFA and MUFA was associated with 26% (RR:0.74;95%CI:0.62,0.88) and 30% (RR:0.70;95%CI:0.50, 0.98) decreased risk of GDM, respectively. ConclusionsGreater intake of total fat and PUFA before pregnancy was associated with lower risk of GDM when replacing carbohydrates. Substitution SFA with PUFA and MUFA was also inversely associated with GDM risk. These findings support the important role of optimal dietary fatty acids composition in the prevention of GDM.

Insulin aspart plus high-dose vitamin D supplementation for gestational diabetes mellitus: analysis of efficacy and risk factors for maternal and infant outcomes.

Gestational diabetes mellitus (GDM) presents not only immediate challenges affecting maternal and infant health but also long-term consequences. Effective prevention and treatment of GDM are crucial for minimizing the short- and long-term health impacts. This retrospective study evaluated the effects of insulin aspart injection plus high-dose vitamin D (HD-VD) supplementation on treatment outcomes and maternal - infant outcomes in patients with GDM. A total of 129 GDM patients admitted to the Zhongshan Hospital Xiamen University from December 2021 to December 2023 were included in this study. According to the intervention regimen, the patients were divided into two groups: a control group of 59 patients receiving insulin aspart injection plus low-dose vitamin D (LD-VD) supplementation and a research group of 70 cases receiving insulin aspart injection plus HD-VD supplementation. The curative effect, blood glucose metabolism (fasting blood glucose [FPG], 2-hour postprandial blood glucose [2hPG], and glycosylated hemoglobin [HbA1c]), homocysteine (HCY), and cystatin C (Cys C), maternal and infant outcomes (maternal outcomes: hypoglycemia, cesarean section, polyhydramnios, and premature rupture of membranes; neonatal outcomes: stillbirth, macrosomia, neonatal respiratory distress syndrome, and Apgar score) were recorded and compared between the two groups. Risk factors affecting maternal and infant outcomes were analyzed. The research group demonstrated a higher overall effective rate in compared to the control group (P<0.05). Post-treatment measurements of FPG, 2hPG, HbA1c, HCY, and Cys C in the research group were statistically lower than the pre-treatment levels and those in the control group (all P<0.05). Additionally, the research group showed better maternal and neonatal outcomes, with fewer adverse pregnancy-related conditions and better neonatal health indicators, including higher Apgar scores (P<0.05). Besides, insulin aspart injection plus high-dose vitamin D was a protective factor for maternal and infant outcomes (P<0.05). Insulin aspart injection plus HD-VD supplementation markedly enhances treatment efficacy and improves maternal and infant outcomes in GDM.

Inositol - why should it be in the spotlight for women in a reproductive age?

Introduction and purpose: Inositol exists in the form of nine isomers, two of which are dominant - myo-inositol (MI) and D-chiro-inositol (DCI). It is a naturally occuring sugar involved in many biological pathways. Due to its insulin-sensitizing, anti-inflammatory and antioxidant properties, inositol has been suggested as a novel treatment agent in prevention and treatment of reproductive disorders. The paper presents currently available data regarding the impact of oral supplementation of inositol for fertility of women and men, reproductive outcomes among subfertile women with polycystic ovarian syndrome (PCOS) and its effectiveness on preventing and treating gestational diabetes mellitus (GDM).&#x0D; Material and methods of research: The search was conducted using PubMed and Google Scholarship databases available to November 2023. &#x0D; Results: Although the evidence is still insufficient, it is suggested that inositol may be beneficial for subfertile women, also those undergoing assisted reproductive techniques and in vitro fertilization. Moreover inositol can positively influence sperm quality. Myoinositol supplementation was also effective and safe for pregnant women with GDM and their children. In these women lower HOMA-IR (Homeostatic Model Assessment – Insulin Resistance) and reduction of fetal macrosomia were observed. Myoinositol also seems to be favorable for overweight or obese women in GDM prevention and treatment. Current findings indicate the positive impact for hormonal changes and restoration in menstrual cyclicity in women with PCOS, improving reproductive disorders in these patients.&#x0D; Conclusions: Overall, although findings are encouraging, further trials for this promising intervention are still required to support oral supplementation of inositol.

Modifiable Risk Factors and Trends in Changes in Glucose Regulation during the First Three Years Postdelivery: The St Carlos Gestational Diabetes Mellitus Prevention Cohort.

Evaluation of the influence of potential risk factors (RFs) on glycemic changes at 3 years postpartum. The glycemic status of 1400 women, in absence of a new pregnancy, was evaluated at 3 months (3 m) and 3 years (3 y) postpartum, after participation in the St. Carlos Gestational Study (2228 normoglycemic pregnant women followed from before gestational week 12 to delivery, from 2015-2017). Abnormal glucose regulation (AGR) was defined as fasting serum glucose ≥ 100 mg/dL and/or HbA1c ≥ 5.7% and/or 2 h 75 g OGTT glucose ≥ 140 mg/dL. In total, 12 modifiable and 3 unmodifiable RFs were analyzed. 3 m postpartum, 110/1400 (7.9%) women had AGR; 3 y postpartum, 137 (9.8%) women exhibited AGR (110 with 3 m normal glucose tolerance [NGT]); 1263 (90.2%) had NGT (83 with 3 m AGR). More women with gestational diabetes mellitus (GDM) progressed to AGR at 3 y (OR: 1.60 [1.33-1.92]) than women without GDM. Yet, most women with 3 m and/or 3 y AGR had no GDM history. Having ≥2 unmodifiable RFs was associated with increased risk for progression to AGR (OR: 1.90 [1.28-2.83]) at 3 y postpartum. Having >5/12 modifiable RFs was associated with increased progression from NGT to AGR (OR: 1.40 [1.00-2.09]) and AGR persistence (OR: 2.57 [1.05-6.31]). Pregestational BMI ≥ 25 kg/m2 (OR: 0.59 [0.41-0.85]), postdelivery weight gain (OR: 0.53 [0.29-0.94]), and waist circumference > 89.5 cm (OR: 0.54 [0.36-0.79]) reduced the likelihood of NGT persisting at 3 y. 3-month and/or 3-year postpartum AGR can be detected if sought in women with no prior GDM. Modifiable and unmodifiable RF predictors of AGR at 3 y postpartum were identified. Universal screening for glycemic alterations should be considered in all women following delivery, regardless of prior GDM. These findings could be useful to design personalized strategies in women with risk factors for 3 y AGR.

Dietary interventions in pregnancy for the prevention of gestational diabetes: a literature review.

The aim of this review is to provide an overview of dietary interventions delivered during pregnancy for the prevention of gestational diabetes mellitus (GDM). GDM increases the risk of adverse pregnancy and neonatal outcomes, and also increases future cardiometabolic risks for both the mother and the offspring. Carrying or gaining excessive weight during pregnancy increases the risk of developing GDM, and several clinical trials in women with overweight or obesity have tested whether interventions aimed at limiting gestational weight gain (GWG) could help prevent GDM. Most dietary interventions have provided general healthy eating guidelines, while some had a specific focus, such as low glycaemic index, increased fibre intake, reducing saturated fat or a Mediterranean-style diet. Although trials have generally been successful in attenuating GWG, the majority have been unable to reduce GDM risk, which suggests that limiting GWG may not be sufficient in itself to prevent GDM. The trials which have shown effectiveness in GDM prevention have included intensive face-to-face dietetic support, and/or provision of key foods to participants, but it is unclear whether these strategies could be delivered in routine practice. The mechanism behind the effectiveness of some interventions over others remains unclear. Dietary modifications from early stages of pregnancy seem to be key, but the optimum dietary composition is unknown. Future research should focus on designing acceptable and scalable dietary interventions to be tested early in pregnancy in women at risk of GDM.

Gestational diabetes mellitus: Awareness, risk factors, perceived effects, and lifestyle intervention among pregnant women in a Nigerian tertiary health institution

Objectives: To assess the awareness, risk factors, perceived effects, and level of awareness of lifestyle interventions for the prevention of gestational diabetes mellitus (GDM) as well as the association between educational background and the level of awareness of GDM. Materials and Methods: A cross-sectional survey of 244 antenatal women was carried out using a validated self-administered questionnaire containing five sections with sections A to E bordering on demographics, awareness of GDM, risk factors, perceived effects on pregnancy, and lifestyle interventions towards prevention from May through August 2021. Data were analyzed using descriptive statistics of frequencies, percentages, means, and standard deviation. The chi-square test was used to assess the association between educational background and level of GDM awareness. Results: Out of 244 respondents who showed awareness of GDM, 212 (86.9%) had an understanding of what GDM is, 212 (86.9%) knew the risk factors, 227 (93.0%) agreed that they knew the effects, 191 (78.3%) knew about lifestyle interventions. Despite the positive responses, disparities exist in their levels of awareness of each alleged variable. There was an association between educational background and level of awareness of GDM with a P-value of 0.0001 (&lt;0.05). Conclusion: The majority of antenatal women were aware of GDM, risk factors, effects, and lifestyle interventions with diverse degree levels. Less than half were fully aware of the risk factors, and the effects on pregnancy. Regular health/medical professional visits were the most acceptable lifestyle intervention for the prevention of GDM. There was a significant association between education and the level of awareness of GDM. Thus, the government is to enact strong policies that will favor female education as education is a strong determinant of awareness of disease conditions.

The impact of health coaching on the prevention of gestational diabetes in overweight/obese pregnant women: a quasi-experimental study

BackgroundPrevious studies have demonstrated that excessive gestational weight gain (GWG) increases the risk of gestational diabetes mellitus (GDM). This study aimed to determine the effect of using health coaching on the prevention of GDM in overweight pregnant women.MethodsIn this quasi-experimental study, 64 eligible overweight women at 12–14 gestational weeks were randomly divided into 2 groups: the coaching group and the control group (usual care group). The intervention group received 8 weeks of the phone coaching program, which integrated GWG and physical activity to reduce the incidence of GDM. The Pregnancy Physical Activity Questionnaire (PPAQ) was used to assess physical activity during pregnancy. The occurrence of gestational diabetes was determined based on the 75-g 2-hour oral glucose tolerance test (OGTT) at 24–28 weeks of gestation. The primary outcome was the incidence of GDM, and the secondary outcomes included physical activity, GWG, and neonatal and maternal birth outcomes.ResultsThe incidence of GDM in the control and intervention groups was 24.1% and 22.6%, respectively. The relative risk (RR) was 0.93 (95% CI, 0.37–2.34; P = 0.887). The post survey results indicated that GWG decreased more considerably in the coaching than in the control group between pre-trial (T0) and post-trial (T1), (MD; -2.49 with 95% CI, -4.38 to -0.60; P < 0.011). Moreover, the total GWG (between pre-pregnancy and birth) diminished more remarkably in the coaching than in the control group, (MD; -2.83 with 95% CI, -5.08 to -0.58; P < 0.014). However, the score of self-efficacy and concern about PPAQ Metabolic Equivalent of Task (METs) did not differ between the coaching and control groups.ConclusionsThe findings and implications of this research could significantly contribute to maternal health and gestational diabetes prevention. Additional support from a midwife coach resulted in better GWG. More studies are needed to assess the impact of health coaching as a component of usual care and its long-term effect on maternal and neonatal outcomes.