The aim of this study was to evaluate the impact of the Dietary Approaches to Stop Hypertension (DASH) diet on glycaemic control and consumption of processed (PF) and ultraprocessed (UPF) foods in pregnant women with pre-gestational diabetes mellitus (PGDM). This is a randomised, controlled, single-blind clinical trial with forty-nine adult women with PGDM, followed at a public maternity hospital in Rio de Janeiro, Brazil. The control group (CG) received a standard diet consisting of 45–55 % of the total energy intake of carbohydrates, 15–20 % of proteins and 25–30 % of lipids. The DASH group (DG) received an adapted DASH diet, which did not differ from the standard diet in the percentage of macronutrients, but had higher contents of fibre, unsaturated fats and minerals such as Ca, Mg and K; and lower contents of Na and saturated fats than the standard diet. In the analysis by protocol, the DG presented a higher incidence of glycaemic control after 12 weeks of intervention (57·1 v. 8·3 %, P = 0·01, moderate effect size) and a lower mean consumption of UPF (−9·9 %, P = 0·01) compared with the CG. There was no statistically significant difference in fasting and postprandial blood glucose concentrations, or in the consumption of PF between the groups (P > 0·05). The DASH diet may be a strategy for glycaemic control in pregnant women with PGDM, favouring the adoption of a nutritionally adequate diet with lower consumption of UPF. Further studies are needed to investigate the effect of the DASH diet on glycaemic profile, and maternal and perinatal outcomes in women with PGDM.
RESUMOObjetivo: Analisar a prevalência do consumo de álcool e os fatores associados a ele, durante a gestação, em mulheres adultas que realizaram pré-natal na Maternidade Escola da UFRJ, entre 1999 e 2014. Métodos: Estudo analítico transversal com 1430 gestantes adultas, divididas em 4 grupos (G), entre 1999 e 2014: GI (n=225), GII (n=209), GIII (n=380) e GIV (n=616). Gestantes possuem idade ≥ 20 anos, gestação de feto único e ausência de doenças crônicas, exceto obesidade. O desfecho foi o consumo de álcool em qualquer período gestacional, identificado em entrevistas ou por prontuários. Empregouse análise multivariada e testou-se modelos hierarquizados para identificar fatores associados. Resultados: A prevalência de consumo de álcool na gestação foi de 12.9%.
Preeclampsia (PE) affects up to five times more women with pre-existing diabetes mellitus (PDM) than women without it. The present study aimed to identify the effect of the DASH diet on PE incidence (primary outcome) and blood pressure, glycated haemoglobin (GH), serum lipids, glutathione peroxidase (GP), C-reactive protein (CRP – secondary outcomes) in pregnant with PDM. This randomised, controlled, single-blind trial studied sixty-eight pregnant women with PDM throughout prenatal care until delivery (18 weeks) at a public maternity hospital, Brazil. The standard diet group (SDG) received a diet containing 45–65 % carbohydrates, 15–20 % protein and 25–30 % lipids. The DASH diet group (DDG) received the adapted DASH diet with a similar macronutrient distribution, but with a higher concentration of fibres, unsaturated fats, calcium, magnesium and potassium as well as lower saturated fat. Student's t, Mann–Whitney U and the Chi-square tests were used to compare outcomes. PE incidence was 22⋅9 % in the SDG and 12⋅1 % in the DDG (P = 0⋅25). GP levels significantly increased in the DDG (intra-group analysis; mean difference = 1588 [CI 181, 2994], P = 0⋅03) and tended to be different from the variation in the SDG (mean difference = −29⋅5 [CI −1305; 1⋅365]; v. DDG: 1588 [CI 181; 2994], P = 0⋅09). GH levels decreased significantly and similarly between groups (SDG: −0⋅61 [CI −0⋅26, −0⋅96], P = 0⋅00) v. DDG: −1⋅1 [CI −0⋅57, −1⋅62], P = 0⋅00). There was no evidence of a difference in PE incidence at the end of the intervention between the two diets. The DASH diet seems to favour PE-related biochemical markers.
Objectives
To evaluate the relationship between vitamin D levels in women with gestational diabetes and the birth weight of their newborns.
Methods
This is a cross-sectional study nested in a controlled clinical trial performed in a public maternity hospital in Rio de Janeiro, with a sample composed of adult pregnant women diagnosed with gestational diabetes mellitus, without other chronic morbidities. The nutritional status of vitamin D was classified as 25(OH)D, being classified as: sufficient between 30 and 100 ng/mL; insufficient: between 20 and 29 ng/mL; and deficient below 20 ng/mL. In this analysis, the data regarding the vitamin D levels at the beginning of the study (T0) of the research were considered, and the dependent variable was the birth weight. Pearson's correlation was performed to evaluate the degree of correlation between two continuous variables, being considered as a level of statistical significance the value of P < 0.05.
Results
The mean maternal age was 35.4 (± 5.9) years (N = 11), and among these, 18.2% (n = 2) had adequate nutritional status, 27.3% (n = 3), overweight and 54, 5% (n = 6), obesity, according to pre-gestational BMI. Among the factors admitted as a risk for hypovitaminosis D (BMI > 25kg/m², brown/black skin color, marital status (married) and occupation), 45.5% (n = 5) presented 3 or more of them. As for nutritional status of vitamin D, 63.6% (n = 7) had insufficiency, 27.3% (n = 3), deficiency and 9.1% (n = 1), sufficiency. The initial mean concentration of 25(OH)D was 21.2 n/mL. It was observed that 72.7% (n = 8) of the pregnant women presented no gestational intercurrences at delivery or in the puerperium, while 18.4% (n = 2) presented unfavorable outcomes. The mean birth weight was 2842.5 (± 1251.1) grams and the mean gestational age at birth was 36.2 (± 6.5) weeks. With respect to neonatal outcomes was observed a significant positive correlation (r = 0, 900; P = 0.037) between serum levels of 25(OH)D at baseline and birthweight.
Conclusions
Preliminary data indicated that best status of vitamin D is related to higher birthweight values.
Funding Sources
FAPERJ (FUNDAÇÃO DE AMPARO À PESQUISA DO ESTADO DO RIO DE JANEIRO).
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