A High Adherence to Six Food Targets of the Mediterranean Diet in the Late First Trimester is Associated with a Reduction in the Risk of Materno-Foetal Outcomes: The St. Carlos Gestational Diabetes Mellitus Prevention Study

Abstract

A prenatal diet affects materno-foetal outcomes. This is a post hoc analysis of the St. Carlos gestational diabetes mellitus (GDM) Prevention Study. It aims to evaluate the effect of a late first-trimester (>12 gestational weeks) degree of adherence to a MedDiet pattern—based on six food targets—on a composite of materno-foetal outcomes (CMFCs). The CMFCs were defined as having emergency C-section, perineal trauma, pregnancy-induced hypertension and preeclampsia, prematurity, large-for-gestational-age, and/or small-for-gestational-age. A total of 874 women were stratified into three groups according to late first-trimester compliance with six food targets: >12 servings/week of vegetables, >12 servings/week of fruits, <2 servings/week of juice, >3 servings/week of nuts, >6 days/week consumption of extra virgin olive oil (EVOO), and ≥40 mL/day of EVOO. High adherence was defined as complying with 5–6 targets; moderate adherence 2–4 targets; low adherence 0–1 targets. There was a linear association between high, moderate, and low adherence, and a lower risk of GDM, CMFCs, urinary tract infections (UTI), prematurity, and small-for-gestational-age (SGA) newborns (all p < 0.05). The odds ratios (95% CI) for GDM and CMFCs in women with a high adherence were 0.35((0.18–0.67), p = 0.002) and 0.23((0.11–0.48), p < 0.001), respectively. Late first-trimester high adherence to the predefined six food targets is associated with a reduction in the risk of GDM, CMFCs, UTI, prematurity, and SGA new-borns.

Association of Proteins Modulating Immune Response and Insulin Clearance during Gestation with Antenatal Complications in Patients with Gestational or Type 2 Diabetes Mellitus

“…Although we support the role of most these proteins in the pathogenesis of diabetes mellitus and their possible impact on fetus growth and development, we incline to consider these proteins as the secondary response effectors with low (or insufficient) specificity and selectivity. In this way, we limited only a small fraction of proteins that met the criteria of (1) sufficient frequency, (2) rare mentioning in regard of other pathologies, (3) relation to the disturbed insulin metabolism and accompanied immune reaction and (4) possibility to connect proteins of interest into proposed molecular mechanism reflecting the process of insulin resistance and associated diabetic fetopathy. At the same time, it was demonstrated that GDM groups (G01 and G02, Supplementary Appendix C and Supplementary Appendix D) are featured by the largest number of specifically altered proteins: there were 56 proteins attributed for G01 (healthy newborns) whereas 37 proteins were specifically revealed for G02 (newborns with signs of DF).…”

“…Conclusion: The combination of the measured markers may assist (AUC = 0.893 (CI 95%, 0.785-0.980) in establishing the clinical finding of the developing DF especially in patients with GDM who are at the highest risk of chronic insulin resistance.Cells 2020, 9, 1032 2 of 22 mellitus, type 2 diabetes mellitus (T2DM) or gestational diabetes mellitus (GDM) suffered by pregnant women. Diabetic fetopathy is the cause of premature birth, chronic hypoxia, respiratory depression, asphyxia of the fetus at birth, accompanied by various metabolic disorders, and can also be the cause of newborns death [1][2][3]. This is one of the most common forms of obstetric complications and perinatal losses evoked from hyperglycemia manifested in a disturbance of glucose tolerance and occurred or was first recognized during pregnancy [4].…”

“…During pregnancy, hyperglycemia is induced by a gradually increased insulin resistance due to both placental hormones and the mother's hormones (prolactin, estrogen and cortisol). The growing concentration of these hormones is compensated by a decrease in the clearance of endogenously produced insulin [2,5].According to the WHO data for 2016, up to 25% of pregnant women are at risk of hyperglycemia during pregnancy [7]. An overwhelming majority (from 75% to 90%) of elevated blood glucose levels during pregnancy emerges from the already progressing GDM [8,9].…”

“…During pregnancy, hyperglycemia is induced by a gradually increased insulin resistance due to both placental hormones and the mother's hormones (prolactin, estrogen and cortisol). The growing concentration of these hormones is compensated by a decrease in the clearance of endogenously produced insulin [2,5].…”

Consumption of fat-free dairy products is not associated with a lower risk of maternofetal adverse events

“…Those who consumed ≥3 servings/day of dairy products at 24-28 gestational weeks (GWs) were included and analyzed (n=2004). The population was stratified into three groups according to intake of fat-free dairy productsskimmed milk and fat-free yoghurt and cheese-(days/ week): infrequent (1-2), average (3)(4)(5)(6) and regular (7). Logistic regression analysis compared ORs (95% CI) for GDM and CMFO between the three groups (where the group of reference was the 'infrequent' intake group).…”