Effectiveness of Following Mediterranean Diet Recommendations in the Real World in the Incidence of Gestational Diabetes Mellitus (GDM) and Adverse Maternal-Foetal Outcomes: A Prospective, Universal, Interventional Study with a Single Group. The St Carlos Study

Abstract

We reported that a Mediterranean Diet (MedDiet), supplemented with extra-virgin olive oil (EVOO) and pistachios, reduces GDM incidence and several other adverse outcomes. In order to assess its translational effects in the real world we evaluated the effect of MedDiet from 1st gestational visit in GDM rate compared with control (CG) and intervention (IG) groups from the previously referred trial. As secondary objective we also compared adverse perinatal outcomes between normoglycemic and diabetic women. This trial is a prospective, clinic-based, interventional study with a single group. 1066 eligible normoglycaemic women before 12 gestational weeks were assessed. 932 women (32.4 ± 5.2 years old, pre-gestational BMI 22.5 ± 3.5 kg/m2) received a motivational lifestyle interview with emphasis on daily consumption of EVOO and nuts, were followed-up and analysed. Binary regression analyses were used to examine the risk for each pregnancy outcome, pregnancy-induced hypertension, preeclampsia, gestational weight gain (GWG), caesarean-section, perineal trauma, preterm delivery, small (SGA) and large for gestational age (LGA), and Neonatal Intensive Care Unit admissions. GDM was diagnosed in 13.9%. This rate was significantly lower than the CG: RR 0.81 (0.73–0.93), p < 0.001 and no different from the IG: RR 0.96 (0.85–1.07), p = 0.468. GWG was lower in diabetic women (10.88 ± 6.46 vs. 12.30 ± 5.42 Kg; p = 0.013). Excessive weight gain (EWG) was also lower in GDM [RR 0.91 (0.86–0.96); p < 0.001] without a significant increase of insufficient weight gain. LGA were also lower (1 (0.8%) vs. 31 (3.9%); p < 0.05)), and SGA were similar (5 (3.8%) vs. 30 (3.7%)). LGA were associated to EWG (RR 1.61 (1.35–1.91), p < 0.001). Differences in other maternal-foetal outcomes were not found. In conclusions an early MedDiet nutritional intervention reduces GDM incidence and maternal-foetal adverse outcomes and should be universally applied as 1st line therapy. GDM might not be consider as a high risk pregnancy any longer.

An Early, Universal Mediterranean Diet-Based Intervention in Pregnancy Reduces Cardiovascular Risk Factors in the “Fourth Trimester”

“…Associations between the adherence to a MedDiet rich in extra virgin olive oil and nuts in pregnancy and improved materno-fetal events have been shown in women with and without GDM [7,8,9,12,13]. Results from these studies seem to indicate the benefits extend to the postpartum period.…”

“…The sample of women used in this cohort study was retrieved mainly from three different studies [7,13,14].…”

“…From 2015–2017, 1675 women were followed-up, of which 999 (59.6%) attended postpartum evaluation and were exclusively breastfeeding. These women mainly belong to the intervention group of the St. Carlos GDM Prevention Study [7] and an intervention study based on real-world clinical practice [13]. Women from both studies received the same dietary intervention and attended the same gestational visits (at 12–14, 24–28, and 36–38 gestational weeks).…”

Gestational diabetes status and dietary intake modify maternal and cord blood allostatic load markers

“…Literature suggests that a Mediterranean style diet high in MUFA and PUFA reduced the incidence of GDM and infants that were LGA. 48 The efficacy of these fatty acids for dietary intervention and the use of maternal AL index as an indicator of intervention effectiveness during GDM deserve further investigation. A few micronutrients were supplemented to GDM women in previous studies but the intervention outcomes for the mother and child dyad showed mixed results.…”

Temporal Trends in Maternal Food Intake Frequencies and Associations with Gestational Diabetes: The Cambridge Baby Growth Study

“…A recent review [4] found that compliance to a Mediterranean-style diet, categorized as one with relatively higher bread, cereal, legume, vegetable, fruit, fish and olive oil intakes and lower or limited animal fat, meat and egg intakes [5], led to a reduction in GDM risk of between 15–38%. Similarly, a trial where the intervention group ate a Mediterranean diet supplemented with olive oil and pistachio nuts led to a relative risk for GDM of 73% of that of a control group fed a standard diet [6] and a similar effect in a follow-up real world (non-trial) situation [7]. Consumption of this diet was also associated with a reduced risk of other adverse effects of pregnancy [8].…”