Pre-Pregnancy Adherence to the Mediterranean Diet and Gestational Diabetes Mellitus: A Case-Control Study

Abstract

Gestational diabetes mellitus (GDM), an important public health problem that affects mothers and offspring, is a common metabolic disorder. We evaluated the effect of the pre-pregnancy Mediterranean diet (MD) level of exposure on the odds of GDM development. A case-control study (291 GDM cases and 1175 controls without GDM) was conducted in pregnant women. Pre-pregnancy dietary intake was assessed using a validated food frequency questionnaire to calculate an MD adherence index (range score 0–9: low ≤ 2; middle 3–4; high 5–6; very high ≥ 7). Adjusted odds ratios (aOR) and their 95% confidence intervals (CI) were estimated using multivariable logistic regression models including age, BMI, family history of diabetes mellitus, previous GDM, miscarriages, and gravidity. Overall, middle-high MD adherence was 216/291 (74.2%) and very high adherence was 17/291 (5.8%) in cases. In controls the corresponding figures were 900/1175 (76.6%) and 73/1175 (6.2%), respectively. Compared to low adherence, high MD adherence was associated with GDM reduction (aOR 0.61, 95% CI 0.39,0.94; p = 0.028), and very high MD adherence was even more strongly associated (aOR 0.33, 95% CI 0.15, 0.72; p = 0.005). The protective effect of adherence to the MD prior to pregnancy should be considered as a preventive tool against the development of GDM.

Mediterranean Diet for the Prevention of Gestational Diabetes in the Covid-19 Era: Implications of Il-6 In Diabesity

“…It was proven that also a late first-trimester (>12 gestational weeks) degree of adherence to a MedDiet pattern seems to positively impact on a composite materno-fetal outcome (CMFCs) such as perineal trauma, emergency C-section, pre-eclampsia, pregnancy-induced hypertension, prematurity, and large or small-for-gestational-age (SGA). The risk of GDM, CMFCs, prematurity, and SGA newborns decreased linearly with high, moderate, and low adherence to MedDiet [ 150 , 151 , 152 ].…”

Intermittent Fasting, Dietary Modifications, and Exercise for the Control of Gestational Diabetes and Maternal Mood Dysregulation: A Review and a Case Report

“…Similarly, excessive intake of ultra-processed food is associated with increased odds of depression in young adults [ 42 ]. On the contrary, moderate to strong pre-pregnancy adherence to a Mediterranean diet, diets that control hypertension, and the Alternate Healthy Eating Index diet reduces the risk of developing GDM by up to 38% [ 41 , 43 ]. In addition, adherence to a Mediterranean diet also reduces depression and mitigates depressive symptoms [ 44 ].…”

“…In addition, adherence to a Mediterranean diet also reduces depression and mitigates depressive symptoms [ 44 ]. Therefore, the literature emphasizes the pivotal role of dietary interventions in GDM and mood disorders [ 43 , 44 ].…”

The Effect of a Maternal Mediterranean Diet in Pregnancy on Insulin Resistance is Moderated by Maternal Negative Affect

“…Healthy diet and lifestyle is the first line therapy to treat GDM or impaired glucose tolerance in pregnancy [8], yet there is limited evidence from clinical trials showing that dietary interventions are effective at reducing the incidence of adverse clinical outcomes. Although recent studies suggest that adherence to a Mediterranean-style diet may reduce maternal glucose levels, lower GDM risk, and improve glycemic control among women diagnosed with GDM [9][10][11][12], the magnitude of these effects is small, particularly with respect to insulin resistance [11], suggesting that other moderating factors may be at play.…”