An Update of Medical Nutrition Therapy in Gestational Diabetes Mellitus.

Gestational diabetes mellitus (GDM) is a serious and frequent pregnancy complication that can lead to short and long-term risks for both mother and fetus. Different health organizations proposed different algorithms for the screening, diagnosis, and management of GDM. Medical Nutrition Therapy (MNT), together with physical exercise and frequent self-monitoring, represents the milestone for GDM treatment in order to reduce maternal and fetal complications. The pregnant woman should benefit from her family support and make changes in their lifestyles, changes that, in the end, will be beneficial for the whole family. The aim of this manuscript is to review the literature about the Medical Nutrition Therapy in GDM and its crucial role in GDM management.

Prenatal exposure to gestational diabetes is associated with anxiety and physical inactivity in children during COVID-19.

BACKGROUND: The coronavirus disease 2019 (COVID-19) is associated with adverse child mental health outcomes and reduced physical activity. Moreover, prenatal exposure to gestational diabetes (GDM) is associated with increased risk for adverse psychological outcomes in children. OBJECTIVES: Assess prenatal exposure to GDM on anxiety levels and physical activity in children during the COVID-19 pandemic. METHODS: Sixty-five children age 9 to 15 reported their physical activity and anxiety levels using the 24-hours physical activity recall and the State-Trait Anxiety Inventory for Children via phone or video meetings. Prenatal exposure to GDM was obtained from maternal electronic medical records. RESULTS: The 38 GDM-exposed children reported significantly higher anxiety levels and were less likely to engage in any vigorous physical activity (VPA) (5% vs 30%) compared to the 27 GDM-unexposed children. Lower levels of physical activity were significantly associated with higher levels of anxiety. Less engagement in VPA explained 75% of the association between GDM exposure and anxiety levels. CONCLUSIONS: Engaging in physical activity during the COVID-19 pandemic may be beneficial for reducing anxiety, particularly amongst GDM-exposed children.

Breastfeeding and Postpartum Glucose Regulation Among Women With Prior Gestational Diabetes: A Systematic Review.

BACKGROUND: Gestational diabetes mellitus is associated with adverse maternal and fetal outcomes and increases subsequent risk of Type 2 diabetes. Researchers have shown that breastfeeding may reduce diabetes risk in women with recent gestational diabetes. RESEARCH AIM: To assess association between infant feeding and postpartum glucose tolerance in mothers with recent gestational diabetes within 1 year postpartum. METHODS: A literature search was performed up to December 31, 2019, retrieving articles related to infant feeding, gestational diabetes, and postpartum glucose regulation in four major databases (PubMed, Cochrane, CINAHL, and Embase). Methodological quality was assessed using tools from the United States National Institutes of Health and the National Heart, Lung, and Blood Institute. RESULTS: The search yielded 15 cohort studies meeting the selection criteria. Of the 15 studies, 13 (86.7%) examined the influence of breastfeeding on postpartum glycemic status, and eight (53.4%) compared the mean blood glucose values between breastfeeding and non-breastfeeding participants. Of the 13 studies that compared postpartum glycemic status, nine (60%) of the research teams found that breastfeeding lowered rates of impaired glucose tolerance, and four (26.7%) showed no significant change. In eight of the studies reporting mean blood glucose values, six (75%) reported significantly lower fasting plasma glucose in breastfeeding participants, with reductions ranging from 3.7 to 7.4 mg/dL (0.2-0.4 mmol/L). CONCLUSION: Breastfeeding has been associated with improved postpartum glucose regulation in mothers with gestational diabetes. In pregnant women with gestational diabetes, breastfeeding may reduce the risk of Type 2 diabetes, and women with gestational diabetes should be strongly encouraged and supported to breastfeed.

Recommendations and management of hyperglycaemia in pregnancy during COVID-19 pandemic in Italy.

Many specialists use the remote management of people with chronic disease as diabetes, but structured management protocols have not been developed yet. The COVID-19 pandemic has given a big boost to the use of telemedicine, as it allows to maintain the physical distance, essential to the containment of contagion having regular health contact. Encouraging results related to the use of telemedicine in women with hyperglycaemia in pregnancy, have been recently published. It is well known that hyperglycaemia alters the immune response to infections, that inflammation, in turn, worsens glycaemic control and that any form of hyperglycaemia in pregnancy (HIP) has effects not only on the mother but also on development of the foetus. Therefore, the Italian Diabetes and Pregnancy Study Group, together with a group of experts, developed these recommendations in order to guide physicians in the management of HIP, providing specific diagnostic, therapeutic and assistance pathways (PDTAs) for the COVID-19 emergency. Three detailed PDTAs were developed, for type 1, type 2 and gestational diabetes.