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1.
Rev Med Chil ; 147(5): 574-578, 2019 May.
Artigo em Espanhol | MEDLINE | ID: mdl-31859889

RESUMO

BACKGROUND: Adherence to treatment is a large obstacle in the management of chronic diseases. AIM: To evaluate therapeutic adherence and its relationship with glycemic control in patients with gestational diabetes using two types of treatment. MATERIAL AND METHODS: The Measurement of Treatment Adherence (MAT) questionnaire was applied to 93 patients with gestational diabetes. Fifty-two used metformin 41 were treated with insulin. Obstetric and socio-demographic data were collected. RESULTS: A higher therapeutic adherence was associated with a better glycemic control. Women with a higher education level had a better adherence to treatment. The adherence and metabolic control were higher in women treated with metformin. CONCLUSIONS: Therapeutic adherence is an important factor for adequate glycemic control.


Assuntos
Diabetes Gestacional/tratamento farmacológico , Hipoglicemiantes/uso terapêutico , Adesão à Medicação/estatística & dados numéricos , Adulto , Estudos Transversais , Diabetes Gestacional/prevenção & controle , Escolaridade , Feminino , Idade Gestacional , Humanos , Insulina/uso terapêutico , Metformina/uso terapêutico , Gravidez , Inquéritos e Questionários , Adulto Jovem
2.
Nutrients ; 11(7)2019 Jul 09.
Artigo em Inglês | MEDLINE | ID: mdl-31323991

RESUMO

Gestational diabetes mellitus (GDM) is defined as "glucose intolerance that is first diagnosed during pregnancy". Mothers with GDM and their infants may experience both short and long term complications. Dietary intervention is the first therapeutic strategy. If good glycaemic control is not achieved, insulin therapy is recommended. There is no consensus on which nutritional approach should be used in GDM. In the last few years, there has been growing evidence of the benefits of a low glycaemic index (LGI) diet on diabetes and cardiovascular disease. The effect of a LGI diet on GDM incidence has been investigated as well. Several studies observed a lower incidence of GDM in LGI diet arms, without adverse maternal and fetal outcomes. The main positive effect of the LGI diet was the reduction of 2-h post-prandial glucose (PPG). Several studies have also evaluated the effect of the LGI diet in GDM treatment. Overall, the LGI diet might have beneficial effects on certain outcomes, such as 2-h PPG, fasting plasma glucose and lipid profile in patients with GDM. Indeed, most studies observed a significant reduction in insulin requirement. Overall, according to current evidence, the LGI nutritional approach is safe and it might therefore be considered in clinical care for GDM.


Assuntos
Diabetes Gestacional/prevenção & controle , Carboidratos da Dieta/administração & dosagem , Carboidratos da Dieta/normas , Diabetes Gestacional/dietoterapia , Feminino , Índice Glicêmico , Humanos , Gravidez , Resultado da Gravidez
3.
PLoS Med ; 16(7): e1002857, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31335871

RESUMO

BACKGROUND: Pregnant women with metabolic risk factors are at high risk of complications. We aimed to assess whether a Mediterranean-style diet reduces adverse pregnancy outcomes in high-risk women. METHODS AND FINDINGS: We conducted a multicentre randomised trial in 5 maternity units (4 in London and 1 in Birmingham) between 12 September 2014 and 29 February 2016. We randomised inner-city pregnant women with metabolic risk factors (obesity, chronic hypertension, or hypertriglyceridaemia) to a Mediterranean-style diet with high intake of nuts, extra virgin olive oil, fruits, vegetables, nonrefined grains, and legumes; moderate to high consumption of fish; low to moderate intake of poultry and dairy products; low intake of red and processed meat; and avoidance of sugary drinks, fast food, and food rich in animal fat versus usual care. Participants received individualised dietary advice at 18, 20, and 28 weeks' gestation. The primary endpoints were composite maternal (gestational diabetes or preeclampsia) and composite offspring (stillbirth, small for gestational age, or admission to neonatal care unit) outcomes prioritised by a Delphi survey. We used an intention-to-treat (ITT) analysis with multivariable models and identified the stratification variables and prognostic factors a priori. We screened 7,950 and randomised 1,252 women. Baseline data were available for 593 women in the intervention (93.3% follow-up, 553/593) and 612 in the control (95.6% follow-up, 585/612) groups. Over a quarter of randomised women were primigravida (330/1,205; 27%), 60% (729/1,205) were of Black or Asian ethnicity, and 69% (836/1,205) were obese. Women in the intervention arm consumed more nuts (70.1% versus 22.9%; adjusted odds ratio [aOR] 6.8, 95% confidence interval [CI] 4.3-10.6, p ≤ 0.001) and extra virgin olive oil (93.2% versus 49.0%; aOR 32.2, 95% CI 16.0-64.6, p ≤ 0.001) than controls; increased their intake of fish (p < 0.001), white meat (p < 0.001), and pulses (p = 0.05); and reduced their intake of red meat (p < 0.001), butter, margarine, and cream (p < 0.001). There was no significant reduction in the composite maternal (22.8% versus 28.6%; aOR 0.76, 95% CI 0.56-1.03, p = 0.08) or composite offspring (17.3% versus 20.9%; aOR 0.79, 95% CI 0.58-1.08, p = 0.14) outcomes. There was an apparent reduction in the odds of gestational diabetes by 35% (aOR 0.65, 95% CI 0.47-0.91, p = 0.01) but not in other individual components of the composite outcomes. Mothers gained less gestational weight (mean 6.8 versus 8.3 kg; adjusted difference -1.2 Kg, 95% CI -2.2 to -0.2, p = 0.03) with intervention versus control. There was no difference in any of the other maternal and offspring complications between both groups. When we pooled findings from the Effect of Simple, Targeted Diet in Pregnant Women With Metabolic Risk Factors on Pregnancy Outcomes (ESTEEM) trial with similar trials using random effects meta-analysis, we observed a significant reduction in gestational diabetes (odds ratio [OR] 0.67, 95% CI 0.53-0.84, I2 = 0%), with no heterogeneity (2 trials, 2,397 women). The study's limitations include the use of participant reported tools for adherence to the intervention instead of objective biomarkers. CONCLUSIONS: A simple, individualised, Mediterranean-style diet in pregnancy did not reduce the overall risk of adverse maternal and offspring complications but has the potential to reduce gestational weight gain and the risk of gestational diabetes. TRIAL REGISTRATION: ClinicalTrials.gov NCT02218931.


Assuntos
Diabetes Gestacional/prevenção & controle , Dieta Mediterrânea , Ganho de Peso na Gestação , Adulto , Técnica Delfos , Diabetes Gestacional/diagnóstico , Diabetes Gestacional/etiologia , Diabetes Gestacional/fisiopatologia , Metabolismo Energético , Inglaterra , Feminino , Humanos , Fenômenos Fisiológicos da Nutrição Materna , Metanálise como Assunto , Estado Nutricional , Valor Nutritivo , Gravidez , Estudos Prospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
4.
Cochrane Database Syst Rev ; 7: CD008873, 2019 07 26.
Artigo em Inglês | MEDLINE | ID: mdl-31348529

RESUMO

BACKGROUND: Vitamin D supplementation during pregnancy may be needed to protect against adverse pregnancy outcomes. This is an update of a review that was first published in 2012 and then in 2016. OBJECTIVES: To examine whether vitamin D supplementation alone or in combination with calcium or other vitamins and minerals given to women during pregnancy can safely improve maternal and neonatal outcomes. SEARCH METHODS: For this update, we searched Cochrane Pregnancy and Childbirth's Trials Register (12 July 2018), contacted relevant organisations (15 May 2018), reference lists of retrieved trials and registries at clinicaltrials.gov and WHO International Clinical Trials Registry Platform (12 July 2018). Abstracts were included if they had enough information to extract the data. SELECTION CRITERIA: Randomised and quasi-randomised trials evaluating the effect of supplementation with vitamin D alone or in combination with other micronutrients for women during pregnancy in comparison to placebo or no intervention. DATA COLLECTION AND ANALYSIS: Two review authors independently i) assessed the eligibility of trials against the inclusion criteria, ii) extracted data from included trials, and iii) assessed the risk of bias of the included trials. The certainty of the evidence was assessed using the GRADE approach. MAIN RESULTS: We included 30 trials (7033 women), excluded 60 trials, identified six as ongoing/unpublished trials and two trials are awaiting assessments.Supplementation with vitamin D alone versus placebo/no interventionA total of 22 trials involving 3725 pregnant women were included in this comparison; 19 trials were assessed as having low-to-moderate risk of bias for most domains and three trials were assessed as having high risk of bias for most domains. Supplementation with vitamin D alone during pregnancy probably reduces the risk of pre-eclampsia (risk ratio (RR) 0.48, 95% confidence interval (CI) 0.30 to 0.79; 4 trials, 499 women, moderate-certainty evidence) and gestational diabetes (RR 0.51, 95% CI 0.27 to 0.97; 4 trials, 446 women, moderate-certainty evidence); and probably reduces the risk of having a baby with low birthweight (less than 2500 g) (RR 0.55, 95% CI 0.35 to 0.87; 5 trials, 697 women, moderate-certainty evidence) compared to women who received placebo or no intervention. Vitamin D supplementation may make little or no difference in the risk of having a preterm birth < 37 weeks compared to no intervention or placebo (RR 0.66, 95% CI 0.34 to 1.30; 7 trials, 1640 women, low-certainty evidence). In terms of maternal adverse events, vitamin D supplementation may reduce the risk of severe postpartum haemorrhage (RR 0.68, 95% CI 0.51 to 0.91; 1 trial, 1134 women, low-certainty evidence). There were no cases of hypercalcaemia (1 trial, 1134 women, low-certainty evidence), and we are very uncertain as to whether vitamin D increases or decreases the risk of nephritic syndrome (RR 0.17, 95% CI 0.01 to 4.06; 1 trial, 135 women, very low-certainty evidence). However, given the scarcity of data in general for maternal adverse events, no firm conclusions can be drawn.Supplementation with vitamin D and calcium versus placebo/no interventionNine trials involving 1916 pregnant women were included in this comparison; three trials were assessed as having low risk of bias for allocation and blinding, four trials were assessed as having high risk of bias and two had some components having a low risk, high risk, or unclear risk. Supplementation with vitamin D and calcium during pregnancy probably reduces the risk of pre-eclampsia (RR 0.50, 95% CI 0.32 to 0.78; 4 trials, 1174 women, moderate-certainty evidence). The effect of the intervention is uncertain on gestational diabetes (RR 0.33,% CI 0.01 to 7.84; 1 trial, 54 women, very low-certainty evidence); and low birthweight (less than 2500 g) (RR 0.68, 95% CI 0.10 to 4.55; 2 trials, 110 women, very low-certainty evidence) compared to women who received placebo or no intervention. Supplementation with vitamin D and calcium during pregnancy may increase the risk of preterm birth < 37 weeks in comparison to women who received placebo or no intervention (RR 1.52, 95% CI 1.01 to 2.28; 5 trials, 942 women, low-certainty evidence). No trial in this comparison reported on maternal adverse events.Supplementation with vitamin D + calcium + other vitamins and minerals versus calcium + other vitamins and minerals (but no vitamin D)One trial in 1300 participants was included in this comparison; it was assessed as having low risk of bias. Pre-eclampsia was not assessed. Supplementation with vitamin D + other nutrients may make little or no difference in the risk of preterm birth < 37 weeks (RR 1.04, 95% CI 0.68 to 1.59; 1 trial, 1298 women, low-certainty evidence); or low birthweight (less than 2500 g) (RR 1.12, 95% CI 0.82 to 1.51; 1 trial, 1298 women, low-certainty evidence). It is unclear whether it makes any difference to the risk of gestational diabetes (RR 0.42, 95% CI 0.10 to 1.73) or maternal adverse events (hypercalcaemia no events; hypercalciuria RR 0.25, 95% CI 0.02 to 3.97; 1 trial, 1298 women,) because the certainty of the evidence for both outcomes was found to be very low. AUTHORS' CONCLUSIONS: We included 30 trials (7033 women) across three separate comparisons. Our GRADE assessments ranged from moderate to very low, with downgrading decisions based on limitations in study design, imprecision and indirectness.Supplementing pregnant women with vitamin D alone probably reduces the risk of pre-eclampsia, gestational diabetes, low birthweight and may reduce the risk of severe postpartum haemorrhage. It may make little or no difference in the risk of having a preterm birth < 37 weeks' gestation. Supplementing pregnant women with vitamin D and calcium probably reduces the risk of pre-eclampsia but may increase the risk of preterm births < 37 weeks (these findings warrant further research). Supplementing pregnant women with vitamin D and other nutrients may make little or no difference in the risk of preterm birth < 37 weeks' gestation or low birthweight (less than 2500 g). Additional rigorous high quality and larger randomised trials are required to evaluate the effects of vitamin D supplementation in pregnancy, particularly in relation to the risk of maternal adverse events.


Assuntos
Resultado da Gravidez , Vitamina D/administração & dosagem , Vitaminas/administração & dosagem , Cálcio na Dieta/administração & dosagem , Diabetes Gestacional/prevenção & controle , Suplementos Nutricionais , Feminino , Humanos , Pré-Eclâmpsia/prevenção & controle , Gravidez , Complicações na Gravidez/prevenção & controle , Nascimento Prematuro/prevenção & controle , Ensaios Clínicos Controlados Aleatórios como Assunto , Vitamina D/análogos & derivados
5.
BMC Womens Health ; 19(1): 88, 2019 07 03.
Artigo em Inglês | MEDLINE | ID: mdl-31269928

RESUMO

BACKGROUND: Women with gestational diabetes have low diet quality. We evaluated the effectiveness of a group-based lifestyle modification program for improvement of dietary quality in women with previous gestational diabetes predominantly within their first postnatal year. METHODS: Women were randomised to intervention (n = 284) or usual care (n = 289). Dietary data was collected at baseline and twelve months using a food frequency questionnaire and recoded into the Australian Recommended Food Score (ARFS). Mixed model analyses investigated the intervention effect on ARFS (per-protocol-set (PPS) excluded women without the minimum intervention exposure). RESULTS: Baseline mean total ARFS was low (31.8 ± 8.9, maximum score = 74) and no significant changes were seen in total ARFS (Cohen's D = - 0.06). 2% reduction in alcohol for intervention (0.05, 0.26) compared with - 1% for usual care (Odds ratio: 0.68; 95%CI 0.46, 0.99). Dairy ARFS sub-category significantly improved (low fat/saturated fat foods) in the intervention group over time compared with usual care for the PPS analysis (dairy + 0.28 in intervention (95%CI 0.08, 0.48) compared with + 0.02 in usual care (95%CI -0.14, 0.18) (group-by-treatment interaction p = 0.05, Cohen's D = 0.14)). CONCLUSIONS: Engaging with the intervention improved aspects of diet quality that aligned with minimum intervention exposure, but the total diet quality remains low. Further research is needed to improve diabetes prevention program engagement. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ANZCTRN12610000338066 , April 2010.


Assuntos
Diabetes Mellitus Tipo 2/dietoterapia , Diabetes Gestacional/dietoterapia , Dieta/estatística & dados numéricos , Cuidado Pós-Natal/métodos , Prevenção Primária/métodos , Adulto , Austrália , Diabetes Mellitus Tipo 2/prevenção & controle , Diabetes Gestacional/prevenção & controle , Feminino , Humanos , Estilo de Vida , Gravidez
6.
Nutrients ; 11(5)2019 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-31052474

RESUMO

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.


Assuntos
Diabetes Gestacional/epidemiologia , Dieta Mediterrânea , Cooperação do Paciente , Adolescente , Adulto , Estudos de Casos e Controles , Diabetes Gestacional/prevenção & controle , Inquéritos sobre Dietas , Feminino , Humanos , Modelos Logísticos , Fenômenos Fisiológicos da Nutrição Materna , Pessoa de Meia-Idade , Gravidez , Fatores de Risco , Espanha/epidemiologia , Adulto Jovem
7.
Obstet Gynecol Surv ; 74(5): 303-312, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31098644

RESUMO

Importance: Physical activity is recognized as one of the most important tools in the management of gestational diabetes mellitus (GDM). Objective: The aim of this review was to compare and analyze regular prenatal exercise programs and examine their effectiveness in the prevention of GDM. Evidence Acquisition: The following databases were used: Academic Search Complete, Health Source-Consumer Edition, Health Source-Nursing/Academic Edition, Master File Premier, MEDLINE, and SportDiscus with full text. The inclusion criteria were as follows: a randomized study, regular training program throughout pregnancy, and supervised by a prenatal activity specialist. Results: The 10 articles selected for the review were divided into 2 groups. The first group comprised 2 studies presenting successful interventions in the prevention of GDM, whereas the second group included 8 articles with no statistically significant effects of the training programs in GDM prevention. Beginning an exercise program at early stages of the pregnancy and high adherence were common features of the effective programs. Conclusions: When designing and carrying out the program, the beginning of the intervention and adherence should be considered. To increase adherence, the program should be attractive and it should meet the participants' needs. Conclusions and Relevance: This review might be used for identifying factors deciding whether an exercise program is an effective intervention to prevent the development of GDM. Moreover, it might also prove useful in the preparation of future guidelines for designing and implementing regular exercise programs effective in preventing GDM in pregnant women by gynecologists, obstetricians, midwives, trainers, and prenatal specialists.


Assuntos
Diabetes Gestacional/prevenção & controle , Terapia por Exercício/métodos , Exercício/psicologia , Feminino , Humanos , Gravidez , Cuidado Pré-Natal/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto
8.
J Diabetes Res ; 2019: 5232308, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31089473

RESUMO

Identification of modifiable dietary factors, which are involved in the development of gestational diabetes mellitus (GDM), could inform strategies to prevent GDM. Therefore, we examined the dietary nutrient patterns and evaluated their relationship with GDM risk in a Chinese population using a case control study design. A total of 1,464 GDM cases and 8,092 non-GDM controls were included in the final analysis. Dietary intake was assessed using a 33-item food frequency questionnaire, and nutrients were estimated using the Chinese Standard Tables of Food Consumption. Dietary nutrient patterns were identified using factor analysis, and their associations with GDM risk were evaluated using unconditional logistic regression models adjusting for total energy intake, maternal age, high blood pressure, education, maternal body mass index (BMI), parity, and family history of diabetes. A "vitamin" nutrient pattern was characterized as the consumption of diet rich in vitamin A, carotene, vitamin B2, vitamin B6, vitamin C, dietary fiber, folate, calcium, and potassium. For every quartile increase in the vitamin factor score during one year prior to conception, the first trimester, and the second trimester of pregnancy, the GDM risk decreased by 9% (OR: 0.91, 95%CI: 0.86-0.96), 9% (OR: 0.91, 95%CI: 0.86-0.96), and 10% (OR: 0.90, 95%CI: 0.85-0.95), respectively. The significant reduced GDM risk was seen in women regardless of age and parity, and slightly stronger effect was found in women whose age ≤ 30 and women who are nulliparous across the three time periods. The significant association was also found in women whose BMI ≤ 24 with similar effect size across the three time periods. Our study suggests that the vitamin nutrient pattern diet is associated with decreased GDM risk. Additional studies are necessary to explore the underlying mechanism of this relationship.


Assuntos
Diabetes Gestacional/diagnóstico , Diabetes Gestacional/epidemiologia , Dieta , Vitaminas/metabolismo , Adulto , Glicemia , Índice de Massa Corporal , Estudos de Casos e Controles , China/epidemiologia , Estudos de Coortes , Diabetes Gestacional/prevenção & controle , Ingestão de Energia , Feminino , Humanos , Gravidez , Primeiro Trimestre da Gravidez , Segundo Trimestre da Gravidez , Terceiro Trimestre da Gravidez , Fatores de Risco , Inquéritos e Questionários , Adulto Jovem
9.
Nutrients ; 11(6)2019 May 28.
Artigo em Inglês | MEDLINE | ID: mdl-31141972

RESUMO

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.


Assuntos
Diabetes Gestacional/prevenção & controle , Dieta Mediterrânea , Entrevista Motivacional , Educação de Pacientes como Assunto , Resultado da Gravidez , Adulto , Biomarcadores/sangue , Glicemia/metabolismo , Diabetes Gestacional/sangue , Diabetes Gestacional/diagnóstico , Diabetes Gestacional/epidemiologia , Feminino , Hemoglobina A Glicada/metabolismo , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Incidência , Insulina/sangue , Fenômenos Fisiológicos da Nutrição Materna , Estado Nutricional , Valor Nutritivo , Gravidez , Estudos Prospectivos , Recomendações Nutricionais , Medição de Risco , Fatores de Risco , Espanha/epidemiologia
10.
Wei Sheng Yan Jiu ; 48(2): 226-231, 2019 Mar.
Artigo em Chinês | MEDLINE | ID: mdl-31133099

RESUMO

OBJECTIVE: To investigate the effect of vitamin D supplementation(VD) in early pregnancy on the serum 25-hydroxyvitamin D(25-OH-D) level and the risk of gestational diabetes mellitus(GDM). METHODS: From October to December 2017, a total of 101 pregnant women with high risk factors for GDM were enrolled in the first pregnancy consultation at the nutrition clinic of Haidian Maternal and Child Health Hospital, and were randomly divided into intervention group and control group. The intervention group was supplemented with 700 U VD and 100 mg of calcium at the beginning of pregnancy, and the control group was supplemented with 100 U VD and 100 mg of calcium at the same time, and the intervention time was until delivery. RESULTS: After intervention, the mean serum 25-OH-D level in the intervention group was(92. 08±29. 69) nmol/L, and that in the control group was(69. 99±25. 10) nmol/L. The serum levels of 25-OH-D in the pregnant women, gestational age and cord blood were higher than those in the control group(P<0. 05). The incidence of GDM in the intervention group was 18. 37%, and the incidence rate in the control group was 28. 85%(P>0. 05). Compared with the control group, the OR value of the risk of GDM in the intervention group was 0. 56(95% CI 0. 22-1. 42)( P<0. 05). CONCLUSION: The supplementation of VD in early pregnancy can significantly improve the VD nutrition level of pregnant women, but does not significantly reduce the incidence of GDM.


Assuntos
Diabetes Gestacional/prevenção & controle , Suplementos Nutricionais , Trimestres da Gravidez/sangue , Deficiência de Vitamina D/complicações , Deficiência de Vitamina D/tratamento farmacológico , Vitamina D/administração & dosagem , Vitaminas/administração & dosagem , Criança , Diabetes Gestacional/sangue , Diabetes Gestacional/etiologia , Feminino , Humanos , Estado Nutricional , Gravidez , Gestantes , Vitamina D/sangue , Deficiência de Vitamina D/sangue , Vitaminas/sangue
11.
PLoS One ; 14(4): e0215372, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31002708

RESUMO

BACKGROUND/OBJECTIVE: Gestational diabetes mellitus (GDM) is a common pregnancy complication, with complex disease mechanisms, and several risk factors may contribute to its onset. We performed an umbrella review to summarize the evidence from meta-analyses of observational studies on risk factors associated with GDM, evaluate whether there are indications of biases in this literature and identify which of the previously reported associations are supported by convincing evidence. METHODS: We searched PubMed and ISI Web of Science from inception to December 2018 to identify meta-analyses examining associations between putative risk factors for GDM. For each meta-analysis we estimated the summary effect size, the 95% confidence interval, the 95% prediction interval, the between-study heterogeneity, evidence of small-study effects, and evidence of excess-significance bias. RESULTS: Thirty eligible meta-analyses were identified, providing data on 61 associations. Fifty (82%) associations had nominally statistically significant findings (P<0.05), while only 15 (25%) were significant at P<10-6 under the random-effects model. Only four risk factors presented convincing evidence:, low vs. normal BMI (cohort studies), BMI ~30-35 kg/m2 vs. normal BMI, BMI >35 kg/m2 vs. normal BMI, and hypothyroidism. CONCLUSIONS: The compilation of results from synthesis of observational studies suggests that increased BMI and hypothyroidism show the strongest consistent evidence for an association with GDM. Diet and lifestyle modifications in pregnancy should be tested in large randomized trials. Our findings suggest that women with known thyroid disease may be offered screening for GDM earlier in pregnancy.


Assuntos
Índice de Massa Corporal , Diabetes Gestacional/diagnóstico , Diabetes Gestacional/prevenção & controle , Hipotireoidismo/complicações , Feminino , Humanos , Metanálise como Assunto , Estudos Observacionais como Assunto , Gravidez , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Risco
12.
Wien Klin Wochenschr ; 131(Suppl 1): 91-102, 2019 May.
Artigo em Alemão | MEDLINE | ID: mdl-30980150

RESUMO

Gestational diabetes mellitus (GDM) is defined as a glucose tolerance disorder with onset during pregnancy and is associated with increased feto-maternal morbidity as well as long-term complications in mother and child. Women who fulfil the criteria of a manifest diabetes in early pregnancy (fasting plasma glucose >126 mg/dl, spontaneous glucose level >200 mg/dl or HbA1c > 6.5% before 20 weeks of gestation) should be classified as having manifest diabetes in pregnancy and treated as such. Screening for undiagnosed type 2 diabetes at the first prenatal visit (evidence level B) is particularly recommended in women at increased risk (history of GDM or prediabetes, malformation, stillbirth, successive abortions or birth weight >4500 g in previous pregnancies, obesity, metabolic syndrome, age >35 years, vascular disease, clinical symptoms of diabetes, e. g. glucosuria, or ethnic groups with increased risk for GDM/T2DM, e.g. Arabian countries, south and southeast Asia and Latin America). A GDM is diagnosed by an oral glucose tolerance test (OGTT) or a fasting glucose concentration ≥92 mg/dl. Performance of the OGTT (120 min, 75 g glucose) may already be indicated in the first trimester in high risk women but is mandatory between 24-28 gestational weeks in all pregnant women with previous non-pathological glucose metabolism (evidence level B). Based on the results of the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study and following the recent WHO recommendations, GDM is present if the fasting plasma glucose level exceeds 92 mg/dl, the 1 h level exceeds 180 mg/dl or the 2 h level exceeds 153 mg/dl after glucose loading (OGTT international consensus criteria). A single increased value is sufficient for the diagnosis and a strict metabolic control is mandatory. After bariatric surgery an OGTT is not recommended due to the risk of postprandial hypoglycemia. All women with GDM should receive nutritional counselling, be instructed in self-monitoring of blood glucose and to increase physical activity to moderate intensity levels, if not contraindicated. If blood glucose levels cannot be maintained in the therapeutic range (fasting <95 mg/dl and 1 h postprandial <140 mg/dl) insulin therapy should be initiated as first choice. Maternal and fetal monitoring is required in order to minimize maternal and fetal/neonatal morbidity and perinatal mortality. After delivery all women with GDM have to be re-evaluated by a 75 g OGTT (WHO criteria) 4-12 weeks postpartum to reclassify the glucose tolerance and every 2 years in cases of normal glucose tolerance (evidence level B). All women have to be informed about their (sevenfold increased relative) risk of developing type 2 diabetes (T2DM) at follow-up and possible preventive measures, in particular weight management, healthy diet and maintenance/increase of physical activity. Monitoring of the development of children and recommendations for a healthy lifestyle are necessary for the whole family. Regular obstetric examinations including ultrasound examinations are recommended. Within the framework of neonatal care, neonates of GDM mothers should undergo blood glucose measurements and if necessary appropriate measures should be initiated.


Assuntos
Diabetes Gestacional , Resultado da Gravidez , Adulto , Glicemia/análise , Glicemia/metabolismo , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Mellitus Tipo 2/prevenção & controle , Diabetes Gestacional/diagnóstico , Diabetes Gestacional/prevenção & controle , Grupos Étnicos , Feminino , Teste de Tolerância a Glucose , Humanos , Recém-Nascido , Insulina , Masculino , Guias de Prática Clínica como Assunto , Gravidez
13.
Wien Klin Wochenschr ; 131(Suppl 1): 103-109, 2019 May.
Artigo em Alemão | MEDLINE | ID: mdl-30980163

RESUMO

In 1989 the St. Vincent Declaration aimed to achieve comparable pregnancy outcomes in diabetic and non-diabetic women. However, currently women with pre-gestational diabetes still feature a higher risk of perinatal morbidity and even increased mortality. This fact is mostly ascribed to a persistently low rate of pregnancy planning and pre-pregnancy care with optimization of metabolic control prior to conception. All women should be experienced in the management of their therapy and on stable glycemic control prior to the conception. In addition, thyroid dysfunction, hypertension as well as the presence of diabetic complications should be excluded before pregnancy or treated adequately in order to decrease the risk for a progression of complications during pregnancy as well as maternal and fetal morbidity. Especially in women with type 1 diabetes mellitus in early pregnancy the risk of hypoglycemia is highest and decreases with the progression of pregnancy due to hormonal changes causing steady increase of insulin resistance. In addition, obesity increases worldwide and contributes to increasing numbers of women at childbearing age with type 2 diabetes mellitus and further deterioration of pregnancy outcomes in diabetic women. Maternal glycemic control should aim to achieve normoglycemia and normal HbA1c levels, possibly without hypoglycemia, but is associated with the development of diabetic embryopathy and fetopathy if dysglycemia occurs. Intensified insulin therapy with multiple daily insulin injections and pump treatment are effective in reaching good metabolic control during pregnancy. Oral glucose lowering drugs (Metformin) may be considered in obese women with type 2 diabetes mellitus to increase insulin sensitivity but should be also prescribed cautiously due to crossing the placenta and lack of long-time follow up data of the offspring.


Assuntos
Diabetes Mellitus Tipo 2 , Diabetes Gestacional , Resultado da Gravidez , Glicemia/análise , Diabetes Mellitus Tipo 2/prevenção & controle , Diabetes Mellitus Tipo 2/terapia , Diabetes Gestacional/prevenção & controle , Diabetes Gestacional/terapia , Feminino , Humanos , Hipoglicemia , Insulina , Guias de Prática Clínica como Assunto , Gravidez
14.
Am J Clin Nutr ; 109(Suppl_7): 705S-728S, 2019 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-30982868

RESUMO

BACKGROUND: Hypertensive disorders of pregnancy (HDP) and gestational diabetes mellitus (GDM) are common maternal complications during pregnancy, with short- and long-term sequelae for both mothers and children. OBJECTIVE: Two systematic review questions were used to examine the relation between 1) dietary patterns before and during pregnancy, 2) HDP, and 3) GDM. METHODS: A search was conducted from January 1980 to January 2017 in 9 databases including PubMed, Embase, and Cochrane. Two analysts independently screened articles using a priori inclusion and exclusion criteria; data were extracted from included articles, and risk of bias was assessed. After qualitative synthesis, a conclusion statement was drafted for each question and the evidence supporting the conclusion was graded. RESULTS: Of the 9103 studies identified, 8 [representing 4 cohorts and 1 randomized controlled trial (RCT)] were included for HDP and 11 (representing 6 cohorts and 1 RCT) for GDM. Limited evidence in healthy Caucasian women with access to health care suggests dietary patterns before and during pregnancy that are higher in vegetables, fruits, whole grains, nuts, legumes, fish, and vegetable oils and lower in meat and refined grains are associated with reduced risk of HDP, including preeclampsia and gestational hypertension. Limited but consistent evidence suggests certain dietary patterns before pregnancy are associated with reduced risk of GDM. These protective dietary patterns are higher in vegetables, fruits, whole grains, nuts, legumes, and fish and lower in red and processed meats. Most of the research was conducted in healthy, Caucasian women with access to health care. Insufficient evidence exists on the associations between dietary patterns before and during pregnancy and risk of HDP in minority women and those of lower socioeconomic status, and dietary patterns during pregnancy and risk of GDM. CONCLUSIONS: Although some conclusions were drawn from these systematic reviews, more research is needed to address gaps and limitations in the evidence.


Assuntos
Diabetes Gestacional/prevenção & controle , Dieta , Comportamento Alimentar , Hipertensão Induzida pela Gravidez/prevenção & controle , Fenômenos Fisiológicos da Nutrição Materna , Diabetes Gestacional/etiologia , Eclampsia/etiologia , Eclampsia/prevenção & controle , Feminino , Humanos , Hipertensão Induzida pela Gravidez/etiologia , Gravidez
15.
J Pregnancy ; 2019: 3849596, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30941218

RESUMO

In 1990, Institute of Medicine (IOM) recommended gestational weight gain (GWG) ranges for women in the United States primarily to improve infant birth weight. Changes in key aspects of reproductive health of women of child bearing age, a rising prevalence of obesity, and noncommunicable diseases prompted the revision of IOM guidelines in 2009. However, there is no such recommendation available for Asian women. This systematic review assesses the utility of IOM-2009 guidelines among Indian and other Asian pregnant women in terms of maternal and fetal outcomes. 624 citations were identified using PubMed and Google Scholar, out of which 13 were included. Prospective/retrospective studies of healthy Asian women with a singleton pregnancy which specifically examined fetal-maternal outcomes relative to IOM-2009 guidelines were included. Results. Majority of pregnant Indian women achieved less GWG than the recommendations whereas a mixed trend was noticed among the other Asian pregnant women. The most common fetal-maternal complications among the excessive GWG women were found to be macrosomia, large for gestational age and caesarean section followed by gestational diabetes and hypertension, whereas low birth weight, small for gestational age and preterm birth, was found to be associated with low GWG women. The findings highlight the need for appropriate GWG limits across the different body mass index levels specifically for Indians and other Asian population. However, there are not enough publications regarding the utility of IOM-2009 guidelines among the Indian and other Asian women. Thus, higher-quality researches are warranted in future to further validate the findings of the present review.


Assuntos
Ganho de Peso na Gestação , Guias de Prática Clínica como Assunto , Adolescente , Adulto , Grupo com Ancestrais do Continente Asiático , Índice de Massa Corporal , Cesárea , Bases de Dados Bibliográficas , Diabetes Gestacional/etiologia , Diabetes Gestacional/prevenção & controle , Feminino , Macrossomia Fetal/etiologia , Macrossomia Fetal/prevenção & controle , Idade Gestacional , Humanos , Hipertensão Induzida pela Gravidez/etiologia , Hipertensão Induzida pela Gravidez/prevenção & controle , Recém-Nascido de Baixo Peso , Gravidez , Nascimento Prematuro/etiologia , Nascimento Prematuro/prevenção & controle , Adulto Jovem
16.
Diabetes Care ; 42(4): 601-608, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30877090

RESUMO

OBJECTIVE: We examined the effects of metformin on diabetes prevention and the subgroups that benefited most over 15 years in the Diabetes Prevention Program (DPP) and its follow-up, the Diabetes Prevention Program Outcomes Study (DPPOS). RESEARCH DESIGN AND METHODS: During the DPP (1996-2001), adults at high risk of developing diabetes were randomly assigned to masked placebo (n = 1,082) or metformin 850 mg twice daily (n = 1,073). Participants originally assigned to metformin continued to receive metformin, unmasked, in the DPPOS (2002-present). Ascertainment of diabetes development was based on fasting or 2-h glucose levels after an oral glucose tolerance test or on HbA1c. Reduction in diabetes incidence with metformin was compared with placebo in subgroups by hazard ratio (HR) and rate differences (RDs). RESULTS: During 15 years of postrandomization follow-up, metformin reduced the incidence (by HR) of diabetes compared to placebo by 17% or 36% based on glucose or HbA1c levels, respectively. Metformin's effect on the development of glucose-defined diabetes was greater for women with a history of prior gestational diabetes mellitus (GDM) (HR 0.59, RD -4.57 cases/100 person-years) compared with parous women without GDM (HR 0.94, RD -0.38 cases/100 person-years [interaction P = 0.03 for HR, P = 0.01 for RD]). Metformin also had greater effects, by HR and RD, at higher baseline fasting glucose levels. With diabetes development based on HbA1c, metformin was more effective in subjects with higher baseline HbA1c by RD, with metformin RD -1.03 cases/100 person-years with baseline HbA1c <6.0% (42 mmol/mol) and -3.88 cases/100 person-years with 6.0-6.4% (P = 0.0001). CONCLUSIONS: Metformin reduces the development of diabetes over 15 years. The subsets that benefitted the most include subjects with higher baseline fasting glucose or HbA1c and women with a history of GDM.


Assuntos
Diabetes Mellitus Tipo 2/prevenção & controle , Hipoglicemiantes/uso terapêutico , Metformina/uso terapêutico , Adulto , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Gestacional/prevenção & controle , Jejum , Feminino , Teste de Tolerância a Glucose , Humanos , Incidência , Pessoa de Meia-Idade , Gravidez
17.
Nutrients ; 11(3)2019 Mar 11.
Artigo em Inglês | MEDLINE | ID: mdl-30862052

RESUMO

Gestational diabetes (GDM) is a highly prevalent disorder of pregnancy which portends a high risk for future type 2 diabetes. Limited evidence indicates lifestyle intervention prevents the development of diabetes, but most previously studied interventions are resource-intensive. Intervention programs that utilise newer technologies may be scalable at lower cost. This 6-month pilot randomized controlled trial tested the delivery of text messages linked to an activity monitor, adaptive physical activity goal setting, and limited face-to-face counseling, as an intervention to improve rates of post-partum glucose tolerance testing and lifestyle behaviours amongst women following a GDM pregnancy. Sixty subjects were randomised 2:1 intervention vs. control. Compared to control subjects, there were trends for intervention subjects to improve diet, increase physical activity, and lose weight. There was no difference between the groups in the rate of glucose tolerance testing. Only 46 (77%) subjects completed some, and 19 subjects completed all the elements of the final evaluation. Feedback regarding the text messages and activity monitor was highly positive. Overall, results suggest that a text message and activity monitor intervention is feasible for a larger study or even as a potentially scalable population health intervention. However, low completion rates necessitate carefully considered modification of the protocol.


Assuntos
Diabetes Gestacional/prevenção & controle , Exercício , Mensagem de Texto , Adulto , Feminino , Humanos , Projetos Piloto , Gravidez , Fatores de Risco
18.
Nutrients ; 11(2)2019 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-30769927

RESUMO

Dietary patterns during pregnancy have been shown to influence the development of gestational diabetes mellitus (GDM). However, evidence from Asian populations is limited and inconsistent. We conducted a prospective cohort study in China to assess the relationship between dietary patterns and GDM. We administered three-day food diaries (TFD) and food frequency questionnaires (FFQ) at the second trimester. GDM was diagnosed with a 75 g 2-h oral glucose tolerance test at 24⁻28 weeks of gestation. We identified dietary patterns using principal components analysis and used multivariable logistic regression to investigate associations of dietary patterns with GDM. Of the 1014 participants, 23.5% were diagnosed with GDM. Both the TFD and FFQ identified a "traditional pattern", consisting of high vegetable, fruit, and rice intake, which was associated with a lower GDM risk (odds ratio (OR) for quartile 4 versus quartile 1: 0.40, 95% CI: 0.23⁻0.71 for traditional pattern (TFD); OR: 0.44, CI: 0.27⁻0.70 for traditional pattern (FFQ)). The protective associations were more pronounced among women ≥35 years old. A whole grain⁻seafood TFD pattern was associated with higher risk of GDM (OR: 1.73, 95% CI: 1.10⁻2.74). These findings may provide evidence for making dietary guidelines among pregnant women in Chinese populations to prevent GDM.


Assuntos
Glicemia , Diabetes Gestacional/prevenção & controle , Comportamento Alimentar , Frutas , Oryza , Verduras , Adulto , Grupo com Ancestrais do Continente Asiático , China/epidemiologia , Estudos de Coortes , Diabetes Gestacional/epidemiologia , Feminino , Alimentos/classificação , Humanos , Gravidez , Estudos Prospectivos , Fatores de Risco
19.
Nutrients ; 11(2)2019 Feb 03.
Artigo em Inglês | MEDLINE | ID: mdl-30717458

RESUMO

Medical nutritional therapy is the first-line approach in managing gestational diabetes mellitus (GDM). Diet is also a powerful modulator of the gut microbiota, whose impact on insulin resistance and the inflammatory response in the host are well known. Changes in the gut microbiota composition have been described in pregnancies either before the onset of GDM or after its diagnosis. The possible modulation of the gut microbiota by dietary interventions in pregnancy is a topic of emerging interest, in consideration of the potential effects on maternal and consequently neonatal health. To date, very few data from observational studies are available about the associations between diet and the gut microbiota in pregnancy complicated by GDM. In this review, we analyzed the available data and discussed the current knowledge about diet manipulation in order to shape the gut microbiota in pregnancy.


Assuntos
Diabetes Gestacional , Dieta , Microbioma Gastrointestinal , Diabetes Gestacional/prevenção & controle , Feminino , Humanos , Inflamação/microbiologia , Inflamação/prevenção & controle , Resistência à Insulina , Gravidez
20.
J Perinat Neonatal Nurs ; 33(1): 35-51, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30676461

RESUMO

The influence of microbial factors on adverse perinatal outcomes has become the focal point of recent investigations, with particular interest in the role of the microbiome and probiotic interventions. The purpose of this scoping review was to identify and critique the most recent evidence about these factors as they relate to pregnancies complicated by preeclampsia (PEC), preterm birth (PTB), and gestational diabetes mellitus (GDM). Four databases (PubMed, EMBASE, Web of Science, and Cochrane) were searched for articles published in English in the last 10 years with the concepts of the microbiome, probiotics, and PEC, PTB, or GDM. Forty-nine articles were eligible for full-text review. Five articles were excluded, leaving 44 articles that met all the eligibility criteria. The relationships between the microbiome and the risk for PEC, PTB, and GDM are not fully elucidated, although probiotic interventions seem beneficial in decreasing PEC and GDM risk. Probiotic interventions targeting bacterial vaginosis and elimination of infection in women at risk for PTB appear to be beneficial. More research is needed to understand the contributions of the microbiome to adverse perinatal outcomes. Probiotic interventions appear to be effective in reducing risk for select outcomes.


Assuntos
Diabetes Gestacional/microbiologia , Microbiota/efeitos dos fármacos , Pré-Eclâmpsia/microbiologia , Resultado da Gravidez , Nascimento Prematuro/microbiologia , Probióticos/administração & dosagem , Diabetes Gestacional/prevenção & controle , Feminino , Humanos , Pré-Eclâmpsia/prevenção & controle , Gravidez , Nascimento Prematuro/prevenção & controle , Medição de Risco
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