Nutrition Therapy in Gestational Diabetes Mellitus: Time to Move Forward

Hernandez, Teri L.; Brand-Miller, Jennie

doi:10.2337/dci18-0014

Cited by 40 publications

(37 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Importantly, NB %fat trended lower on the CHOICE higher–complex carbohydrate/low-fat diet in a limited pilot sample of 12 mother/offspring dyads. The findings are consistent with other RCTs where meals were not provided but also support that diets lower in glycemic index, low in saturated fat, and higher in fiber appear to attenuate excess fetal growth ( 43 , 47 ). The final data from the CHOICE RCT powered for a diet difference in NB %fat as the primary outcome should be available within the next year.…”

Section: Can We Intervene With Diet? Challenging the Conventional Lowsupporting

confidence: 90%

Metabolic Culprits in Obese Pregnancies and Gestational Diabetes Mellitus: Big Babies, Big Twists, Big Picture

Barbour

2019

Diabetes Care

View full text Add to dashboard Cite

Pregnancy has been equated to a "stress test" in which placental hormones and growth factors expose a mother's predisposition toward metabolic disease, unleashing her previously occult insulin resistance (IR), mild b-cell dysfunction, and glucose and lipid surplus due to the formidable forces of pregnancy-induced IR. Although pregnancy-induced IR is intended to assure adequate nutrition to the fetus and placenta, in mothers with obesity, metabolic syndrome, or those who develop gestational diabetes mellitus, this overnutrition to the fetus carries a lifetime risk for increased metabolic disease. Norbert Freinkel, nearly 40 years ago, coined this excess intrauterine nutrient exposure and subsequent offspring developmental risk "fuel-mediated teratogenesis," not limited to only excess maternal glucose. Our attempts to better elucidate the causes and mechanisms behind this double-edged IR of pregnancy, to metabolically characterize the intrauterine environment that results in changes in newborn body composition and later childhood obesity risk, and to examine potential therapeutic approaches that might target maternal metabolism are the focus of this article. Rapidly advancing technologies in genomics, proteomics, and metabolomics offer us innovative approaches to interrogate these metabolic processes in the mother, her microbiome, the placenta, and her offspring that contribute to a phenotype at risk for future metabolic disease. If we are successful in our efforts, the researcher, endocrinologist, obstetrician, and health care provider fortunate enough to care for pregnant women have the unique opportunity to positively impact health outcomes not only in the short term but in the long run, not just in one life but in twodand possibly, for the next generation.

show abstract

Section: Can We Intervene With Diet? Challenging the Conventional Lowsupporting

confidence: 90%

Metabolic Culprits in Obese Pregnancies and Gestational Diabetes Mellitus: Big Babies, Big Twists, Big Picture

Barbour

2019

Diabetes Care

View full text Add to dashboard Cite

show abstract

“…Current treatment strategies in the initial management of women with GDM centre on medical nutrition therapy, however this approach remains a challenging treatment with regard to adherence in GDM 39,40 . Furthermore, emphasis on restriction of dietary carbohydrate and a corresponding increased reliance on fat can result in exacerbation of maternal IR [41][42][43][44] . Diet-treated GDM patients with increased levels of circulating miR-330-3p may achieve better glycaemic control, with levels of miR-330-3p decreasing with increasing disease severity and exogenous insulin requirement.…”

Section: Discussionmentioning

confidence: 99%

Circulating miR-330-3p in Late Pregnancy is Associated with Pregnancy Outcomes Among Lean Women with GDM

Pfeiffer

Sánchez-Lechuga

Donovan

et al. 2020

Sci Rep

View full text Add to dashboard Cite

Gestational Diabetes Mellitus (GDM) is characterised by insulin resistance accompanied by reduced beta-cell compensation to increased insulin demand, typically observed in the second and third trimester and associated with adverse pregnancy outcomes. There is a need for a biomarker that can accurately monitor status and predict outcome in GDM, reducing foetal-maternal morbidity and mortality risks. To this end, circulating microRNAs (miRNAs) present themselves as promising candidates, stably expressed in serum and known to play crucial roles in regulation of glucose metabolism. We analysed circulating miRNA profiles in a cohort of GDM patients (n = 31) and nondiabetic controls (n = 29) during the third trimester for miRNA associated with insulin-secretory defects and glucose homeostasis. We identified miR-330-3p as being significantly upregulated in lean women with GDM compared to nondiabetic controls. Furthermore, increased levels of miR-330-3p were associated with better response to treatment (diet vs. insulin), with lower levels associated with exogenous insulin requirement. We observed miR-330-3p to be significantly related to the percentage of caesarean deliveries, with miR-330-3p expression significantly higher in spontaneously delivered GDM patients. We report this strong novel association of circulating miR-330-3p with risk of primary caesarean delivery as a pregnancy outcome linked with poor maternal glycaemic control, strengthening the growing body of evidence for roles of diabetes-associated miRNAs in glucose homeostasis and adaptation to the complex changes related to pregnancy. Gestational Diabetes Mellitus (GDM) is diagnosed as the development of hyperglycaemia during the second or third trimester in pregnant women not previously diagnosed with diabetes 1. The global epidemic of obesity and diabetes has resulted in an increase in the prevalence of diabetes mellitus in women of childbearing age and estimates currently place 5% to 20% of pregnancies as affected by GDM worldwide, due to differences in population demographics, diagnostic criteria, screening methods and maternal lifestyle 2. The significant risk-associations between hyperglycaemia not considered to be within the diagnostic range for overt diabetes and adverse perinatal and maternal outcomes require more accurate measures for monitoring status and predicting outcome in GDM 3. The pathophysiology of GDM manifests as a result of the progressive insulin resistance (IR) and subsequent increased insulin secretion requirement that occurs during normal pregnancy 4. As a result, most women with GDM develop pancreatic beta-cell dysfunction secondary to IR, resulting in impaired glucose tolerance in a setting of IR similar to that of T2DM 5. However, the possible causes of beta-cell dysfunction and IR are not well described, including the contributions of autoimmune and monogenic factors. Meta-analysis of gene expression profiles has indicated that the transcriptome profile in GDM is more similar to that of autoimmune type 1 diabetes mellitus (T1DM...

show abstract

“…Preventive measures to reduce the likelihood of excessive GWG may lower the risk of primary CD. This goal could be achieved through a strict diet and a planned target weight gain throughout pregnancy [ 25 – 27 ].…”

Section: Discussionmentioning

confidence: 99%

Risk score for predicting primary cesarean delivery in women with gestational diabetes mellitus

Phaloprakarn

Tangjitgamol

2020

BMC Pregnancy Childbirth

View full text Add to dashboard Cite

Background Women with gestational diabetes mellitus (GDM) have a higher risk of cesarean delivery (CD) than glucose-tolerant women. The aim of this study was to develop and validate a risk score for predicting primary CD in women with GDM. Methods A risk score for predicting primary CD was developed using significant clinical features of 385 women who had a diagnosis of GDM and delivered at our institution between January 2011 and December 2014. The score was then tested for validity in another cohort of 448 individuals with GDM who delivered between January 2015 and December 2018. Results The risk score was developed using the features nulliparity, excess gestational weight gain, and insulin use. The scores that classified the pregnant women as low risk (0 points), intermediate risk (1–3 points), and high risk (≥ 4 points) were directly associated with the primary CD rates of the women in the development cohort: 14.7, 38.2 and 62.3%, respectively (P < 0.001). The model showed good calibration and acceptable discriminative power with a C statistic of 0.724 (95% confidence interval, 0.670–0.777). Similar results were observed in the validation cohort. Conclusion A risk score using the features nulliparity, excess gestational weight gain, and insulin use can estimate the risk for primary CD in women with GDM.

show abstract

Nutrition Therapy in Gestational Diabetes Mellitus: Time to Move Forward

Cited by 40 publications

References 31 publications

Metabolic Culprits in Obese Pregnancies and Gestational Diabetes Mellitus: Big Babies, Big Twists, Big Picture

Metabolic Culprits in Obese Pregnancies and Gestational Diabetes Mellitus: Big Babies, Big Twists, Big Picture

Circulating miR-330-3p in Late Pregnancy is Associated with Pregnancy Outcomes Among Lean Women with GDM

Risk score for predicting primary cesarean delivery in women with gestational diabetes mellitus

Contact Info

Product

Resources

About