Prevention of insulin resistance by dietary intervention among pregnant mothers: A randomized controlled trial

Abstract

Background:Chronic insulin resistance (IR) is a basic part of the pathophysiology of gestational diabetes mellitus. Nutrition significantly impacts IR and weight loss reduces insulin levels, whereas weight gain increases the concentrations. Therefore, we surveyed the effect of nutrition intervention on IR in pregnant women and whether this effect is irrespective of weight gaining in accordance with Institute of Medicine limits.Methods:This prospective, randomized clinical trial was carried out among 150 primiparous pregnant mothers in fifteen health centers, five hospitals, and 15 private obstetrical offices in Isfahan. The nutrition intervention included education of healthy diet with emphasize on 50%–55% of total energy intake from carbohydrate (especially complex carbohydrates), 25%–30% from fat (to increase mono unsaturated fatty acids and decrease saturated and trans-fatty acids), and 15%–20% from protein during pregnancy for experimental group. The controls received the usual prenatal care by their health-care providers.Results:This trial decreased pregnancy-induced insulin increases (P = 0.01) and IR marginally (P = 0.05). ANCOVA demonstrated that control of gestational weight gaining was more effective to decrease IR (P = 0.02) while insulin values decreased by nutrition intervention and irrespective of weight control (P = 0.06). Fasting plasma glucose (FPG) concentrations did not decrease by intervention (P = 0.56) or weight management (P = 0.15).Conclusions:The current intervention was effective to decrease pregnancy-induced insulin increases and IR. Considering study results on FPG levels and incidence of GDM, we suggest repeat of study design in a larger sample.

Dietary Intake and Beliefs of Pregnant Women with Gestational Diabetes in Cape Town, South Africa

“…Recent Cochrane reviews reported that dietary interventions have proven successful in: reducing the incidence of GDM and marginally lower fasting blood glucose levels at 32 to 36 weeks in pregnant women [ 9 ], meeting postpartum weight goals, decreasing postpartum depression and reducing the incidence of large-for-gestational age (LGA) and neonatal fat mass in pregnant women with GDM [ 16 ]. These dietary interventions have included a focus on macronutrient distribution [ 17 ], the promotion of a Mediterranean diet [ 18 ], a low glycaemic index (GI) diet [ 19 ] and increasing dietary fibre [ 20 ].…”

Prevention of postpartum weight retention during one year after childbirth by prenatal nutrition education: A randomized controlled trial

“…[ 20 ] The long -term effects of the present intervention seem to be due to the degree of success in management of gestational weight gain. As we previously reported that our nutrition intervention prevented of excessive gestational weight gain in all BMI group[ 8 ]; while Phelan et al . 's and Olson et al .…”

“…[ 5 15 ] Likewise, Rong et al .’ demonstrated that GWG affects the long-term postpartum weight retention. [ 21 ] Our nutrition trial enhanced the participants’ self-efficacy of gestational weight management[ 8 ] which may also be associated with post-partum weight management as Phelan et al . reported.…”

“…Additionally, prenatal nutrition training will not have a negative effect on breastfeeding. Thus, in the present article which is part of an intervention for improving gestational weight gain,[ 8 ] we assessed the effect of prenatal nutrition education program on the retained weights at 8, 26, and 52 weeks after delivery in primiparous women. The determination of percentage of women who reached to pre-gravid weight is another aim.…”

The association between maternal dietary protein intake and risk of gestational diabetes mellitus

“…A clinical trial in which healthy diet with emphasize on 15%–20% of total energy intake from protein was prescribed reported a decrease in pregnancy-induced insulin increment and insuline resistance during pregnancy. [56]…”