Medical nutrition therapy for gestational diabetes mellitus based on Mediterranean Diet principles: a subanalysis of the St Carlos GDM Prevention Study

doi:10.1136/bmjdrc-2018-000550

. 2018 Oct 11;6(1):e000550.

doi: 10.1136/bmjdrc-2018-000550. eCollection 2018.

Medical nutrition therapy for gestational diabetes mellitus based on Mediterranean Diet principles: a subanalysis of the St Carlos GDM Prevention Study

Carla Assaf-Balut^#^{1

2}, Nuria Garcia de la Torre^#^{1

3}, Alejandra Durán^{1

2}, Manuel Fuentes⁴, Elena Bordiú^{1

2}, Laura Del Valle¹, Johanna Valerio¹, Cristina Familiar¹, Inés Jiménez¹, Miguel Angel Herraiz^{2

5}, Nuria Izquierdo^{2

5}, Maria José Torrejón⁶, Isabelle Runkle^{1

2}, Maria Paz de Miguel^{1

2}, Inmaculada Moraga¹, Maria Carmen Montañez¹, Ana Barabash^{1

3}, Martín Cuesta^{1

3}, Miguel A Rubio^{1

2}, Alfonso Luis Calle-Pascual^{1

2

3}

Affiliations

¹ Endocrinology and Nutrition Department, Hospital Clínico San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain.
² Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain.
³ Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Madrid, Spain.
⁴ Preventive Medicine Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain.
⁵ Gynecology and Obstetrics Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain.
⁶ Clinical Laboratory Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain.

^# Contributed equally.

PMID: 30397489
PMCID: PMC6202993
DOI: 10.1136/bmjdrc-2018-000550

Medical nutrition therapy for gestational diabetes mellitus based on Mediterranean Diet principles: a subanalysis of the St Carlos GDM Prevention Study

Carla Assaf-Balut et al. BMJ Open Diabetes Res Care. 2018.

. 2018 Oct 11;6(1):e000550.

doi: 10.1136/bmjdrc-2018-000550. eCollection 2018.

Authors

Affiliations

¹ Endocrinology and Nutrition Department, Hospital Clínico San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain.
² Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain.
³ Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Madrid, Spain.
⁴ Preventive Medicine Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain.
⁵ Gynecology and Obstetrics Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain.
⁶ Clinical Laboratory Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain.

^# Contributed equally.

PMID: 30397489
PMCID: PMC6202993
DOI: 10.1136/bmjdrc-2018-000550

Abstract

Objectives: To assess whether Mediterranean Diet (MedDiet)-based medical nutrition therapy facilitates near-normoglycemia in women with gestational diabetes mellitus (GDMw) and observe the effects on adverse pregnancy outcomes.

Research design and methods: This is a secondary analysis of the St Carlos GDM Prevention Study, conducted between January and December 2015 in Hospital Clínico San Carlos (Madrid, Spain). One thousand consecutive women with normoglycemia were included before 12 gestational weeks (GWs), with 874 included in the final analysis. Of these, 177 women were diagnosed with gestational diabetes mellitus (GDM) and 697 had normal glucose tolerance. All GDMw received MedDiet-based medical nutrition therapy with a recommended daily extra virgin olive oil intake ≥40 mL and a daily handful of nuts. The primary goal was comparison of hemoglobin A1c (HbA_1c) levels at 36-38 GWs in GDMw and women with normal glucose tolerance (NGTw).

Results: GDMw as compared with NGTw had higher HbA_1c levels at 24-28 GWs (5.1%±0.3% (32±0.9 mmol/mol) vs 4.9%±0.3% (30±0.9 mmol/mol), p=0.001). At 36-38 GWs values were similar between the groups. Similarly, fasting serum insulin and homeostatic model assessment insulin resitance (HOMA-IR) were higher in GDMw at 24-28 GWs (p=0.001) but became similar at 36-38 GWs. 26.6% of GDMw required insulin for glycemic control. GDMw compared with NGTw had higher rates of insufficient weight gain (39.5% vs 22.0%, p=0.001), small for gestational age (6.8% vs 2.6%, p=0.009), and neonatal intensive care unit admission (5.6% vs 1.7%, p=0.006). The rates of macrosomia, large for gestational age, pregnancy-induced hypertensive disorders, prematurity and cesarean sections were comparable with NGTw.

Conclusions: Using a MedDiet-based medical nutrition therapy as part of GDM management is associated with achievement of near-normoglycemia, subsequently making most pregnancy outcomes similar to those of NGTw.

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Conflict of interest statement

Competing interests: None declared.

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References

1. Metzger BE, Lowe LP, et al. . HAPO Study Cooperative Research Group. Hyperglycemia and adverse pregnancy outcomes. N Engl J Med 2008;358:1991–2002. 10.1056/NEJMoa0707943 - DOI - PubMed
1. Metzger BE, Gabbe SG, Persson B, et al. . International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy: Response to weinert. Diabetes Care 2010;33:e98–82. 10.2337/dc10-0719 - DOI - PMC - PubMed
1. World Health Organization. Global Report on Diabetes. Isbn 2016;978:88.
1. Duran A, Sáenz S, Torrejón MJ, et al. . Introduction of IADPSG criteria for the screening and diagnosis of gestational diabetes mellitus results in improved pregnancy outcomes at a lower cost in a large cohort of pregnant women: the St. Carlos Gestational Diabetes Study. Diabetes Care 2014;37:2442–50. 10.2337/dc14-0179 - DOI - PubMed
1. Assaf-Balut C, García de la Torre N, Rubio MA, et al. . Change in postpartum insulin resistance syndrome in women with prior GDM identified by Carpenter-Coustan and IADPSG criteria. Endocrinol Diabetes Nutr 2017;64:400–3. 10.1016/j.endinu.2017.04.007 - DOI - PubMed

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[1] Metzger BE, Lowe LP, et al. . HAPO Study Cooperative Research Group. Hyperglycemia and adverse pregnancy outcomes. N Engl J Med 2008;358:1991–2002. 10.1056/NEJMoa0707943 - DOI - PubMed

[2] Metzger BE, Lowe LP, et al. . HAPO Study Cooperative Research Group. Hyperglycemia and adverse pregnancy outcomes. N Engl J Med 2008;358:1991–2002. 10.1056/NEJMoa0707943 - DOI - PubMed

[3] Metzger BE, Gabbe SG, Persson B, et al. . International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy: Response to weinert. Diabetes Care 2010;33:e98–82. 10.2337/dc10-0719 - DOI - PMC - PubMed

[4] Metzger BE, Gabbe SG, Persson B, et al. . International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy: Response to weinert. Diabetes Care 2010;33:e98–82. 10.2337/dc10-0719 - DOI - PMC - PubMed

[5] World Health Organization. Global Report on Diabetes. Isbn 2016;978:88.

[6] World Health Organization. Global Report on Diabetes. Isbn 2016;978:88.

[7] Duran A, Sáenz S, Torrejón MJ, et al. . Introduction of IADPSG criteria for the screening and diagnosis of gestational diabetes mellitus results in improved pregnancy outcomes at a lower cost in a large cohort of pregnant women: the St. Carlos Gestational Diabetes Study. Diabetes Care 2014;37:2442–50. 10.2337/dc14-0179 - DOI - PubMed

[8] Duran A, Sáenz S, Torrejón MJ, et al. . Introduction of IADPSG criteria for the screening and diagnosis of gestational diabetes mellitus results in improved pregnancy outcomes at a lower cost in a large cohort of pregnant women: the St. Carlos Gestational Diabetes Study. Diabetes Care 2014;37:2442–50. 10.2337/dc14-0179 - DOI - PubMed

[9] Assaf-Balut C, García de la Torre N, Rubio MA, et al. . Change in postpartum insulin resistance syndrome in women with prior GDM identified by Carpenter-Coustan and IADPSG criteria. Endocrinol Diabetes Nutr 2017;64:400–3. 10.1016/j.endinu.2017.04.007 - DOI - PubMed

[10] Assaf-Balut C, García de la Torre N, Rubio MA, et al. . Change in postpartum insulin resistance syndrome in women with prior GDM identified by Carpenter-Coustan and IADPSG criteria. Endocrinol Diabetes Nutr 2017;64:400–3. 10.1016/j.endinu.2017.04.007 - DOI - PubMed

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Medical nutrition therapy for gestational diabetes mellitus based on Mediterranean Diet principles: a subanalysis of the St Carlos GDM Prevention Study

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Medical nutrition therapy for gestational diabetes mellitus based on Mediterranean Diet principles: a subanalysis of the St Carlos GDM Prevention Study

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