Nutrition therapy in managing pregnant women with gestational diabetes mellitus
AbstractIn recent years, there has been a tendency to increase the number of pregnant women with gestational diabetes mellitus (GDM). GDM in pregnant women is associated with an increased risk of adverse pregnancy outcomes, complications during childbirth, and subsequently type 2 diabetes mellitus. Lifestyle modification is essential for the prevention of GDM. Diet therapy is one of the main methods of treating the disease. The article discusses modern ideas about the role of diet therapy in the treatment of GDM.
Keywords:gestational diabetes mellitus; pregnancy; diet therapy; nutrition; gestational weight gain
Funding. The study had no sponsor support.
Conflict of interest. The authors declare no conflict of interest.
For citation: Kyrtikov S.I., Orazmuradov A.A., Bekbaeva I.V., Akhmatova A.N., Haddad Kh., Zokirova N.M., Zulumyan T.N., Suleyma- nova Zh.Zh., Mukovnikova E.V., Orazmuradova A.A. Nutrition therapy in managing pregnant women with gestational diabetes mellitus. Akusherstvo i ginekologiya: novosti, mneniya, obuchenie [Obstetrics and Gynecology: News, Opinions, Training]. 2022; 10 (3): 48–55. DOI: https://doi.org/10.33029/2303-9698-2022-10-3-48-55 (in Russian)
REFERENCES
1. Russian Association of Endocrinologists, Russian Society of Obstetricians and Gynecologists. Gestational diabetes mellitus. Diagnosis, treatment, obstetric tactics, postpartum observation. Clinical guidelines, 2020. (in Russian)
2. Seregina D.S., Nikolayenkov I.P., Kuzminykh T.U. Obesity represents a strong pathogenetic link with the pathology of pregnancy and childbirth. Zhurnal akusherstva i zhenskikh bolezney [Journal of Obstetrics and Women’s Diseases]. 2020; 69 (2): 73–82. DOI: https://doi.org/10.17816/JOWD69273-82. (in Russian)
3. McIntyre H.D., Catalano P., Zhang C., Desoye G., Mathiesen E.R., Damm P. Gestational diabetes mellitus. Nat Rev Dis Primers. 2019; 5 (1): 47. DOI: https://doi.org/10.1038/s41572-019-0098-8 PMID: 31296866.
4. Ovesen P.G., Fuglsang J., Andersen M.B., Wolff C., Petersen O.B., David McIntyre H. Temporal trends in gestational diabetes prevalence, treatment, and outcomes at Aarhus University Hospital, Skejby, between 2004 and 2016. J Diabetes Res. 2018; 2018: 5937059. DOI: https://doi.org/10.1155/2018/5937059 PMID: 29736403; PMCID: PMC5875052.
5. Scholtens D.M., Kuang A., Lowe L.P., Hamilton J., Lawrence J.M., Lebenthal Y., et al. Hyperglycemia and Adverse Pregnancy Outcome Follow-Up Study (HAPO FUS): maternal glycemia and childhood glucose metabolism. Diabetes Care. 2019; 42 (3): 381–92. DOI: https://doi.org/10.2337/dc18-2021
6. Kurtzhals L.L., Norgaard S.K., Secher A.L., Nichum V.L., Ronneby H., Tabor A., et al. The impact of restricted gestational weight gain by dietary intervention on fetal growth in women with gestational diabetes mellitus. Diabetologia. 2018; 61 (12): 2528–38. DOI: https://doi.org/10.1007/s00125-018-4736-6 Epub 2018 Sep 25. PMID: 30255376.
7. Li X., Zhang W., Lin J., Liu H., Yang Z., Teng Y., et al. Risk factors for adverse maternal and perinatal outcomes in women with preeclampsia: analysis of 1396 cases. J Clin Hypertens. (Greenwich). 2018; 20 (6): 1049–57. DOI: https://doi.org/10.1111/jch.13302.
8. Szmuilowicz E.D., Josefson J.L., Metzger B.E. Gestational diabetes mellitus. Endocrinol Metab Clin North Am. 2019; 48 (3): 479–93. DOI: https://doi.org/10.1016/j.ecl.2019.05.001
9. International Diabetes Federation (IDF). Diabetic Atlas. 9th ed., 2019. (in Russian)
10. Yamamoto J.M., Kellett J.E., Balsells M., García-Patterson A., Hadar E., Solà I., et al. Gestational diabetes mellitus and diet: a systematic review and meta-analysis of randomized controlled trials examining the impact of modified dietary interventions on maternal glucose control and neonatal birth weight. Diabetes Care. 2018; 41 (7): 1346–61. DOI: https://doi.org/10.2337/dc18-0102 PMID: 29934478.
11. American Diabetes Association. 13. Management of diabetes in pregnancy. Diabetes Care. 2017; 40 (suppl 1): S114–9. DOI: https://doi.org/10.2337/dc17-S016 PMID: 27979900.
12. Yaktine A.L., Rasmussen K.M., Youth F.; National Research Council; Institute of Medicine; Board on Children; Committee to Reexamine IOM Pregnancy Weight Guidelines. Weight Gain During Pregnancy: Reexamining the Guidelines. In: K.M. Rasmussen, A.L. Yaktine (eds). Washington, DC: National Academies Press, 2009.
13. LifeCycle Project-Maternal Obesity and Childhood Outcomes Study Group; Voerman E., Santos S., Inskip H., Amiano P., Barros H., Charles M.A., et al. Association of gestational weight gain with adverse maternal and infant outcomes. JAMA. 2019; 321 (17): 1702–15. DOI: https://doi.org/10.1001/jama.2019.3820 PMID: 31063572; PMCID: PMC6506886.
14. Viecceli C., Remonti L.R., Hirakata V.N., Mastella L.S., Gnielka V., Opper- mann M.L., et al. Weight gain adequacy and pregnancy outcomes in gestational diabetes: a meta-analysis. Obes Rev. 2017; 18 (5): 567–80. DOI: https://doi.org/10.1111/obr.12521 Epub 2017 Mar 8. PMID: 28273690.
15. Peterson C.M., Jovanovic-Peterson L. Percentage of carbohydrate and glycemic response to breakfast, lunch, and dinner in women with gestational diabetes. Diabetes. 1991; 40: 172–4. DOI: https://doi.org/10.2337/diab.40.2.S172
16. Rasmussen L., Poulsen C.W., Kampmann U., Smedegaard S.B., Ovesen P.G., Fuglsang J. Diet and healthy lifestyle in the management of gestational diabetes mellitus. Nutrients. 2020; 12 (10): 3050. DOI: https://doi.org/10.3390/nu12103050 Epub 2020 Oct 6.
17. American Diabetes Association; Bantle J.P., Wylie-Rosett J., Albright A.L., Apovian C.M., Clark N.G., Franz M.J., et al. Nutrition Recommendations and Interventions for Diabetes: a position statement of the American Diabetes Association. Diabetes Care. 2007; 31 (suppl 1): S61–78. DOI: https://doi.org/10.2337/dc08-s061
18. Nordic Nutrition of Ministers. Nordic Nutrition Recommendations 2012. 5th ed. Norden; Copenhagen, 2014: 1–629.
19. Hernandez T.L., Van Pelt R.E., Anderson M.A., Daniels L.J., West N.A., Donahoo W.T., et al. A Higher-complex carbohydrate diet in gestational diabetes mellitus achieves glucose targets and lowers postprandial lipids: a randomized crossover study. Diabetes Care. 2014; 37: 1254–62. DOI: https://doi.org/10.2337/dc13-2411
20. Lv S., Yu S., Chi R., Wang D. Effects of nutritional nursing intervention based on glycemic load for patient with gestational diabetes mellitus. Ginekol Pol. 2019; 90: 46–9. DOI: https://doi.org/10.5603/GP.2019.0007
21. Ovesen P., Damm P., Renault K., Holm A.M., Wolff C., Knold B., et al. Sandbjerg 2007 – GUIDELINE. Behandling af Gestationel Diabetes Mellitus. Middelfart, Denmark, 2007. URL: http://gynobsguideline.dk/wp/wp-content/uploads/2013/02/GDM-Sandbjerg-2014-godkendt-2014.pdf (date of access July 17, 2020)
22. Moreno-Castilla C., Hernández M., Bergua M., Alvarez M.C., Arce M.A., Rodriguez K., et al. Low-carbohydrate diet for the treatment of gestational diabetes mellitus. Diabetes Care. 2013; 36: 2233–8. DOI: https://doi.org/10.2337/dc12-2714
23. Rasmussen L., Christensen M.L., Poulsen C.W., Rud C., Christensen A.S., Andersen J., et al. Effect of high versus low carbohydrate intake in the morning on glycemic variability and glycemic control measured by continuous blood glucose monitoring in women with gestational diabetes mellitus – a randomized crossover study. Nutritiens. 2020; 12: 475. DOI: https://doi.org/10.3390/nu12020475
24. Kalhan S.C., Tserng K.-Y., Gilfillan C., Dierker L.J. Metabolism of urea and glucose in normal and diabetic pregnancy. Metabolism. 1982; 31: 824–33. DOI: https://doi.org/10.1016/0026-0495(82)90082-8
25. Kalhan S.C., Denne S.C., Patel D.M., Nuamah I.F., Savin S.M. Leucine kinetics during a brief fast in diabetes in pregnancy. Metabolism. 1994; 43: 378–84. DOI: https://doi.org/10.1016/0026-0495(94)90108-2
26. Zimmer D.M., Golichowski A.M., Karn C.A., Brechtel G., Baron A.D., Denne S.C. Glucose and amino acid turnover in untreated gestational diabetes. Diabetes Care. 1996; 19: 591–6. DOI: https://doi.org/10.2337/diacare.19.6.591
27. Ghadimi H., Pecora P. Free amino acids of cord plasma as compared with maternal plasma during pregnancy. Pediatrics. 1964; 33: 500–6.
28. Kuruvilla A.G., D’Souza S.W., Glazier J.D., Mahendran D., Maresh M.J., Sibley C.P. Altered activity of the system a amino acid transporter in microvillous membrane vesicles from placentas of macrosomic babies born to diabetic women. J Clin Invest. 1994; 94: 689–95. DOI: https://doi.org/10.1172/JCI117386
29. Jansson T., Ekstrand Y., Björn C., Wennergren M., Powell T.L. Alterations in the activity of placental amino acid transporters in pregnancies complicated by diabetes. Diabetes. 2002; 51: 2214–9. DOI: https://doi.org/10.2337/diabetes.51.7.2214
30. Dicke J.M., Henderson G.I. Placental amino acid uptake in normal and complicated pregnancies. Am J Med Sci. 1988; 295: 223–7. DOI: https://doi.org/10.1097/00000441-198803000-00012
31. Metzger B.E., Phelps R.L., Freinkel N., Navickas I.A. Effects of gestational diabetes on diurnal profiles of plasma glucose, lipids, and individual amino acids. Diabetes Care. 1980; 3: 402–9. DOI: https://doi.org/10.2337/diacare.3.3.402
32. Kalkhoff R., Kandaraki E., Morrow P., Mitchell T., Kelber S., Borkowf H. Relationship between neonatal birth weight and maternal plasma amino acid profiles in lean and obese nondiabetic women and in type I diabetic pregnant women. Metabolism. 1988; 37: 234–9. DOI: https://doi.org/10.1016/0026-0495(88)90101-1
33. Kadakia R., Talbot O., Kuang A., Bain J.R., Muehlbauer M.J., Stevens R.D., et al. Cord blood metabolomics: association with newborn anthropometrics and c-peptide across ancestries. J Clin Endocrinol Metab. 2019; 104: 4459–72. DOI: https://doi.org/10.1210/jc.2019-00238
34. Perng W., Rifas-Shiman S.L., McCulloch S., Chatzi L., Mantzoros C., Hivert M.-F., et al. Associations of cord blood metabolites with perinatal characteristics, newborn anthropometry, and cord blood hormones in project viva. Metabolism. 2017; 76: 11–22. DOI: https://doi.org/10.1016/j.metabol.2017.07.001
35. Melina V., Craig W., Levin S. Position of the academy of nutrition and dietetics: vegetarian diets. J Acad Nutr Diet. 2016; 116: 1970–80. DOI: https://doi.org/10.1016/j.jand.2016.09.025
36. Piccoli G.B., Clari R., Vigotti F., Leone F., Attini R., Cabiddu G., et al. Vegan-vegetarian diets in pregnancy: danger or panacea? A systematic narrative review. BJOG. 2015; 122: 623–33. DOI: https://doi.org/10.1111/1471-0528.13280
37. Sebastiani G., Barbero A.H., Borràs-Novell C., Casanova M.A., Aldecoa- Bilbao V., Andreu-Fernández V., et al. The effects of vegetarian and vegan diet during pregnancy on the health of mothers and offspring. Nutrients. 2019; 11: 557. DOI: https://doi.org/10.3390/nu11030557
38. Tan C., Zhao Y., Wang S. Is a vegetarian diet safe to follow during pregnancy? A systematic review and meta-analysis of observational studies. Crit Rev Food Sci Nutr. 2019; 59: 2586–96. DOI: https://doi.org/10.1080/10408398.2018.1461062
39. Pawlak R., Parrott S.J., Raj S., Cullum-Dugan D., Lucus D. How prevalent is vitamin B12deficiency among vegetarians? Nutr Rev. 2013; 71: 110–7. DOI: https://doi.org/10.1111/nure.12001
40. Jamilian M., Asemi Z. The Effect of soy intake on metabolic profiles of women with gestational diabetes mellitus. J Clin Endocrinol Metab. 2015; 100: 4654–61. DOI: https://doi.org/10.1210/jc.2015-3454
41. Innis S. Essential fatty acid transfer and fetal development. Placenta. 2005; 26: S70–5. DOI: https://doi.org/10.1016/j.placenta.2005.01.005
42. Koletzko B., Lien E., Agostoni C., Böhles H., Campoy C., Cetin I., et al. The roles of long-chain polyunsaturated fatty acids in pregnancy, lactation and infancy: review of current knowledge and consensus recommendations. J Périnat Med. 2008; 36: 5–14. DOI: https://doi.org/10.1515/JPM.2008.001
43. Haggarty P. Fatty acid supply to the human fetus. Annu Rev Nutr. 2010; 21: 237–55. DOI: https://doi.org/10.1146/annurev.nutr.012809.104742
44. Cunningham P., McDermott L.C. Long chain PUFA transport in human term placenta. J Nutr. 2009; 139: 636–9. DOI: https://doi.org/10.3945/jn.108.098608
45. Duttaroy A.K. Transport of fatty acids across the human placenta: a review. Prog Lipid Res. 2009; 48: 52–61. DOI: https://doi.org/10.1016/j.plipres.2008.11.001
46. Cetin I., Giovannini N., Alvino G., Agostoni C., Riva E., Giovannini M., et al. Intrauterine growth restriction is associated with changes in polyunsaturated fatty acid fetal-maternal relationships. Pediatr Res. 2002; 52: 750–5. DOI: https://doi.org/10.1203/00006450-200211000-00023
47. Jamilian M., Dizaji S.H., Bahmani F., Taghizadeh M., Memarzadeh M.R., Karamali M., et al. A randomized controlled clinical trial investigating the effects of omega-3 fatty acids and vitamin E co-supplementation on biomarkers of oxidative stress, inflammation and pregnancy outcomes in gestational diabetes. Can J Diabetes. 2017; 41: 143–9. DOI: https://doi.org/10.1016/j.jcjd.2016.09.004
48. Jamilian M., Samimi M., Mirhosseini N., Ebrahimi F.A., Aghadavod E., Taghizadeh M., et al. A randomized double-blinded, placebo-controlled trial investigating the effect of fish oil supplementation on gene expression related to insulin action, blood lipids, and inflammation in gestational diabetes mellitus-fish oil supplementation and gestational diabetes. Nutrients. 2018; 10: 163. DOI: https://doi.org/10.3390/nu10020163
49. Samimi M., Jamilian M., Asemi Z., Esmaillzadeh A. Effects of omega-3 fatty acid supplementation on insulin metabolism and lipid profiles in gestational diabetes: Randomized, double-blind, placebo-controlled trial. Clin Nutr. 2015; 34: 388–93. DOI: https://doi.org/10.1016/j.clnu.2014.06.005
50. Ostadrahimi A., Mohammad-Alizadeh-Charandabi S., Mirghafourvand M., Yaghoubi S., Shahrisa E., Farshbaf-Khalili A. Effects of fish oil supplementation on gestational diabetes mellitus (GDM): a systematic review. Iran Red Crescent Med J. 2016; 18: e24690. DOI: https://doi.org/10.5812/ircmj.24690
51. Kominiarek M.A., Rajan P. Nutrition recommendations in pregnancy and lactation. Med Clin. 2016; 100: 1199–215. DOI: https://doi.org/10.1016/j.mcna.2016.06.004
52. Institute of Medicine. Nutrition During Pregnancy. Washington, DC: National Academies Press, 1990.
53. Lucock M. Folic acid: nutritional biochemistry, molecular biology, and role in disease processes. Mol Genet Metab. 2000; 71: 121–38. DOI: https://doi.org/10.1006/mgme.2000.3027
54. Burdge G.C., Lillycrop K.A. Nutrition, epigenetics, and developmental plasticity: implications for understanding human disease. Annu Rev Nutr. 2010; 30: 315–39. DOI: https://doi.org/10.1146/annurev.nutr.012809.104751
55. Farkas A.S., Böttiger A.K., Isaksson H.S., Finnell R.H., Ren A., Nilsson T.K. Epigenetic alterations in folate transport genes in placental tissue from fetuses with neural tube defects and in leukocytes from subjects with hyperhomocysteinemia. Epigenetics. 2013; 8: 303–16. DOI: https://doi.org/10.4161/epi.23988
56. Pregravidar preparation. Clinical Protocol of the Interdisciplinary Association of Reproductive Medicine Specialists (MARS). Version 2.0. Moscow: Redaktsiya zhurnala StatusPraesens, 2020. (in Russian)
57. Guven M.A., Kilinc M., Batukan C., Ekerbicer H.C., Aksu T. Elevated second trimester serum homocysteine levels in women with gestational diabetes mellitus. Arch Gynecol Obstet. 2006; 274: 333–7. DOI: https://doi.org/10.1007/s00404-006-0191-6
58. Mitri J., Pittas A.G. Vitamin D and diabetes. Endocrinol Metab Clin North Am. 2014; 43: 205–32. DOI: https://doi.org/10.1016/j.ecl.2013.09.010
59. Alvarez J.A., Ashraf A.P. Role of vitamin D in insulin secretion and insulin sensitivity for glucose homeostasis. Int J Endocrinol. 2010; 2010: 1–18. DOI: https://doi.org/10.1155/2010/351385
60. Kampmann U., Mosekilde L., Juhl C., Moller N., Christensen B., Rejnmark L., et al. Effects of 12weeks high dose vitamin D3 treatment on insulin sensitivity, beta cell function, and metabolic markers in patients with type 2 diabetes and vitamin D insufficiency – a double-blind, randomized, placebo-controlled trial. Metabolism. 2014; 63: 1115–24. DOI: https://doi.org/10.1016/j.metabol.2014.06.008
61. Poel Y., Hummel P., Lips P., Stam F., Van Der Ploeg T., Simsek S. Vitamin D and gestational diabetes: a systematic review and meta-analysis. Eur J Intern Med. 2012; 23: 465–9. DOI: https://doi.org/10.1016/j.ejim.2012.01.007
62. Asemi Z., Hashemi T., Karamali M., Samimi M., Esmaillzadeh A. Effects of vitamin D supplementation on glucose metabolism, lipid concentrations, inflammation, and oxidative stress in gestational diabetes: a double-blind randomized controlled clinical trial. Am J Clin Nutr. 2013; 98: 1425–32. DOI: https://doi.org/10.3945/ajcn.113.072785
63. Zhang Q., Cheng Y., He M., Li T., Ma Z., Cheng H. Effect of various doses of vitamin D supplementation on pregnant women with gestational diabetes mellitus: a randomized controlled trial. Exp Ther Med. 2016; 12: 1889–95. DOI: https://doi.org/10.3892/etm.2016.3515
64. Chamani M., Moosazadeh M., Tabrizi R., Samimi M., Karamali M., Jamilian M., et al. The effects of vitamin D supplementation on glucose metabolism and lipid profiles in patients with gestational diabetes: a systematic review and meta-analysis of randomized controlled trials. Horm Metab Res. 2017; 49: 647–53. DOI: https://doi.org/10.1055/s-0043-115225
65. Asemi Z., Karamali M., Esmaillzadeh A. Effects of calcium–vitamin D co-supplementation on glycaemic control, inflammation and oxidative stress in gestational diabetes: a randomised placebo-controlled trial. Diabetologia. 2014; 57: 1798–806. DOI: https://doi.org/10.1007/s00125-014-3293-x
66. Kost og Kosttilskud. URL: https://www.sst.dk/da/viden/graviditet-og-foedsel/information-til-gravide/kost-og-kosttilskud (date of access August 15, 2020)
67. Bo S., Menato G., Villois P., Gambino R., Cassader M., Cotrino I., et al. Iron supplementation and gestational diabetes in midpregnancy. Am J Obstet Gynecol. 2009; 201: e1–6. DOI: https://doi.org/10.1016/j.ajog.2009.04.049