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 The effects of vitamin D and omega-3 fatty acids co-supplementation on biomarkers of inflammation, oxidative stress and pregnancy outcomes in patients with gestational diabetes Dietary Omega-3 Fatty Acid Supplementation Reduces Inflammation in Obese Pregnant Women: A Randomized Double-Blind Controlled Clinical Trial Effect of omega-3 supplementation on inflammatory parameters in patients on chronic ambulatory peritoneal dialysis 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. Omega-3 fatty acid supplementation affects pregnancy outcomes in gestational diabetes: a randomized, double-blind, placebo-controlled trial The effects of vitamin D and omega-3 fatty acid co-supplementation on glycemic control and lipid concentrations in patients with gestational diabetes. Decreased cord blood IL-4, IL-13, and CCR4 and increased TGF-beta levels after fish oil supplementation of pregnant women. Fish-oil supplementation in pregnancy does not reduce the risk of gestational diabetes or preeclampsia. Gestational diabetes risk factors and long-term consequences for both mother and offspring: a literature review Comparison of risk factors and pregnancy outcomes of gestational diabetes mellitus diagnosed during early and late pregnancy. Lactation intensity and fasting plasma lipids, lipoproteins, non-esterified free fatty acids, leptin and adiponectin in postpartum women with recent gestational diabetes mellitus: the SWIFT cohort.
Gestational diabetes mellitus ( GDM ) is a common complication of pregnancy , and it is mostly associated with postpartum diabetes , insulin resistance , and dyslipidemia . Fish oil ( omega-3 ) supplementation has been shown to reduce the risk of different chronic diseases such as cardiovascular disease , type 2 diabetes , and cancers , though the evidence of its impact on gestational diabetes is scarce . Our goal in this study was to determine the effect of fish oil administration on gene expression related to insulin action , blood lipids , and inflammation in women with GDM . Participants with GDM ( n = 40 ) , aged 18–40 years , were r and omized to take either 1000 mg fish oil capsules , containing 180 mg eicosapentaenoic acid and 120 mg docosahexaenoic acid ( n = 20 ) , or placebo ( n = 20 ) twice a day for 6 weeks . Gene expression related to insulin , lipids , and inflammation was quantified in peripheral blood mononuclear cells ( P BMC s ) of GDM women using Reverse Transcription Polymerase Chain Reaction ( RT-PCR ) method . Results of RT-PCR indicated that omega-3 supplementation  upregulated gene expression of peroxisome proliferator-activated receptor gamma ( PPAR-γ ) ( P = 0.04 ) in P BMC s of patients with GDM , compared with the placebo . In addition , gene expression of the low-density lipoprotein receptor ( LDLR ) ( P < 0.001 ) , interleukin-1 ( IL-1 ) ( P = 0.007 ) , and tumor necrosis factor alpha ( TNF-α ) ( P = 0.01 ) was downregulated in P BMC s of women with GDM , following omega-3 supplementation . No significant effect of omega-3 supplementation was indicated on gene expression of IL-8 in P BMC s of patients with GDM . Overall , fish oil supplementation for 6 weeks in women with GDM  significantly improved gene expression of PPAR-γ , IL-1 , and TNF-α , but not gene expression of IL-8 Background This study was carried out to determine the effects of vitamin D and omega-3 fatty acids co- supplementation on biomarkers of inflammation , oxidative stress and pregnancy outcomes  in gestational diabetes ( GDM ) patients . Methods This r and omized , double-blind , placebo-controlled trial was conducted among 120 GDM women . Participants were r and omly divided into four groups to receive : 1 ) 1000 mg omega-3 fatty acids containing 180 mg eicosapentaenoic acid ( EPA ) and 120 mg docosahexaenoic acid ( DHA ) twice a day + vitamin D placebo ( n = 30 ) ; 2 ) 50,000 IU vitamin D every 2 weeks + omega-3 fatty acids placebo ( n = 30 ) ; 3 ) 50,000 IU vitamin D every 2 weeks + 1000 mg omega-3 fatty acids twice a day ( n = 30 ) and 4 ) vitamin D placebo + omega-3 fatty acids placebo ( n = 30 ) for 6 weeks . Results Subjects who received vitamin D plus omega-3 fatty acids supplements compared with vitamin D , omega-3 fatty acids and placebo had significantly decreased high-sensitivity C-reactive protein ( −2.0 ± 3.3 vs. -0.8 ± 4.4 , −1.3 ± 2.4 and + 0.9 ± 2.7 mg/L , respectively , P = 0.008 ) , malondialdehyde ( −0.5 ± 0.5 vs. −0.2 ± 0.5 , −0.3 ± 0.9 and + 0.5 ± 1.4 μmol/L , respectively , P < 0.001 ) , and increased total antioxidant capacity ( + 92.1 ± 70.1 vs. + 55.1 ± 123.6 , + 88.4 ± 95.2 and + 1.0 ± 90.8 mmol/L , respectively , P = 0.001 ) and glutathione ( + 95.7 ± 86.7 vs. + 23.0 ± 62.3 , + 30.0 ± 66.5 and −7.8 ± 126.5 μmol/L , respectively , P = 0.001 ) . In addition , vitamin D and omega-3 fatty acids co-supplementation , compared with vitamin D , omega-3 fatty acids and placebo , result ed in lower incidences of newborns ’ hyperbilirubinemiain ( P = 0.037 ) and newborns ’ hospitalization ( P = 0.037 ) . Conclusion Overall , vitamin D and omega-3 fatty acids co-supplementation for 6 weeks among GDM women had beneficial effects on some biomarkers of inflammation , oxidative stress and pregnancy outcomes Objective Long-chain omega 3 fatty acids , eicosapentaenoic acid ( EPA , 20:5n-3 ) and docosahexaenoic acid ( DHA , 22:6n-3 ) exert potent anti-inflammatory properties in humans . This study characterized the effects of omega-3 ω-3 fatty acids supplements ( ω-3 FA ) on the inflammatory status in the placenta and adipose tissue of overweight/obese pregnant women . Study Design A r and omized , double-masked controlled trial was conducted in overweight/obese pregnant women that were r and omly assigned to receive DHA plus EPA ( 2g/day ) or the equivalent of a placebo twice a day from week 10–16 to term . Inflammatory pathways were characterized in : 1 ) adipose tissue and placenta of treated vs. untreated women ; and 2 ) adipose and trophoblast cells cultured with long chain FAs . Results The sum of plasma DHA and EPA increased by 5.8 fold and ω-3 FA/ ω-6 FA ratio was 1.5 in treated vs. untreated women ( p < 0.005 ) . Plasma CRP concentrations were reduced ( p<0.001 ) . The adipose tissue and placenta of treated women exhibited a significant decrease in TLR4 adipose and placental expression as well as IL6 , IL8 , and TNFα In vitro , EPA and DHA suppressed the activation of TLR4 , IL6 , IL8 induced by palmitate in culture of adipose and trophoblast cells . Conclusion Supplementation of overweight/obese pregnant women with dietary ω-3 FAs for > 25 weeks reduced inflammation in maternal adipose and the placental tissue . TLR4 appears as a central target of the anti-inflammatory effects at the cellular level . Trial Registration Clinical Trials.gov Background : End stage renal disease ( ESRD ) is a state of micro inflammation that attenuates patient′s life span and quality of life . Inflammatory markers like interlukin 6 ( IL-6 ) and C- reactive protein ( CRP ) can predict inflammatory state in ESRD patients . Dietary limitations are risk factors for omega-3 deficiency in these patients . Omega-3 supplementation is an attractive material that proposed in inflammation modulation . The aim of this study is evaluation of effect of omega-3 supplementation on IL-6 and CRP level in chronic ambulatory peritoneal dialysis ( CAPD ) patients . Material s and Methods : This r and omized controlled double-blind clinical trial is performed in 40 CAPD patients in two academic hospitals in Isfahan , Iran . One group received 1000 mg omega-3 capsule ( each capsule contains 180 mg Eicosapentanoic and 120 mg Dosahexanoic acid ) three times a day orally for 8 weeks ( n = 20 ) and the other matched group by placebo ( n = 20 ) . Serum level of IL-6 and quantitative CRP ( Q-CRP ) were measured in beginning and the end of the study . Finally all data were analyzed by SPSS version 18 . Results : Mean age of patients was 53 years old in omega-3 group patients and 54 years old in placebo group . There were not any differences in CRP and IL-6 level in the beginning and the end of study between two groups ( P : 0.81 and 0.10 for CRP and 0.26 and 0.23 for IL-6 , respectively ) . Conclusion : Omega-3 supplementation did not effect on inflammatory markers ( Q-CRP and IL-6 ) in CAPD patients after 8 weeks OBJECTIVES Limited data are available for assessing the effects of omega-3 fatty acids and vitamin E co-supplementation on metabolic profiles and pregnancy outcomes in gestational diabetes ( GDM ) . This study was design ed to determine the effects of omega-3 fatty acids and vitamin E co-supplementation on biomarkers of oxidative stress , inflammation and pregnancy outcomes in women with GDM . METHODS This r and omized , double-blind , placebo-controlled clinical trial was conducted in 60 patients with GDM who were not taking oral hypoglycemic agents . Patients were r and omly allocated to intake either 1000 mg omega-3 fatty acids from flaxseed oil plus 400 IU vitamin E supplements ( n=30 ) or placebo ( n=30 ) for 6 weeks . Fasting blood sample s were obtained from the women at the beginning of the study and after the 6-week intervention to quantify related markers . RESULTS After 6 weeks of intervention , omega-3 fatty acids and vitamin E co-supplementation , compared with the placebo , result ed in a significant rise in total antioxidant capacity ( TAC ) ( + 187.5±224.9 vs. -32.5±136.1 mmol/L ; p<0.001 ) ; nitric oxide ( NO ) ( + 5.0±7.7 vs. -12.0±28.0 µmol/L ; p=0.002 ) and a significant decrease in plasma malondialdehyde ( MDA ) concentrations ( -0.1±0.9 vs. + 0.6±1.4 µmol/L ; p=0.03 ) . Co-supplementation with omega-3 fatty acids and vitamin E showed no detectable changes in plasma glutathione and serum high-sensitivity C-reactive protein levels . Joint omega-3 fatty acids and vitamin E supplementation result ed in lower incidences of hyperbilirubinemia in newborns ( 10.3 % vs. 33.3 % ; p=0.03 ) . CONCLUSIONS Overall , omega-3 fatty acids and vitamin E co-supplementation for 6 weeks in women with GDM had beneficial effects on plasma TAC , MDA and NO and on the incidence of the newborns ' hyperbilirubinemia Abstract Objective : This study was design ed to assess the effects of omega-3 fatty acid supplementation on inflammatory factors , biomarkers of oxidative stress , and pregnancy outcomes among pregnant women with gestational diabetes ( GDM ) . Methods : This r and omized , double-blind , placebo-controlled clinical trial was performed among 56 women with GDM . Subjects were r and omly selected to receive either 1000 mg omega-3 fatty acid supplements ( containing 180 mg eicosapentaenoic acid and 120 mg docosahexanoic acid ) ( n = 27 ) or a placebo ( n = 27 ) for 6 weeks . Fasting blood sample s were taken at study baseline and after 6 weeks of intervention to quantify biochemical variables . Newborn ’s weight , height , head circumference , Apgar score , and hyperbilirubinemia were determined . Results : At the end of the 6 weeks , taking omega-3 fatty acid significantly decreased serum high-sensitivity C-reactive protein ( hs-CRP ) ( change from baseline : −245.1 ± 1570.5 versus + 913.9 ± 2329.4 ng/mL , p = 0.03 ) and plasma malondialdehyde ( MDA ) concentrations ( −0.4 ± 1.3 versus + 0.6±2.3 , p = 0.04 ) compared with the placebo . Supplementation with omega-3 had a low incidence of hyperbilirubinemiain newborns ( 7.7 % versus 33.3 % , p = 0.02 ) and decreased newborns ’ hospitalization rate ( 7.7 % versus 33.3 % , p = 0.02 ) . Conclusions : Taken together , omega-3 fatty acid supplementation  in GDM women had beneficial effects on maternal serum hs-CRP , plasma MDA levels , incidence of newborn ’s hyperbilirubinemia , and hospitalization OBJECTIVE This study was performed to evaluate the effects of vitamin D and omega-3 fatty acids co-supplementation on glucose metabolism and lipid concentrations in gestational diabetes ( GDM ) patients . METHODS This r and omized double-blind placebo-controlled clinical trial was done among 140 GDM patients . Participants were r and omly divided into 4 groups to receive : ( 1 ) 1000 mg omega-3 fatty acids containing 360 mg eicosapentaenoic acid and 240 mg docosahexaenoic acid ( DHA ) twice a day + vitamin D placebo ( n = 35 ) ; ( 2 ) 50,000 IU vitamin D every 2 weeks + omega-3 fatty acids placebo ( n = 35 ) ; ( 3 ) 50,000 IU vitamin D every 2 weeks + 1000 mg omega-3 fatty acids twice a day ( n = 35 ) , and ( 4 ) vitamin D placebo + omega-3 fatty acids placebo ( n = 35 ) for 6 weeks . RESULTS After 6 weeks of intervention , patients who received combined vitamin D and omega-3 fatty acids supplements compared with vitamin D , omega-3 fatty acids , and placebo had significantly decreased fasting plasma glucose ( -7.3 ± 7.8 , -6.9 ± 6.6 , -4.0 ± 2.5 , and + 1.0 ± 11.4 mg/dL , respectively , P < .001 ) , serum insulin levels ( -1.9 ± 1.9 , -1.3 ± 6.3 , -0.4 ± 6.3 , and + 2.6 ± 6.5 μIU/mL , respectively , P = .005 ) , homeostatic model of assessment for insulin resistance ( -0.7 ± 0.6 , -0.5 ± 1.4 , -0.2 ± 1.5 , and + 0.6 ± 1.5 , respectively , P < .001 ) and increased quantitative insulin sensitivity check index ( + 0.01 ± 0.01 , + 0.008 ± 0.02 , + 0.002 ± 0.02 , and -0.005 ± 0.02 , respectively , P = .001 ) . In addition , changes in serum triglycerides ( -8.2 ± 41.0 , + 7.6 ± 31.5 , + 3.6 ± 29.9 , and + 20.1 ± 29.6 mg/dL , respectively , P = .006 ) and very low-density lipoprotein cholesterol ( -1.6 ± 8.2 , + 1.5 ± 6.3 , + 0.8 ± 6.0 , and + 4.0 ± 5.9 mg/dL , respectively , P = .006 ) in the vitamin D plus omega-3 fatty acids group were significantly different from the changes in these indicators in the vitamin D , omega-3 fatty acids , and placebo groups . CONCLUSION Overall , vitamin D and omega-3 fatty acids co-supplementation for 6 weeks among GDM patients  had beneficial effects on fasting plasma glucose , serum insulin levels , homeostatic model of assessment for insulin resistance , quantitative insulin sensitivity check index , serum triglycerides , and very low-density lipoprotein cholesterol levels BACKGROUND Altered intakes of n-3 and n-6 polyunsaturated fatty acids were suggested to modulate allergic disease , but intervention trials yielded inconclusive results . Because allergies are primed in early infancy and in utero , the fetus might be more accessible to nutritional intervention strategies . OBJECTIVE We sought to investigate how supplementation of pregnant women with a fish oil ( FO ) preparation  modulates allergy-related immune parameters in mothers and offspring . METHODS We performed a multicenter , r and omized , double-blind , placebo-controlled trial . Three hundred eleven pregnant women received daily either FO with 0.5 g of docosahexaenoic acid and 0.15 g of eicosapentaenoic acid , 400 mug of methyl-tetra-hydrofolic acid , both , or placebo from the 22nd gestational week . T(H)1/T(H)2-related molecules were quantified in 197 maternal and 195 cord blood sample s by using real-time RT-PCR . Data are given as geometric means [ 95 % CIs ] . RESULTS FO supplementation was associated with increased TGF-beta mRNA in maternal ( 0.85 [ 0.8 - 0.89 ] ; placebo : 0.68 [ 0.64 - 0.72 ] ) and cord blood ( 0.85 [ 0.81 - 0.9 ] ; placebo : 0.75 [ 0.71 - 0.79 ] ) . IL-1 ( 0.69 [ 0.66 - 0.73 ] ; placebo : 0.83 [ 0.79 - 0.88 ] ) and IFN-gamma ( 0.54 [ 0.51 - 0.57 ] ; placebo : 0.65 [ 0.61 - 0.69 ] ) were decreased in mothers only ( P < .001 ) . Cord blood mRNA levels of IL-4 ( 0.54 [ 0.52 - 0.57 ] ; placebo : 0.64 [ 0.61 - 0.68 ] ) , IL-13 ( 0.61 [ 0.58 - 0.65 ] ; placebo : 0.85 [ 0.80 - 0.89 ] ) , CCR4 ( 0.70 [ 0.67 - 0.73 ] ; placebo : 0.88 [ 0.84 - 0.92 ] ; all P < .001 ) , and natural killer ( P < .001 ) and CCR3+CD8 + T cells ( P < .04 ) were decreased in the FO group . CONCLUSION Supplementation with FO during pregnancy is associated with decreased mRNA levels of T(H)2-related molecules in the fetus and decreased maternal inflammatory cytokines . We speculate that both effects are mediated by TGF-beta BACKGROUND There is uncertainty regarding the efficacy of increasing n-3 long-chain PUFA ( LCPUFA ) intake during pregnancy in reducing the risk of  gestational diabetes mellitus ( GDM ) and preeclampsia .  OBJECTIVES The objective was to determine whether n-3 LCPUFA supplementation in pregnancy reduces the incidence of GDM or preeclampsia . A secondary objective was to assess the effect of n-3 LCPUFA supplementation on perinatal complications . DESIGN This was a double-blind , multicenter r and omized control trial-the DHA to Optimize Mother Infant Outcome ( DOMInO ) trial . Pregnant women ( n = 2399 ) of < 21 wk gestation were r and omly assigned to receive DHA-enriched fish oil ( 800 mg/d ) or vegetable oil capsules without DHA from trial entry to birth . The presence of GDM or preeclampsia was assessed through a blinded audit of medical records . Birth outcomes and prenatal complications were also assessed . RESULTS The overall incidences of GDM and preeclampsia were 8 % and 5 % , respectively , based on clinical diagnosis . The RR of GDM was 0.97 ( 95 % CI : 0.74 , 1.27 ) and of preeclampsia was 0.87 ( 95 % CI : 0.60 , 1.25 ) , and they did not differ significantly between the groups . Birth weight , length , and head circumference z scores also did not differ between the groups . There were 12 perinatal deaths and 5 neonatal convulsions in the control group compared with 3 perinatal deaths and no neonatal convulsions in the DHA group ( P = 0.03 in both cases ) . CONCLUSION DHA supplementation of 800 mg/d in the second half of pregnancy does not reduce the risk of GDM or preeclampsia . Whether supplementation reduces the risk of perinatal death and neonatal convulsions requires further investigation . The DOMInO trial was registered with the Australian New Zeal and Clinical Trials Registry as TRN12605000569606 ABSTRACT Introduction : Established risk factors for gestational diabetes mellitus ( GDM ) include ethnicity , obesity , and family history of diabetes . Untreated GDM patients have higher rates of maternal and perinatal morbidity . GDM is an independent risk factor for future longer-term risk of type 2 diabetes mellitus ( T2DM ) , metabolic syndrome , cardiovascular morbidity , malignancies , ophthalmic , psychiatric , and renal disease in the mother . Offspring risk long-term adverse health outcomes , including T2DM , subsequent obesity , impacted neurodevelopmental outcome , increased neuropsychiatric morbidity , and ophthalmic disease . Areas covered : We critically review data from retrospective , prospect i ve , and meta- analysis studies pertaining to established GDM risk factors , complications during pregnancy and birth ( both mother and offspring ) , and long-term consequences ( both mother and offspring ) . Expert commentary : Many of the adverse consequences of GDM might be avoided with proper management and treatment . Patients belonging to high-risk ethnic groups , and /or with body mass index ≥ 25 kg/m2 , and /or known history of diabetes in first-degree relatives may benefit from universal screening and diagnostic criteria proposed by the International Association of Diabetes and Pregnancy Study Group ( IADPSG ) . The IADPSG one-step method has several advantages , including simplicity of execution , greater patient-friendliness , and higher diagnostic accuracy . Additionally , evidence suggests that the recent increased popularity of bariatric surgery will help to decrease GDM rates over next 5 years . Similarly , metformin may be useful for treating and preventing obstetrical complications in confirmed GDM patients OBJECTIVE To compare risk factors and pregnancy outcomes of gestational diabetes mellitus ( GDM ) diagnosed during early and late pregnancy . DESIGN Prospect i ve population -based cohort study . SETTING Community health care centers of Isfahan , Iran . PARTICIPANTS AND MEASUREMENTS 1000 pregnant women who were eligible and consented to participate underwent fasting plasma glucose testing at the first prenatal visit ( 6 - 14 weeks ) . The women free from GDM or overt diabetes were screened at 24 - 28 weeks of gestation using a 75-g , 2-hour oral glucose tolerance test . The diagnosis of GDM was reached through the International Association of the Diabetes and Pregnancy Study Groups . Early-onset GDM was defined as the diagnosis of GDM at the first prenatal visit . Late-onset GDM was defined as the diagnosis of GDM later at 24 - 28 weeks . FINDINGS Prevalence of GDM was 10 % ( 95 % CI : 8.1 - 11.9 ) at the first prenatal visit . GDM incidence was 9.3 % ( 95 % CI : 7.4 - 11.2 ) at 24 - 28 weeks of gestation . Family history of diabetes , and previous gestational diabetes and maternal age were the independent risk factors for GDM during early and late diagnosis . GDM was associated with increased risk of macrosomia , large for gestational age , and cesarean section in both periods while , neonates of women with early-onset GDM were more likely to have an apgar score at 1-min < 7 , and neonatal respiratory distress syndrome and were more admitted to the neonatal intensive care unit . KEY CONCLUSION AND IMPLICATION FOR PRACTICE Despite early screening and current practice management , early-onset GDM was associated with poorer pregnancy outcomes compared to the late-onset group . Women with early-onset GDM would benefit from more strict surveillance and management strategies to improve pregnancy outcomes . Further studies are needed to evaluate the efficacy of alternative management approaches in these high risk women OBJECTIVES Lactation may influence future progression to type 2 diabetes after gestational diabetes mellitus ( GDM ) . However , biomarkers associated with progression to glucose intolerance have not been examined in relation to lactation intensity among postpartum women with previous GDM . This study investigates whether higher lactation intensity is related to more favorable blood lipids , lipoproteins and adipokines after GDM pregnancy independent of obesity , socio-demographics and insulin resistance . METHODS The Study of Women , Infant Feeding , and Type 2 Diabetes ( SWIFT ) is a prospect i ve cohort study that recruited 1035 women diagnosed with GDM by the 3-h 100 g oral glucose tolerance tests ( OGTTs ) after delivery of a live birth in 2008 - 2011 . Research staff conducted 2-h 75 g OGTTs , and assessed lactation intensity , anthropometry , lifestyle behaviors and socio-demographics at 6 - 9 weeks postpartum ( baseline ) . We assayed  fasting plasma lipids , lipoproteins , non-esterified free fatty acids , leptin and adiponectin  from stored sample s obtained at 6 - 9 weeks postpartum in 1007 of the SWIFT participants who were free of diabetes at baseline .  Mean biomarker concentrations were compared among lactation intensity groups using multivariable linear regression models . RESULTS Increasing lactation intensity showed grade d monotonic associations with fully adjusted mean biomarkers : 5%-8 % higher high-density lipoprotein cholesterol ( HDL-cholesterol ) , 20%-28 % lower fasting triglycerides , 15%-21 % lower leptin ( all trend P-values < 0.01 ) , and with 6 % lower adiponectin , but only after adjustment for insulin resistance ( trend P-value = 0.04 ) . CONCLUSION Higher lactation intensity was associated with more favorable biomarkers for type 2 diabetes , except for lower plasma adiponectin , after GDM delivery . Long-term follow-up studies are needed to assess whether these effects of lactation persist to predict progression to glucose intolerance
BACKGROUND Omega-3 fatty acid supplementation shows some treatment efficacy for gestational diabetes .
This systematic review and meta- analysis is conducted to investigate the efficacy of omega-3 fatty acid supplementation for glycemic control in patients with gestational diabetes .