A Prospective Study of Prepregnancy Dietary Iron Intake and Risk for Gestational Diabetes Mellitus Risk of gestational diabetes mellitus in relation to maternal egg and cholesterol intake. A prospective study of prepregnancy dietary fat intake and risk of gestational diabetes. Physical activity and gestational diabetes mellitus among Hispanic women. Randomized Controlled Trial Investigating the Effects of a Low–Glycemic Index Diet on Pregnancy Outcomes in Women at High Risk of Gestational Diabetes Mellitus: The GI Baby 3 Study Pre-pregnancy potato consumption and risk of gestational diabetes mellitus: prospective cohort study Adherence to healthy lifestyle and risk of gestational diabetes mellitus: prospective cohort study Myo-inositol Supplementation for Prevention of Gestational Diabetes in Obese Pregnant Women: A Randomized Controlled Trial Pragmatic controlled trial to prevent childhood obesity in maternity and child health care clinics: pregnancy and infant weight outcomes (The VACOPP Study) Diet during early pregnancy and development of gestational diabetes. Effect of dietary myo-inositol supplementation in pregnancy on the incidence of maternal gestational diabetes mellitus and fetal outcomes: a randomized controlled trial Maternal dietary patterns and gestational diabetes mellitus: a large prospective cohort study in China. Prepregnancy Consumption of Fruits and Fruit Juices and the Risk of Gestational Diabetes Mellitus Prospective Study of Pre-Gravid Sugar-Sweetened Beverage Consumption and the Risk of Gestational Diabetes Mellitus A prospective study of dietary patterns, meat intake and the risk of gestational diabetes mellitus Results From a European Multicenter Randomized Trial of Physical Activity and/or Healthy Eating to Reduce the Risk of Gestational Diabetes Mellitus: The DALI Lifestyle Pilot DALI: Vitamin D and lifestyle intervention for gestational diabetes mellitus (GDM) prevention: an European multicentre, randomised trial – study protocol Perinatal outcomes in nutritionally monitored obese pregnant women: a randomized clinical trial. Iron intake, haemoglobin and risk of gestational diabetes: a prospective cohort study Supplemental iron intake and the risk of glucose intolerance in pregnancy: re-analysis of a randomised controlled trial in Finland. Maternal Plasma Ascorbic Acid (Vitamin C) and Risk of Gestational Diabetes Mellitus Pre-pregnancy fried food consumption and the risk of gestational diabetes mellitus: a prospective cohort study Uncoupling between insulin and release of a D-chiro-inositol-containing inositolphosphoglycan mediator of insulin action in obese women With polycystic ovary syndrome. Gestational Diabetes Mellitus Can Be Prevented by Lifestyle Intervention: The Finnish Gestational Diabetes Prevention Study (RADIEL) Prepregnancy low-carbohydrate dietary pattern and risk of gestational diabetes mellitus: a prospective cohort study. Fish-oil supplementation in pregnancy does not reduce the risk of gestational diabetes or preeclampsia. Primary Prevention of Gestational Diabetes Mellitus and Large-for-Gestational-Age Newborns by Lifestyle Counseling: A Cluster-Randomized Controlled Trial
OBJECTIVE It is important to identify modifiable factors that may lower gestational diabetes mellitus ( GDM ) risk .  Dietary iron is of particular interest given that iron is a strong prooxidant , and high body iron levels can damage pancreatic β-cell function and impair glucose metabolism . The current study is to determine if prepregnancy dietary and supplemental iron intakes are associated with the risk of GDM . RESEARCH DESIGN AND METHODS A prospect i ve study was conducted among 13,475 women who reported a singleton pregnancy between 1991 and 2001 in the Nurses ’ Health Study II . A total of 867 incident GDM cases were reported . Pooled logistic regression was used to estimate the relative risk ( RR ) of GDM by quintiles of iron intake controlling for dietary and nondietary risk factors . RESULTS  Dietary heme iron intake was positively and significantly associated with GDM risk . After adjusting for age , BMI , and other risk factors , RRs ( 95 % CIs ) across increasing quintiles of heme iron were 1.0 ( reference ) , 1.11 ( 0.87–1.43 ) , 1.31 ( 1.03–1.68 ) , 1.51 ( 1.17–1.93 ) , and 1.58 ( 1.21–2.08 ) , respectively ( P for linear trend 0.0001 ) . The multivariate adjusted RR for GDM associated with every 0.5-mg per day of increase in intake was 1.22 ( 1.10–1.36 ) . No significant associations were observed between total dietary , nonheme , or supplemental iron intake and GDM risk . CONCLUSIONS These findings suggest that higher prepregnancy intake of dietary heme iron is associated with an increased GDM risk Higher egg and cholesterol intakes are associated with increased risk of type 2 diabetes mellitus .  However , their association with gestational diabetes mellitus ( GDM ) has not been evaluated . The authors assessed such associations in both a prospect i ve cohort study ( 1996 - 2008 ; 3,158 participants ) and a case-control study ( 1998 - 2002 ; 185 cases , 411 controls ) .  A food frequency question naire was used to assess maternal diet . Multivariable models were used to derive relative risks and 95 % confidence intervals . Compared with no egg consumption , adjusted relative risks for GDM were 0.94 , 1.01 , 1.12 , 1.54 , and 2.52 for consumption of ≤1 , 2 - 3 , 4 - 6 , 7 - 9 , and ≥10 eggs/week , respectively ( P for trend=0.008 ) . Women with high egg consumption ( ≥7/week ) had a 1.77-fold increased risk compared with women with lower consumption ( 95 % confidence interval ( CI ) : 1.19 , 2.63 ) . The relative risk for the highest quartile of cholesterol intake ( ≥294 mg/day ) versus the lowest ( < 151 mg/day ) was 2.35 ( 95 % CI : 1.35 , 4.09 ) . In the case-control study , the adjusted odds ratio for consuming ≥7 eggs/week versus < 7 eggs/week was 2.65 ( 95 % CI : 1.48 , 4.72 ) , and the odds of GDM increased with increasing cholesterol intake ( P for trend=0.021 ) . In conclusion ,  high  egg and cholesterol intakes before and during pregnancy are associated with increased risk of GDM BACKGROUND Fatty acids play a vital role in glucose homeostasis ; however , studies on habitual dietary fat intakes and gestational diabetes mellitus ( GDM ) risk are limited and provide conflicting findings . OBJECTIVE We determined whether the total amount and the type and source of prepregnancy dietary fats are related to risk of GDM . DESIGN A prospect i ve study was conducted in 13,475 women who reported a singleton pregnancy between 1991 and 2001 in the Nurses ' Health Study II . In these women , 860 incident GDM cases were reported . The adjusted RR of GDM was estimated for quintiles of total fat , specific fat , and the source of fat intakes by pooled logistic regression . RESULTS Higher animal fat and cholesterol intakes were significantly associated with increased GDM risk . Across increasing quintiles of animal fat , RRs ( 95 % CIs ) for GDM were 1.00 ( reference ) , 1.55 ( 1.20 , 1.98 ) , 1.43 ( 1.09 , 1.88 ) , 1.40 ( 1.04 , 1.89 ) , and 1.88 ( 1.36 , 2.60 ) ( P-trend = 0.05 ) . Corresponding RRs ( 95 % CIs ) for dietary cholesterol  were 1.00 ( reference ) , 1.08 ( 0.84 , 1.32 ) , 1.02 ( 0.78 , 1.29 ) , 1.20 ( 0.93 , 1.55 ) , and 1.45 ( 1.11 , 1.89 ) ( P-trend = 0.04 ) . The substitution of 5 % of energy from animal fat for an equal percentage of energy from carbohydrates was associated with significantly increased risk of GDM [ RR ( 95 % CI ) : 1.13 ( 1.08 , 1.18 ) ; P < 0.0001 ] . No significant associations were observed between dietary polyunsaturated fat , monounsaturated fat , or trans fat intakes and GDM risk . CONCLUSION Higher prepregnancy intakes of animal fat and cholesterol were associated with elevated GDM risk OBJECTIVE Studies in predominantly non-Hispanic white population s have suggested that physical activity during pregnancy is associated with a reduced risk of gestational diabetes mellitus ( GDM ) . There are few such studies in Hispanic women , a group at increased risk for GDM . METHODS We conducted a prospect i ve cohort study of household/caregiving , occupational , sports/exercise , and active living habits and the risk of GDM among 1006 Hispanic ( predominantly Puerto Rican ) prenatal care patients in western Massachusetts from 2000 to 2004 . Prepregnancy , early pregnancy , and midpregnancy physical activity was assessed using the Kaiser Physical Activity Survey . RESULTS A total of 33 women ( 3.3 % ) were diagnosed with GDM , and 119 women ( 11.8 % ) were diagnosed with abnormal glucose tolerance . There were no significant associations between GDM risk and occupational and active living activities  in prepregnancy , early pregnancy , and midpregnancy or with a change in levels of household/caregiving , occupational , and active living activities from prepregnancy to during pregnancy . However , after controlling for age and prepregnancy body mass index ( BMI ) , women in the highest quartile of prepregnancy ( OR = 0.2 , 95 % CI 0.1 - 0.8 , p(trend ) = 0.03 ) and midpregnancy ( OR = 0.2 , 95 % CI 0.1 - 0.8 , p(trend ) = 0.004 ) household/caregiving activities  as well as midpregnancy sports/exercise ( 0.1 , 95 % CI 0.0 - 0.7 , p(trend ) = 0.12 ) had a reduced risk of GDM compared with women in the lowest quartile . CONCLUSIONS Findings in this Hispanic population , although based on small numbers of cases , are consistent with prior research among predominantly non-Hispanic white population OBJECTIVE Dietary interventions can improve pregnancy outcomes in women with gestational diabetes mellitus ( GDM ) . We compared the effect of a low – glycemic index ( GI ) versus a conventional high-fiber ( HF ) diet on pregnancy outcomes , birth weight z score , and maternal metabolic profile in women at high risk of GDM . RESEARCH DESIGN AND METHODS One hundred thirty-nine women [ mean ( SD ) age 34.7 ( 0.4 ) years and prepregnancy BMI 25.2 ( 0.5 ) kg/m2 ] were r and omly assigned to a low-GI ( LGI ) diet ( n = 72 ; target GI ∼50 ) or a high-fiber , moderate-GI ( HF ) diet ( n = 67 ; target GI ∼60 ) at 14–20 weeks ’ gestation .  Diet was assessed by 3-day food records and infant body composition by air-displacement plethysmography , and pregnancy outcomes were assessed from medical records . RESULTS The LGI group achieved a lower GI than the HF group [ mean ( SD ) 50 ( 5 ) vs. 58 ( 5 ) ; P < 0.001 ] . There were no differences in glycosylated hemoglobin , fructosamine , or lipids at 36 weeks or differences in birth weight [ LGI 3.4 ( 0.4 ) kg vs. HF 3.4 ( 0.5 ) kg ; P = 0.514 ] , birth weight z score [ LGI 0.31 ( 0.90 ) vs. HF 0.24 ( 1.07 ) ; P = 0.697 ] , ponderal index [ LGI 2.71 ( 0.22 ) vs. HF 2.69 ( 0.23 ) kg/m3 ; P = 0.672 ] , birth weight centile [ LGI 46.2 ( 25.4 ) vs. HF 41.8 ( 25.6 ) ; P = 0.330 ] , % fat mass [ LGI 10 ( 4 ) vs. HF 10 ( 4 ) ; P = 0.789 ] , or incidence of GDM . CONCLUSIONS In intensively monitored women at risk for GDM , a low-GI diet and a healthy diet produce similar pregnancy outcomes Study question What is the association between potato consumption before pregnancy and the risk of gestational diabetes mellitus ( GDM )  ? Methods This prospect i ve cohort study included 15 632 women from the Nurses ’ Health Study II ( 1991 - 2001 ) . They had no previous GDM or chronic diseases before pregnancy .  Consumption of potatoes and other foods was assessed every four years . Incident first time GDM was ascertained from self reports of a physician diagnosis of GDM , which was previously vali date d by medical records . Study answer and limitations Over the 10 year follow-up there were 854 incident cases of GDM among 21 693 singleton pregnancies . After adjustment for age , parity , and dietary and non-dietary factors , women who consumed more potatoes before pregnancy had higher rates of developing GDM . Substitution of two servings a week of total potatoes with other vegetables , legumes , and whole grain foods was significantly associated with a 9 - 12 % lower risk of GDM . Consumption and diabetes were self reported , and severity of diabetes was unknown . More than 90 % of women were white . A causal association can not be assumed . What this paper adds Higher levels of potato consumption before pregnancy are associated with greater risk of GDM , and substitution of potatoes with other vegetables , legumes , or whole grain foods might lower the risk . Funding , competing interests , data sharing Funding was received from the Intramural Research Program of the Eunice Kennedy Shriver National Institute of Child Health and Human Development , the National Institutes of Health , and the American Diabetes Association ( No 7 - 12-MN-34 ) . The authors have no competing interests or additional data to share Objective To quantify the association between a combination of healthy lifestyle factors before pregnancy ( healthy body weight , healthy diet , regular exercise , and not smoking ) and the risk of gestational diabetes . Design Prospect i ve cohort study . Setting Nurses ’ Health Study II , United States . Participants 20 136 singleton live births in 14 437 women without chronic disease . Main outcome measure Self reported incident gestational diabetes diagnosed by a physician , vali date d by medical records in a previous study . Results Incident first time gestational diabetes was reported in 823 pregnancies . Each lifestyle factor measured was independently and significantly associated with risk of gestational diabetes . The combination of three low risk factors ( non-smoker , ≥150 minutes a week of moderate to vigorous physical activity , and healthy eating ( top two fifths of Alternate Healthy Eating Index-2010 adherence score ) ) was associated with a 41 % lower risk of gestational diabetes compared with all other pregnancies ( relative risk 0.59 , 95 % confidence interval 0.48 to 0.71 ) . Addition of body mass index ( BMI ) < 25 before pregnancy ( giving a combination of four low risk factors ) was associated with a 52 % lower risk of gestational diabetes compared with all other pregnancies ( relative risk 0.48 , 0.38 to 0.61 ) . Compared with pregnancies in women who did not meet any of the low risk lifestyle factors , those meeting all four criteria had an 83 % lower risk of gestational diabetes ( relative risk 0.17 , 0.12 to 0.25 ) . The population attributable risk percentage of the four risk factors in combination ( smoking , inactivity , overweight , and poor diet ) was 47.5 % ( 95 % confidence interval 35.6 % to 56.6 % ) . A similar population attributable risk percentage ( 49.2 % ) was observed when the distributions of the four low risk factors from the US National Health and Nutrition Examination Survey ( 2007 - 10 ) data were applied to the calculation . Conclusions Adherence to a low risk lifestyle before pregnancy is associated with a low risk of gestational diabetes and could be an effective strategy for the prevention of gestational diabetes OBJECTIVE : To evaluate whether myo-inositol supplementation , an insulin sensitizer , reduces the rate of gestational diabetes mellitus ( GDM ) and lowers insulin resistance in obese pregnant women . METHODS : In an open-label , r and omized trial , myo-inositol ( 2 g plus 200 micrograms folic acid twice a day ) or placebo ( 200 micrograms folic acid twice a day ) was administered from the first trimester to delivery in pregnant obese women ( prepregnancy body mass index 30 or greater . We calculated that 101 women in each arm would be required to demonstrate a 65 % GDM reduction in the  myo-inositol  group with a statistical power of 80 % ( & agr;=0.05 ) . The primary outcomes were the incidence of GDM and the change in insulin resistance from enrollment until the diagnostic oral glucose tolerance test . RESULTS : From January 2011 to April 2014 , 220 pregnant women at 12–13 weeks of gestation were r and omized at two Italian university hospitals , 110 to myo-inositol and 110 to placebo .  Most characteristics were similar between groups . The GDM rate was significantly reduced in the myo-inositol group compared with the control group , 14.0 % compared with 33.6 % , respectively ( P=.001 ; odds ratio 0.34 , 95 % confidence interval 0.17–0.68 ) . Furthermore , women treated with myo-inositol showed a significantly greater reduction in the homeostasis model assessment of insulin resistance compared with the control group , −1.0±3.1 compared with 0.1±1.8 ( P=.048 ) . CONCLUSION : Myo-inositol supplementation , started in the first trimester , in obese pregnant women seems to reduce the incidence in GDM through a reduction of insulin resistance . CLINICAL TRIAL REGISTRATION : Clinical Trials.gov , www . clinical trials.gov , NCT01047982 Background According to current evidence , the prevention of obesity should start early in life . Even the prenatal environment may expose a child to unhealthy weight gain ; maternal gestational diabetes is known to be among the prenatal risk factors conducive to obesity . Here we report the effects of antenatal dietary and physical activity counselling on pregnancy and infant weight gain outcomes . Methods The study was a non-r and omised controlled pragmatic trial aim ing to prevent childhood obesity , the setting being municipal maternity health care clinics . The participants ( n = 185 ) were mothers at risk of developing gestational diabetes mellitus and their offspring . The children of the intervention group mothers were born between 2009 and 2010 , and children of the control group in 2008 . The intervention started between 10–17 gestational weeks and consisted of individual counselling on diet and physical activity by a public health nurse , and two group counselling sessions by a dietician and a physiotherapist .  The expectant mothers also received a written information leaflet to motivate them to breastfeed their offspring for at least 6 months . We report the proportion of mothers with pathological glucose tolerance at 26–28 weeks ’ gestation , the mother ’s gestational weight gain ( GWG ) and newborn anthropometry . Infant weight gain from 0 to 12 months of age was assessed as weight-for-length st and ard deviation scores ( SDS ) and mixed effect linear regression models . Results Intervention group mothers had fewer pathological oral glucose tolerance test results ( 14.6 % vs. 29.2 % ; 95 % CI 8.9 to 23.0 % vs. 20.8 to 39.4 % ; p-value 0.016 ) suggesting that the intervention improved gestational glucose tolerance . Mother ’s GWG , newborn anthropometry or infant weight gain did not differ significantly between the groups . ConclusionS ince the intervention reduced the prevalence of gestational diabetes mellitus , it may have the potential to diminish obesity risk in offspring . However , results from earlier studies suggest that the possible effect on the offspring ’s weight gain may manifest only later in childhood . Trial registration Clinical Trials gov : Diet composition may be a modifiable predictor of risk for  abnormal glucose tolerance during pregnancy . Prior studies suggest that diets high in total fat , saturated fat , red and processed meats , and with high glycaemic load increase the risk of developing gestational diabetes mellitus ( GDM ) , while polyunsaturated fats , carbohydrates and fibre are protective . The aim of this study was to investigate associations of these and other nutrients and foods , including n-3 fatty acids , trans fats , whole grains and dietary patterns , with risk of GDM . We studied 1733 women with singleton pregnancies enrolled in Project Viva , a prospect i ve pregnancy and birth cohort study in eastern MA . Using multinomial logistic regression , we examined associations of first trimester diet , assessed by vali date d food frequency question naire , with results of glucose tolerance testing at 26 - 28 weeks of gestation . A total of 91 women developed GDM and 206 women had impaired glucose tolerance ( IGT ) . Pre-pregnancy body mass index ( BMI ) was a strong predictor for GDM risk ( OR 3.44 [ 95 % CI 1.88 , 6.31 ] for pre-pregnancy BMI > or = 30 vs. < 25 kg/m(2 ) ) . After adjustment for confounders , the OR [ 95 % CI ] for risk of GDM for total dietary fat was 1.00 [ 0.96 , 1.05 ] , for saturated fat 0.98 [ 0.88 , 1.08 ] , for polyunsaturated fat 1.09 [ 0.94 , 1.26 ] , for trans fat 0.87 [ 0.51 , 1.49 ] , and for carbohydrates 1.00 [ 0.96 , 1.03 ] per each 1 % of total energy . The adjusted OR [ 95 % CI ] for risk of GDM for a one st and ard deviation increase in energy-adjusted glycaemic load ( 32 units , about two soft drinks ) was 0.96 [ 0.76 , 1.22 ] and for each daily serving of whole grains was 0.90 [ 0.73 , 1.13 ] . Dietary patterns and intake of red and processed meats were not predictive of glucose tolerance outcome . Estimates for IGT were similar to those for GDM . Intake of n-3 fatty acids was associated with increased GDM risk ( OR 1.11 [ 95 % CI 1.02 , 1.22 ] per each 300 mg/day ) , but not with IGT risk . Except for this finding , perhaps due to chance , these data do not show that nutrient or food intake in early pregnancy is linked to risk of GDM . Nutritional status entering pregnancy , as reflected by pre-pregnancy BMI , is probably more important than pregnancy diet in development of GDM Abstract Objective : To test the hypothesis that dietary myo-inositol may improve insulin resistance and the development of gestational diabetes mellitus ( GDM ) in women at high risk of this disorder . Design : A prospect i ve , r and omized , double-blind , placebo controlled clinical trial , pilot study . Participants : Non-obese singleton pregnant women with an elevated fasting glucose in the first or early second trimester were studied throughout pregnancy . Intervention : Supplementation with myo-inositol or placebo during pregnancy . Main outcome measure : Development of GDM on a 75 g oral glucose tolerance test at 24–28 weeks ’ gestation . Secondary outcome measures were increased in BMI , need for maternal insulin therapy , macrosomia , polyhydramnios , neonatal birthweight and hypoglycemia . Results : Thirty-six women were allocated to receive myo-inositol and 39 placebo .  The incidence of GDM in mid-pregnancy was significantly reduced ( p = 0.001 ) in women r and omized to receive myo-inositol compared to placebo ( relative risk 0.127 ) . Women r and omized to receive myo-inositol also required less insulin therapy , delivered at a later gestational age , had significantly smaller babies with fewer episodes of neonatal hypoglycemia . Conclusions : Myo-inositol supplementation in pregnancy reduced the incidence of GDM in women at high risk of this disorder . The reduction in incidence of GDM in the treatment arm was accompanied by improved outcomes Few studies have explored the relationship between dietary patterns and the risk of gestational diabetes mellitus ( GDM ) .  Evidence from non-Western areas is particularly lacking . In the present study , we aim ed to examine the associations between dietary patterns and the risk of GDM in a Chinese population . A total of 3063 pregnant Chinese women from an ongoing prospect i ve cohort study were included . Data on dietary intake were collected using a FFQ at 24 - 27 weeks of gestation . GDM was diagnosed using a 75 g , 2 h oral glucose tolerance test . Dietary patterns were determined by principal components factor analysis . A log-binomial regression model was used to examine the associations between dietary pattern and the risk of GDM . The analysis identified four dietary patterns : vegetable pattern ; protein-rich pattern ; prudent pattern ; sweets and seafood pattern . Multivariate analysis showed that the highest tertile of the vegetable pattern was associated with a decreased risk of GDM ( relative risk ( RR ) 0·79 , 95 % CI 0·64 , 0·97 ) , compared with the lowest tertile , whereas the highest tertile of the sweets and seafood pattern was associated with an increased risk of GDM ( RR 1·23 , 95 % CI 1·02 , 1·49 ) . No significant association was found for either the protein-rich or the prudent pattern . The protective effect of a high vegetable pattern score was more evident among women who had a family history of diabetes ( P for interaction=0·022 ) . These findings suggest that the vegetable pattern was associated with a decreased risk of GDM , while the sweets and seafood pattern was associated with an increased risk of GDM . These findings may be useful in dietary counselling during pregnancy OBJECTIVE Examine the association of prepregnancy habitual consumption of fruits and fruit juices and  gestational diabetes mellitus ( GDM ) risk .  RESEARCH DESIGN AND METHODS A prospect i ve study among women with at least one singleton pregnancy in the Nurses ’ Health Study II from 1991 to 2001 . RESULTS Among 13,475 women , 860 reported a first diagnosis of GDM .  The adjusted relative risks ( RRs ) for GDM from the lowest to highest quintile of whole fruit consumption were 1.00 ( referent ) , 0.80 ( 95 % CI 0.65–0.98 ) , 0.90 ( 0.73–1.10 ) , 0.80 ( 0.64–1.00 ) , and 0.93 ( 0.76–1.16 ) , respectively . The corresponding RRs for fruit juice were 1.00 , 0.82 ( 0.66–1.01 ) , 0.78 ( 0.63–0.96 ) , 0.84 ( 0.68–1.04 ) , and 1.00 ( 0.81–1.23 ) . CONCLUSIONS These data suggest that prepregnancy higher consumption of whole fruits is not associated with an increased GDM risk . The association between fruit juices and GDM risk appears to be nonlinear OBJECTIVE Consumption of sugar-sweetened beverages ( SSBs ) was related to an elevated risk of type 2 diabetes and insulin resistance in several recent studies among middle- or older-aged population s. Studies on SSB consumption and glucose intolerance among pregnant women , however , are lacking . We therefore examined the association between regular SSB consumption before pregnancy and the risk of gestational diabetes mellitus ( GDM ) . RESEARCH DESIGN AND METHODS This was a prospect i ve study among 13,475 U.S. women who reported at least one singleton pregnancy between 1992 and 2001 in the Nurses ' Health Study II . GDM was self-reported and vali date d by medical record review in a sub sample . Cox proportional hazards models with multivariate adjustments were applied to examine the association of SSB consumption with GDM risk . RESULTS During 10 years of follow-up , 860 incident GDM case subjects were identified . After adjustment for age , parity , race , physical activity , smoking , alcohol intake , prepregnancy BMI , and Western dietary pattern , intake of sugar-sweetened cola was positively associated with the risk of GDM , whereas no significant association was found for other SSBs and diet beverages . Compared with women who consumed < 1 serving/month , those who consumed ≥5 servings/week of sugar-sweetened cola had a 22 % greater GDM risk ( relative risk 1.22 [ 95 % CI 1.01–1.47 ] ) . CONCLUSIONS Findings from this study suggest that prepregnancy higher consumption of sugar-sweetened cola ( ≥5 servings/week ) is associated with an elevated GDM risk , whereas no significant association with GDM risk was observed for other SSBs and diet beverages Aims /hypothesisThe aim of this study was to prospect ively examine whether dietary patterns are related to risk of gestational diabetes mellitus ( GDM ) .  Methods This prospect i ve cohort study included 13,110 women who were free of cardiovascular disease , cancer , type 2 diabetes and history of GDM . Subjects completed a vali date d semi-quantitative food frequency question naire in 1991 , and reported at least one singleton pregnancy between 1992 and 1998 in the Nurses ’ Health Study II . Two major dietary patterns ( i.e. ‘ prudent ’ and ‘ Western ’ ) were identified through factor analysis . The prudent pattern was characterised by a high intake of fruit , green leafy vegetables , poultry and fish , whereas the Western pattern was characterised by high intake of red meat , processed meat , refined grain products , sweets , French fries and pizza . Results We documented 758 incident cases of GDM . After adjustment for age , parity , pre-pregnancy BMI and other covariates , the relative risk ( RR ) of GDM , comparing the highest with the lowest quintile of the Western pattern scores , was 1.63 ( 95 % CI 1.20–2.21 ; ptrend=0.001 ) , whereas the RR comparing the lowest with the highest quintile of the prudent pattern scores was 1.39 ( 95 % CI 1.08–1.80 ; ptrend=0.018 ) . The RR for each increment of one serving/day was 1.61 ( 95 % CI 1.25–2.07 ) for red meat and 1.64 ( 95 % CI 1.13–2.38 ) for processed meat . Conclusions /interpretationThese findings suggest that pre-pregnancy dietary patterns may affect women ’s risk of developing GDM . A diet high in red and processed meat was associated with a significantly elevated risk OBJECTIVE Ways to prevent gestational diabetes mellitus ( GDM ) remain unproven . We compared the impact of three lifestyle interventions ( healthy eating [ HE ] , physical activity [ PA ] , and both HE and PA [ HE+PA ] ) on GDM risk in a pilot multicenter r and omized trial . RESEARCH DESIGN AND METHODS Pregnant women at risk for GDM ( BMI ≥29 kg/m2 ) from nine European countries were invited to undertake a 75-g oral glucose tolerance test before 20 weeks ' gestation . Those without GDM were r and omized to HE , PA , or HE+PA . Women received five face-to-face and four optional telephone coaching sessions , based on the principles of motivational interviewing . A gestational weight gain ( GWG ) < 5 kg was targeted . Coaches received st and ardized training and an intervention toolkit . Primary outcome measures were GWG , fasting glucose , and insulin sensitivity ( HOMA ) at 35–37 weeks . RESULTS Among the 150 trial participants , 32 % developed GDM  by 35–37 weeks and 20 % achieved GWG < 5 kg . HE women had less GWG ( −2.6 kg [ 95 % CI −4.9 , −0.2 ] ; P = 0.03 ) and lower fasting glucose ( −0.3 mmol/L [ −0.4 , −0.1 ] ; P = 0.01 ) than those in the PA group at 24–28 weeks . HOMA was comparable . No significant differences between HE+PA and the other groups were observed . CONCLUSIONS An antenatal HE intervention is associated with less GWG and lower fasting glucose compared with PA alone . These findings require a larger trial for confirmation but support the use of early HE interventions in obese pregnant women Background Gestational diabetes mellitus ( GDM ) is an increasing problem world-wide . Lifestyle interventions and /or vitamin D supplementation might help prevent GDM in some women . Methods / design Pregnant women at risk of GDM ( BMI ≥29 ( kg/m2 ) ) from 9 European countries will be invited to participate and consent obtained before 19 + 6 weeks of gestation . After giving informed consent , women without GDM will be included ( based on IADPSG criteria : fasting glucose<5.1mmol ; 1 hour glucose < 10.0 mmol ; 2 hour glucose < 8.5 mmol ) and r and omized to one of the 8 intervention arms using a 2 × (2 × 2 ) factorial design : ( 1 ) healthy eating ( HE ) , 2 ) physical activity ( PA ) , 3 ) HE+PA , 4 ) control , 5 ) HE+PA+vitamin D , 6 ) HE+PA+placebo , 7 ) vitamin D alone , 8) placebo alone ) , pre-stratified for each site . In total , 880 women will be included with 110 women allocated to each arm . Between entry and 35 weeks of gestation , women allocated to a lifestyle intervention will receive 5 face-to-face , and 4 telephone coaching sessions , based on the principles of motivational interviewing . The lifestyle intervention includes a discussion about the risks of GDM , a weight gain  target < 5 kg and either 7 healthy eating ‘ messages ’ and /or 5 physical activity ‘ messages ’ depending on r and omization . Fidelity is monitored by the use of a personal digital assistance ( PDA ) system . Participants r and omized to the vitamin D intervention receive either 1600 IU vitamin D or placebo for daily intake until delivery . Data is collected at baseline measurement , at 24–28 weeks , 35–37 weeks of gestation and after delivery . Primary outcome measures are gestational weight gain , fasting glucose and insulin sensitivity , with a range of obstetric secondary outcome measures including birth weight . Discussion DALI is a unique Europe-wide r and omised controlled trial , which will gain insight into preventive measures against the development of GDM in overweight and obese women . Trial registration IS RCT BACKGROUND Although obesity in pregnancy continues to be associated with ongoing health problems , many clinicians have been reluctant to place nondiabetic , obese , pregnant women on a monitored , calorie-appropriate nutritional regimen for fear of fetal growth restriction , low birth weight , or starvation ketosis . METHODS A total of 257 patients were enrolled in the r and omized study , with a loss-to-follow-up rate of 9.73 % . Patients were assigned r and omly to either the control ( unmonitored ) group ( n=116 ) , consisting of conventional prenatal dietary management , or to the study ( monitored ) group ( n=116 ) , which was prescribed a balanced nutritional regimen and were asked to record in a diary all of the foods eaten during each day .  Women were eligible for the study if they were pregnant with a single fetus between 12 and 28 weeks of gestation and had a prepregnancy body mass index of more than 30 kg/m2 . The primary outcome was to compare perinatal outcomes in the control vs the study groups . The secondary measure was to compare outcomes in adherent and nonadherent patients in the study group . RESULTS Omnibus MANOVA showed statistically significant differences between the study and control groups regarding 3 variables : ( 1 ) gestational hypertension , p < .46 ; ( 2 ) mother 's last weight before delivery , p < .001 ; and ( 3 ) mother 's 6-week postpartum weight , p < .001 . Patients gaining 15 pounds or more during their pregnancy showed statistically significant differences between the groups for 8 variables . CONCLUSION Obese pregnant women may be placed on a healthy , well-balanced , monitored nutritional program during their antepartum course without adverse perinatal outcomes Objective To investigate the possible association between total daily iron intake during pregnancy , haemoglobin in early pregnancy and the risk of gestational diabetes mellitus ( GDM ) in women at increased risk of GDM . Design A prospect i ve cohort study ( based on a cluster-r and omised controlled trial , where the intervention and the usual care groups were combined ) . Setting Primary healthcare maternity clinics in 14 municipalities in south-western Finl and . Participants 399 Pregnant women who were at increased risk of GDM participated in a GDM prevention trial and were followed throughout pregnancy . Main outcome measurements The main outcome was GDM diagnosed with oral glucose tolerance test at 26–28 weeks ’ gestation or based on a diagnosis recorded in the Finnish Medical Birth registry . Data on  iron intake was collected using a 181-item food frequency question naire and separate questions for supplement use at 26–28 weeks ’ gestation . Results  GDM was diagnosed in 72 women ( 18.1 % ) in the study population . The OR for total iron intake as a continuous variable was 1.006 ( 95 % CI 1.000 to 1.011 ; p=0.038 ) after adjustment for body mass index , age , diabetes in first-degree or second-degree relatives , GDM or macrosomia in earlier pregnancy , total energy intake , dietary fibre , saturated fatty acids and total gestational weight gain . Women in the highest fifth of total daily iron intake had an adjusted OR of 1.66 ( 95 % CI 0.84 to 3.30 ; p=0.15 ) for GDM . After excluding participants with low haemoglobin levels ( ≤120 g/l ) already in early pregnancy the adjusted OR was 2.35 ( 95 % CI 1.13 to 4.92 ; p=0.023 ) . Conclusions Our results suggest that high iron intake during pregnancy increases the risk of GDM especially in women who are not anaemic in early pregnancy and who are at increased risk of GDM . These findings suggest that routine iron supplementation should be reconsidered in this risk group of women Observational studies suggest that high iron intake during pregnancy is associated with the risk of  gestational diabetes .  As such studies are prone to bias , we re-analysed data from a r and omised controlled trial of iron supplementation to see whether it supports the risk found in observational studies . The trial was conducted in primary health care setting in five municipalities in Finl and in 1985 - 1986 . The participants were 2944 women ( 95 % of pregnant women in the area ) who were r and omly allocated either to ( 1 ) the selective iron group ( elemental iron 50 mg twice a day only if diagnosed as anaemic , continuing until their haemoglobin increased to 110 g L(-1 ) ) or ( 2 ) the routine iron group ( elemental iron 100 mg day(-1 ) throughout the pregnancy regardless of haemoglobin level ) . The numbers of women in the analyses were 1358 and 1336 , respectively . The main outcome measure was a composite variable including any glucose intolerance-related outcome ( e.g. glucosuria , gestational diabetes , large-for-gestational-age child ) in mothers ' or children 's patient records during pregnancy and post-partum . There were no statistically significant differences in the incidence of the primary outcome between the selective iron and the routine iron groups ( 13.0 vs. 11.0 % , P = 0.12 ) . The most common outcome was large-for-gestational-age calculated from children 's hospital data ( 8.3 vs. 8.2 % , P = 0.95 ) . The results were mainly similar when stratified by the mothers ' baseline haemoglobin level , body mass index or gestational weight gain . Routine iron supplementation throughout pregnancy did not increase the risk of glucose intolerance during pregnancy . The results need to be confirmed in future trials Background : Antioxidants , particularly vitamin C ( ascorbic acid ) , have the capacity to influence glucose tolerance . Modification of diet could reduce the likelihood of developing gestational diabetes mellitus . Methods : In a prospect i ve cohort study of pregnant women , we studied the association of maternal plasma ascorbic acid concentrations , measured at an average of 13 weeks ’ gestation , with subsequent risk of gestational diabetes . Maternal plasma ascorbic acid concentrations were determined using automated enzymatic procedures . Dietary vitamin C intake during the periconceptional period and early pregnancy was ascertained using a semiquantitative food frequency question naire . We fitted generalized linear models to derive estimates of relative risks and 95 % confidence intervals ( CIs ) . Results : Approximately 4 % ( n = 33 ) of 755 women who completed pregnancy developed gestational diabetes mellitus . Plasma ascorbic acid concentrations were inversely associated with the risk of gestational diabetes ( P for trend = 0.023 ) . After adjusting for maternal age , race , prepregnancy adiposity , parity , family history of type 2 diabetes , and household income , women with plasma ascorbic acid < 55.9 μmol/L ( lowest quartile ) experienced a 3.1-fold increased risk of gestational diabetes ( 95 % CI = 1.0–9.7 ) compared with women whose concentrations were ≥74.6 μmol/L ( upper quartile ) . Women who consumed < 70 mg vitamin C daily experienced a 1.8-fold increased risk of gestational diabetes compared with women who consumed higher amounts ( 95 % CI = 0.8–4.4 ) . Conclusions : If confirmed , our results raise the possibility that current efforts to encourage population s to consume diets rich in antioxidants , including vitamin C , could reduce the occurrence of gestational diabetes mellitus Aims /hypothesisFried foods are frequently consumed in Western countries . However , the health effects of frequent fried food consumption in humans are not well understood . We aim ed to prospect ively examine the association between pre-pregnancy  fried food consumption and risk of incident gestational diabetes mellitus ( GDM ) . Methods We included 21,079 singleton pregnancies from 15,027 women in the Nurses ' Health Study II cohort . Since 1991 and every 4 years thereafter , we collected diet information , including consumption of fried foods at home and away from home , using a vali date d food frequency question naire . We used generalised estimating equations with log-binomial models to estimate the RRs and 95 % CIs . Results We documented 847 incident GDM pregnancies during 10 years of follow-up . After adjustment for age , parity , dietary and non-dietary factors , the RRs ( 95 % CIs ) of GDM among women who consumed total fried foods 1–3 , 4–6 and ≥7 times/week , compared with those who consumed it less than once/week , were 1.13 ( 0.97 , 1.32 ) , 1.31 ( 1.08 , 1.59 ) and 2.18 ( 1.53 , 3.09 ) , respectively ( p for trend < 0.001 ) . The association persisted after further adjustment for BMI ( p for trend = 0.01 ) . When analysed separately , we found a significant association of GDM  with fried food consumption away from home , but not with fried food consumption at home . Conclusions /interpretationFrequent fried food consumption , particularly away from home , was significantly associated with a greater risk of incident GDM . Our study indicates potential benefits of limiting fried food consumption in the prevention of GDM in women of reproductive age BACKGROUND Obese women with polycystic ovary syndrome ( PCOS ) manifest impaired insulin-stimulated release of a d-chiro-inositol-containing inositolphosphoglycan ( DCI-IPG ) insulin mediator during oral glucose tolerance testing ( OGTT ) , which appears to be restored by the administration of metformin . This suggests that either obesity or PCOS is associated with a defect in the coupling of the stimulation of the insulin receptor by insulin to the release of the DCI-IPG mediator . The objective of this study was to compare the release of bioactive DCI-IPG between normal nonobese women and obese PCOS women during stimulation with two different concentrations of insulin when glucose levels are clamped . METHODS We performed a cross-sectional case-control study at the clinical research center of an academic medical center . A two-step euglycemic-hyperinsulinemic clamp was carried out in 8 nonobese normal and 8 obese PCOS women , during which DCI-IPG bioactivity was monitored . RESULTS At baseline , PCOS women were significantly more obese , hyperinsulinemic , and insulin resistant than the controls . During the clamp studies , DCI-IPG bioactivity increased significantly over the first 45 min of the low-insulin step of the clamp in normal nonobese women ( P = 0.046 ) and then decreased to baseline levels ; DCI-IPG increased again after initiation of the high-insulin step ( P = 0.029 ) . Despite higher insulin levels during the clamp in PCOS women , DCI-IPG bioactivity remained flat throughout both insulin steps and was thus significantly lower than in controls during the initial periods of both steps . CONCLUSIONS The coupling between insulin action and the release of the DCI-IPG mediator is selectively impaired in obese PCOS women , which may contribute to the insulin resistance in these women OBJECTIVE To assess whether gestational diabetes mellitus ( GDM ) can be prevented by a moderate lifestyle intervention in pregnant women who are at high risk for the disease . RESEARCH DESIGN AND METHODS Two hundred ninety-three women with a history of GDM and /or a prepregnancy BMI of ≥30 kg/m2 were enrolled in the study at < 20 weeks of gestation and were r and omly allocated to the intervention group ( n = 155 ) or the control group ( n = 138 ) . Each subject in the intervention group received individualized counseling on diet , physical activity , and weight control from trained study nurses , and had one group meeting with a dietitian . The control group received st and ard antenatal care . The diagnosis of GDM was based on a 75-g , 2-h oral glucose tolerance test at 24–28 weeks of gestation . RESULTS A total of 269 women were included in the analyses .  The incidence of GDM was 13.9 % in the intervention group and 21.6 % in the control group ( [ 95 % CI 0.40–0.98 % ] ; P = 0.044 , after adjustment for age , prepregnancy BMI , previous GDM status , and the number of weeks of gestation ) . Gestational weight gain was lower in the intervention group ( −0.58 kg [ 95 % CI −1.12 to −0.04 kg ] ; adjusted P = 0.037 ) . Women in the intervention group increased their leisure time physical activity more and improved their dietary quality compared with women in the control group . CONCLUSIONS A moderate individualized lifestyle intervention reduced the incidence of GDM by 39 % in high-risk pregnant women . These findings may have major health consequences for both the mother and the child BACKGROUND Low-carbohydrate diets ( LCDs ) have been vastly popular for weight loss . The association between a low-carbohydrate dietary pattern and risk of  gestational diabetes mellitus ( GDM )  remains unknown . OBJECTIVE We aim ed to prospect ively examine the association of 3  prepregnancy low-carbohydrate dietary patterns with risk of GDM . DESIGN We included 21,411 singleton pregnancies in the Nurses ' Health Study II . Prepregnancy LCD scores were calculated from vali date d food-frequency question naires , including an overall LCD score on the basis of intakes of carbohydrate , total protein , and total fat ; an animal LCD score on the basis of intakes of carbohydrate , animal protein , and animal fat ; and a vegetable LCD score on the basis of intakes of carbohydrate , vegetable protein , and vegetable fat . A higher score reflected a higher intake of fat and protein and a lower intake of carbohydrate , and it indicated closer adherence to a low-carbohydrate dietary pattern . RRs and 95 % CIs were estimated by using generalized estimating equations with log-binomial models . RESULTS We documented 867 incident GDM pregnancies during 10 y follow-up . Multivariable-adjusted RRs ( 95 % CIs ) of GDM for comparisons of highest with lowest quartiles were 1.27 ( 1.06 , 1.51 ) for the overall LCD score ( P-trend = 0.03 ) , 1.36 ( 1.13 , 1.64 ) for the animal LCD score ( P-trend = 0.003 ) , and 0.84 ( 0.69 , 1.03 ) for the vegetable LCD score ( P-trend = 0.08 ) . Associations between LCD scores and GDM risk were not significantly modified by age , parity , family history of diabetes , physical activity , or overweight status . CONCLUSIONS A prepregnancy low-carbohydrate dietary pattern with high protein and fat from animal-food sources is positively associated with GDM risk , whereas a prepregnancy low-carbohydrate dietary pattern with high protein and fat from vegetable food sources is not associated with the risk . Women of reproductive age who follow a low-carbohydrate dietary pattern may consider consuming vegetable rather than animal sources of protein and fat to minimize their risk of GDM 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 In a cluster-r and omized trial , Riitta Luoto and colleagues find that counseling on diet and activity can reduce the birthweight of babies born to women at risk of developing  gestational diabetes mellitus ( GDM  ) , but fail to find an effect on GDM
Background Gestational diabetes mellitus ( GDM ) , defined as any degree of glucose intolerance with onset during pregnancy , is increasing worldwide , mostly because obesity among women of reproductive age is continuously escalating .
GDM is associated with adverse maternal and fetal outcomes .
The aim of this article was to systematic ally review literature on the effectiveness of nutritional factors before or during pregnancy to prevent GDM .
Methods We assessed the primary prevention of GDM through nutritional factors , as diet and supplements .