A Medical Nutrition Therapy Program Improves Perinatal Outcomes in Mexican Pregnant Women With Gestational Diabetes and Type 2 Diabetes Mellitus Estudio Parto: postpartum diabetes prevention program for hispanic women with abnormal glucose tolerance in pregnancy: a randomised controlled trial – study protocol A Low Glycemic Index Staple Diet Reduces Postprandial Glucose Values in Asian Women With Gestational Diabetes Mellitus Identification of those most likely to benefit from a low-glycaemic index dietary intervention in pregnancy. [Adherence to a medical nutrition therapy program in pregnant women with diabetes, measured by three methods, and its association with glycemic control]. Effect of a low glycaemic index diet on blood glucose in women with gestational hyperglycaemia. Pregnancy and Glycemic Index Outcomes study: effects of low glycemic index compared with conventional dietary advice on selected pregnancy outcomes. A community-based parish nurse intervention program for Mexican American women with gestational diabetes.
Diabetes in pregnancy is a major public health problem in Mexico .  Nutrition therapy is an important component of treatment . Intensive nutrition intervention has not been implemented for Mexican pregnant women with diabetes . Its effect on different types of diabetes mellitus has not been studied . Purpose The authors assessed the effect of a medical nutrition therapy ( MNT ) program on perinatal complications in Mexico City . Methods Quasi-experimental design with a historical control . Women were assigned to a MNT program ( n = 88 ) and were followed up with every 2 weeks until delivery ( 2004 - 2007 ) . The control group ( n = 86 ) was selected from medical charts ( 2001 - 2003 ) and the same inclusion criteria were used . In each group , 55 % of women had type 2 diabetes mellitus and 45 % had gestational diabetes . The MNT program included a moderate intake of carbohydrate ( 40%-45 % of total energy ) and reduction in energy intake , capillary glucose self-monitoring , and education . The control group received usual hospital routine care . Statistical analysis included descriptive statistics , chi-square , and multivariate logistic regression ( OR , 95 % CI ) as indicated . Results Women in the MNT program had a lower risk of preeclampsia , fewer maternal hospitalization , and neonatal deaths in both types of diabetes . Low birth weight was less frequent only in women with gestational diabetes receiving MNT , while neonatal intensive care unit admissions were lower only in women with type 2 diabetes . Conclusions An intensive MNT program , including counseling , education , and capillary glucose self-monitoring , has a positive effect over preeclampsia , maternal hospitalization , and neonatal death in women with diabetes in pregnancy . MNT guidelines should be implemented in Mexican health care facilities treating diabetes in pregnancy Background Diabetes and obesity have reached epidemic proportions in the U.S. with rates consistently higher among Hispanics as compared to non-Hispanic whites . Among Hispanic women diagnosed with gestational diabetes mellitus ( GDM ) , 50 % will go on to develop type 2 diabetes within 5 years of the index pregnancy . Although r and omised controlled trials among adults with impaired glucose tolerance have shown that diet and physical activity reduce the risk of type 2 diabetes , such programs have not been tested in high-risk postpartum women . The overall goal of this r and omised controlled trial is to test the efficacy of a culturally and linguistically modified , individually-tailored lifestyle intervention to reduce risk factors for type 2 diabetes and cardiovascular disease among postpartum Hispanic women with a history of abnormal glucose tolerance during pregnancy . Methods / Design Hispanic pregnant women who screen positive for GDM will be recruited and r and omly assigned to a Lifestyle Intervention ( n = 150 ) or a Health & Wellness ( control ) Intervention ( n = 150 ) . Multimodal contacts ( i.e. , in-person , telephone , and mailed material s ) will be used to deliver the intervention from late pregnancy ( 29 weeks gestation ) to 12 months postpartum . Targets of the intervention are to achieve Institute of Medicine Guidelines for postpartum weight loss ; American Congress of Obstetrician and Gynecologist guidelines for physical activity ; and American Diabetes Association guidelines for diet . The intervention draws from Social Cognitive Theory and the Transtheoretical Model and addresses the specific cultural and environmental challenges faced by low-income Hispanic women . Assessment s will be conducted at enrollment , and at 6-weeks , 6-months , and 12-months postpartum by trained bicultural and bilingual personnel blinded to the intervention arm . Efficacy will be assessed via postpartum weight loss and biomarkers of insulin resistance and cardiovascular risk . Changes in physical activity and diet will be measured via 7-day actigraph data and three unannounced 24-hour dietary recalls at each assessment time period . Discussion Hispanic women are the fastest growing minority group in the U.S. and have the highest rates of sedentary behavior and postpartum diabetes after a diagnosis of GDM . This r and omised trial uses a high-reach , low-cost strategy that can readily be translated into clinical practice in underserved and minority population s . Trial registration Background A low glycemic index ( GI ) diet is beneficial for glucose control in patients with diabetes mellitus . This study aim ed to investigate the influence of a low-GI diet on postpr and ial glucose levels in women with gestational diabetes mellitus ( GDM ) . Methods Pregnant women with GDM were r and omized to receive a normal diabetic control diet or a low-GI staple diet for 5 days . A low-GI staple food was used to replace rice in lunch and dinner for the low-GI staple diet group , whereas the total energy and carbohydrate levels remained equal in both groups . Fasting and postpr and ial glucose levels were determined daily . Results A total of 140 pregnant women with GDM were included in the study , including 66 in the low-GI staple diet group and 74 in the normal diabetic diet control group . No differences existed in baseline characteristics between the 2 groups ( all P > 0.05 ) . After dietary intervention , glucose levels were significantly reduced in the low-GI staple diet group ( all P < 0.01 ) and the control group ( all P < 0.008 ) . Postintervention glucose values after breakfast , lunch , and dinner were significantly reduced in the treatment group compared with those in the control group ( all P < 0.05 ) . The percentage changes from baseline of all glucose values were significantly greater in the treatment group than in the control group ( all P < 0.05 ) . Conclusions A low-GI staple diet significantly reduces postpr and ial glucose levels in women with GDM The present study is a secondary analysis of the ROLO study , a r and omised control trial of a low-glycaemic index ( GI ) diet in pregnancy to prevent the recurrence of fetal macrosomia . The objectives of the present study were to identify which women are most likely to respond to a low-GI dietary intervention in pregnancy with respect to three outcome measures : birth weight ; maternal glucose intolerance ; gestational weight gain ( GWG ) . In early pregnancy , 372 women had their mid-upper arm circumference recorded and BMI calculated . Concentrations of glucose , insulin and leptin were measured in early pregnancy and at 28 weeks . At delivery , infant birth weight was recorded and fetal glucose , C-peptide and leptin concentrations were measured in the cord blood . Women who benefited in terms of infant birth weight were shorter , with a lower education level . Those who maintained weight gain within the GWG guidelines were less overweight in both their first and second pregnancies , with no difference being observed in maternal height . Women who at 28 weeks of gestation developed glucose intolerance , despite the low-GI diet , had a higher BMI and higher glucose concentrations in early pregnancy with more insulin resistance . They also had significantly higher-interval pregnancy weight gain . For each analysis , women who responded to the intervention had lower leptin concentrations in early pregnancy than those who did not . These findings suggest that the maternal metabolic environment in early pregnancy is important in determining later risks of excessive weight gain and metabolic disturbance , whereas birth weight is mediated more by genetic factors . It highlights key areas , which warrant further interrogation before future pregnancy intervention studies , in particular , maternal education level and inter-pregnancy weight gain INTRODUCTION The measurement of adherence to nutrition therapy is essential to evaluate if the outcomes are related to given recommendations . MATERIAL AND METHODS The aim of this study was to describe adherence to a Medical Nutrition Therapy Program in Mexican pregnant women with diabetes , using three different methods ; and evaluate its association with glycemic control . Adherence was measured with a question naire ( 0 - 100 % ) , women 's self-perception ( 0 - 100 % ) and energy intake adequacy by multiple pass 24 hour recall ( 85 - 115 % of recommendation ) . Women were r and omly assigned to two different dietary strategies .  Glycemic control was determined by capillary glucose self-monitoring . RESULTS Women analyzed in this study ( n=69 ) had an age range of 22 - 42 years ; 47.8 % had type 2 diabetes ( DM2 ) and 52.2 % had gestational diabetes ( GDM ) .  Energy intake adequacy was higher in women with GDM ( 41.9 % vs. 37.7 % , p = 0.001 ) . Average adherence measured with the question naire was 55 % ; no differences were found by type of diabetes . Self-perception was higher in women with DM2 ( 84 % ) when compared to women with GDM ( 70 % ) ( p = 0.039 ) . No differences were found in the three methods by study group . Optimal glycemic control was observed in 50 % of women ; no association was found with adherence measured with any of the three methods studied . CONCLUSIONS The observed differences in adherences suggest that it may be recommendable to combine different measurement methods and include social and psychological factors that affect behavioral change AIM The objectives of this pilot study were to determine the feasibility and effect on glycaemic control of a low-glycaemic-index ( GI ) diet in women with gestational diabetes or impaired glucose tolerance of pregnancy . METHODS participants , recruited from the Diabetes-in-Pregnancy Clinic of an inner-city teaching hospital serving a predominantly non-Caucasian population , were r and omized to a low-GI ( n=23 ) or control ( n=24 ) diet and followed from 28 weeks gestation until delivery .  Self-monitored-blood-glucose ( SMBG ) , maternal and infant weight were collected from medical charts .  Dietary intakes were assessed using diet records and question naires . RESULTS diet GI on control ( 58 , 95 % CI : 56,60 ) was significantly higher than on low-GI ( 49 , 95 % CI : 47,51 ; p=0.001 ) . Glycaemic control improved on both diets , but more postpr and ial glucose values were within target on low-GI ( 58.4 % of n=1891 ) than control ( 48.7 % of n=1834 ; p<0.001 ) . SMBG post-breakfast was directly related to pre-pregnancy BMI in the control , but not the low-GI group ( BMI * diet interaction ; p=0.021 ) . Participants accepted the study foods and were willing to consume them post-intervention . CONCLUSIONS a low-GI diet was feasible and acceptable in this sample and facilitated control of postpr and ial glucose . A larger study is needed to determine the effect of a low-GI diet on maternal and infant outcomes BACKGROUND Eating carbohydrate foods with a high glycemic index ( GI ) has been postulated to result in fetoplacental overgrowth and higher infant body fat . A diet with a low glycemic index ( LGI ) has been shown to reduce birth percentiles and the ponderal index ( PI ) . OBJECTIVES We investigated whether offering LGI dietary advice at the first antenatal visit would result in a lower fetal birth weight , birth percentile , and PI than providing healthy eating ( HE ) advice . This advice had to be presented within the re sources of routine antenatal care . DESIGN The Pregnancy and Glycemic Index Outcomes study was a 2-arm , parallel- design , r and omized , controlled trial that compared the effects of LGI dietary advice with HE advice on pregnancy outcomes . Eligible volunteers who attended for routine antenatal care at < 20 wk of gestation were r and omly assigned to either group . RESULTS A total of 691 women were enrolled , and 576 women had final data considered . In the LGI group , the GI was reduced from a mean ( ± SEM ) of 56 ± 0.3 at enrollment to 52 ± 0.3 ( P < 0.001 ) at the final assessment . There were no significant differences in primary outcomes of fetal birth weight , birth percentile , or PI . In a multivariate regression analysis , the glycemic load was the only significant dietary predictor ( P = 0.046 ) of primary outcomes but explained < 1 % of all variation . CONCLUSION A low-intensity dietary intervention with an LGI diet compared with an HE diet in pregnancy did not result in any significant differences in birth weight , fetal percentile , or PI OBJECTIVE To examine the effects of a Parish Nurse Intervention Program ( PNIP ) on maternal health behaviors , glycemic control , and neonatal outcomes among Mexican American women with gestational diabetes . DESIGN A r and omized controlled trial comparing care as usual ( CAU ) with a supplementary 1-hour education session for diabetes education reinforcement by a Parish Nurse . SETTING An outpatient treatment clinic for gestational diabetes within a 250-bed tertiary care , non-profit hospital with a Parish Nurse partnership . PARTICIPANTS One hundred Mexican American women were included in the study with r and omization into Parish Nurse Intervention Program ( n=49 ) and care as usual ( n=51 ) groups . MAIN OUTCOME MEASURES The Health Promoting Lifestyle Profile II ( HPLP II ) and two measures of glycemic control pre- and post-intervention , as well as newborn size , and days of maternal and neonatal hospitalization . RESULTS Outcomes indicate significantly improved Health Promoting Lifestyle Profile II scores in the Parish Nurse Intervention Program group post-intervention compared with the Care As Usual group . No significant differences between groups regarding glycemic control , macrosomia , or days of maternal or neonatal hospitalization were found . CONCLUSIONS A Parish Nurse Intervention Program for pregnant women of Mexican descent with gestational diabetes is effective in leading to improved self-reported health promoting behaviors
BACKGROUND AND OBJECTIVE Gestational Diabetes Mellitus ( GDM ) is a serious health concern for pregnant women , with Hispanic women at particular risk for developing the condition .
The aim of this review was to critically examine GDM intervention programs for Hispanic women , in the United States of America ( US ) .