4. Discussion
vision of eating habits, diabetes mellitus, prediabetes, MetS, GDM, T2DM, pregestational obesity
ADVERSE EVENTS, DIABETES MELLITUS, PREDIABETES, GDM, MISCARRIAGES
A MedDiet-based nutritional intervention enriched with EVOO and nuts implemented early in pregnancy (before the 12th GW) and maintained throughout the postpartum period in the IG women was accompanied by a higher MEDAS score, which was in turn associated with lower rates of AGR and MetS at 3 years postdelivery compared with the CG women who initiated the intervention after delivery. Women in the IG presented more risk factors for the development of AGR and MetS, such as older age and a more frequent history of gestational adverse events (miscarriages and/or diagnosis of GDM). Despite these factors, the rates of AGR and/or MetS were lower. This fact reinforces the importance of starting the nutritional intervention as early as possible during pregnancy to reduce the possibility of an unfavorable postnatal metabolic impact. The response rate to postnatal follow-up was about 60% of the participants, as expected, indicating the difficulty in carrying out postnatal follow-up as recommended by all scientific societies.A recent systematic review also highlighted that lifestyle and nutritional interventions maintained in the postpartum period can induce changes in glucose regulation [Considering the specific cut-off points to determine each of the MetS and/or AGR components, GDM emerged as the main risk factor associated with MetS and AGR development at 3 years postpartum. Although the rates of MetS and AGR were substantially reduced when comparing prior studies [Other established risk factors, such as Hispanic ethnicity, maternal age, pregestational obesity, and a prior history of GDM or family history of T2DM, were also considered in the current study. In this analysis, only the Hispanic race was found to be associated with a higher rate of MetS and AGR at 3 years postpartum. Previous studies have shown a higher risk of the development of GDM in Hispanic women compared with Caucasian women, as well as postpartum AGR or MetS. Similarly, a family history of diabetes mellitus has also been found to increase the risk of postpartum prediabetes in women with a diagnosis of GDM [This study has certain limitations. First, the differences in relation to the MEDAS score between the IG and CG were small, since MedDiet-based nutritional recommendations were provided to both groups (similarly, supplementation or restriction in the consumption of nuts and EVOO). Thus, small or absent differences in the questionnaire scores were to be expected. Secondly, the IG was larger than the CG. Moreover, IG women were older and had more previous adverse events; thus, worse outcomes could be expected in the IG, whereas the results indicated the opposite, further supporting the benefits of the nutritional intervention. Lastly, semiquantitative questionnaires may not always be accurate in terms of the responses obtained. However, they are validated, are the instruments most frequently used to obtain a vision of eating habits, and are always applied by specialized professionals to minimize bias. The greatest strength of our study lies in the study of both populations, NGT women and those with GDM, since most studies only evaluate nutritional intervention in women who have developed GDM.