Discussion
T1DM, cardiovascular disease, TohdiniThe, GDM, Diabetes, diabetes
HIGH-RISK PREGNANCIES, CARDIOVASCULAR DISEASE, GDM, DIABETES, HYPERTENSIVE DISORDER, OXIDATIVE STRESS, HYPERTENSION, DIABETES
No differences between the group that received the standard diet and the group that received the adapted DASH diet were observed for the incidence of PE during the intervention. DDG showed an increase in serum concentrations of glutathione peroxidase and both diets contributed to a reduction of glycated haemoglobin. As the authors are unaware of any previous research evaluating the effect of the DASH diet on pregnant women with PDM, the discussion draws on the findings of studies with pregnant women with some other risk factors for PE.The incidence of total PE in this study was 17⋅7 %. According to Persson In the present study, the adapted DASH diet was not associated with any improvement in blood pressure or incidence of PE, which corroborates the findings of Fulay Studies have found that women with DM and PE have higher serum glycated haemoglobin concentrations during pregnancyThe adapted DASH diet in this study had no effect on serum lipid concentrations, unlike in the women with GDM studied by Asemi Regarding the oxidative stress marker, the DDG group had increased glutathione peroxidase and a tendency to reduce levels of the inflammatory marker CRP, which suggests improved control of oxidative stress. According to Taravati and TohdiniThe nutritional intake of the women on the DASH diet described by Asemi Interestingly, the food intake of the research participants from both groups met the Brazilian Diabetes Society recommendationsThe modest findings of this research could be attributable to the difference between the metabolic conditions of the population under study and pregnant women with GDM or hypertensive disorders and the variations in dietary adherence observed in both groups throughout the study, resulting in a similar nutritional intake, not to mention the influence of Brazilian dietary habits. Further, both groups received prenatal care at a referral hospital for mid- to high-risk pregnancies from a multidisciplinary team which involved regular medical appointments and a minimum of six prenatal appointments with a nutritionist, meaning that both study groups were given guidance in line with the dietary recommendations of the Brazilian Society of Diabetes.To date, no studies have verified the effect of the DASH diet on the prevention of PE in pregnant women with PDM, making this research unique in its scope. One limitation was the sample size, which was not large enough to ascertain the effects of the DASH diet and the fact that a private laboratory outside the study site was used to collect the blood for the analysis of the biochemical parameters, constituting a difficulty in obtaining more samples for analysis. Furthermore, the study period coincided with the COVID-19 pandemic, which meant data collection had to be interrupted due to the need for social isolation. The population of pregnant women with PDM is very heterogeneous concerning the type of diabetes and the presence of comorbidities, so it was not possible to conduct separate analyses for the women with T1DM and T2DM.The adoption of the standard diet or adapted DASH diet, together with multidisciplinary prenatal care, seems to have resulted in adequate glycaemic control, with no difference in the incidence of PE, considering partial adherence to diets. Nonetheless, the adapted DASH diet seems to favour biochemical markers related to oxidative stress, which are associated with the development of PE. This finding suggests that the adapted DASH diet may be an option for pregnant women with PDM who have other risk factors for cardiovascular disease in addition to chronic hypertension. However, further studies are needed with larger sample sizes to confirm these results.