The effects of a combined intervention (docosahexaenoic acid supplementation and home-based dietary counseling) on metabolic control in obese and overweight pregnant women: the MIGHT study.

BACKGROUND: Lifestyle interventions have shown limited effectiveness in the prevention of gestational diabetes mellitus. The combination of lifestyle interventions with omega-3 polyunsaturated fatty acid supplementation could have a synergetic effect on maternal and offspring outcomes. OBJECTIVE: We evaluated the effects of docosahexaenoic acid supplementation among obese and overweight pregnant women (independently or combined with a dietary counseling intervention) on metabolic control in mothers and their offspring. STUDY DESIGN: This study was a randomized controlled trial with a 2×2 factorial design. The following inclusion criteria were used: <15 weeks of gestation; body mass index ≥25 kg/m2 at the first prenatal visit; singleton pregnancy; and 18 years of age or older. The recruited women (n=1002) were randomly allocated to 1 of the 4 parallel groups: Group 1: dietary counseling plus 800 mg/day of docosahexaenoic acid (n=250); Group 2: routine counseling plus 800 mg/day docosahexaenoic acid (n=252); Group 3: dietary counseling plus 200 mg/day docosahexaenoic acid (n=249); and Group 4: routine counseling plus 200 mg/day docosahexaenoic acid (n=251), considered as the reference group. The dietary intervention comprised 3 sessions, and it was focused on reducing the consumption of foods that most contributed to daily sugar intake. Primary outcomes were gestational diabetes mellitus defined according to the national guidelines; macrosomia (birthweight >4000 g); and neonatal insulin resistance (cord blood Homeostasis Model Assessment for Insulin Resistance ≥2.60), which was assessed in a subsample of 226 newborns. The analysis was by intention to treat and by efficacy. The trial was registered on ClinicalTrials.gov (NCT02574767). RESULTS: The overall incidence of gestational diabetes mellitus was 20.2% (Group 1, 21.0%; Group 2, 20.1%; Group 3, 18.9%; and Group 4, 20.9%). Mean birthweight was 3403.0 g (standard deviation, 575.3), and the incidence of macrosomia was 11.9% (Group 1, 13.2%; Group 2, 10.8%; Group 3, 11.5%; and Group 4, 12.1%). Median cord blood Homeostasis Model Assessment for Insulin Resistance was 0.9 (interquartile range, 0.6-1.7), and 10.2% showed cord blood insulin resistance (Group 1, 12.0%; Group 2, 12.0%; Group 3, 9.7%; and Group 4, 5.1%). No significant differences were found among groups regarding primary outcomes (P<.05). Glucose concentrations in the cord blood samples were lower in those adherents to the docosahexaenoic acid supplementation (P<.05). CONCLUSION: For women who were overweight or obese at the beginning of pregnancy, this combined intervention did not reduce the risk of gestational diabetes in mothers or macrosomia and insulin resistance in neonates.

Evaluation of the Stability of Fatty Acids in Erythrocytes from Human Umbilical Cord.

The interest in the amount of polyunsaturated fatty acids (PUFA) in the umbilical cord blood (UCB) is increasing, but the stability of erythrocyte PUFA in these samples during storage and washing of the erythrocytes has not been directly evaluated. The purpose of this study was to analyze the effect of the lapse of time on the fatty acid (FA) content from UCB sample collection and maintained at 4 °C (0-12 h) until erythrocyte separation and washing. Palmitic acid (16:0), stearic acid (18:0), 18:1n-7/n-9, linoleic acid (18:2n-6), arachidonic acid (20:4n-6), 22:4n-6, eicosapentaenoic acid (20:5n-3), docosapentaenoic acid (22:5n-3), and docosahexaenoic acid (22:6n-3) together accounted for 87% of the FA profile in the umbilical vein erythrocytes. No difference was observed in the concentration of any of the FA studied, nor in the sum of saturated fatty acids (SFA), PUFA, or LC-PUFA in umbilical erythrocytes obtained at delivery and stored up to 12 h before the separation of erythrocytes. However, if a washing step was included in the processing of the erythrocytes, a decrease in the concentration of 16:0, 18:0, 18:3n-3, 20:4n-6, 22:4n-6, total SFA, PUFA, LC-PUFA, and n-6 LC-PUFA was evidenced, compared to unwashed erythrocytes. The FA concentration in umbilical cord erythrocytes did not change between samples stored from 0 to 12 h until erythrocyte separation. Erythrocyte washing before storage decreased the concentration of significant individual and total SFA, PUFA, and LC-PUFA. These results should be considered when planning the collection of UCB samples for the study of fatty acid concentration due to the nonscheduled timing of deliveries.

Trends and predictors of gestational diabetes mellitus in Chile.

OBJECTIVE: To examine the temporal trends in gestational diabetes mellitus (GDM) prevalence in Chile, and to determine the main predictors of GDM. METHODS: A secondary analysis was conducted of all birth records at Hospital Dr. Sótero del Río, Chile, from January 1, 2002, to December 31, 2015. We excluded those women with pre-existing type 2 diabetes, those with missing data, and those with unlikely data. GDM was defined as fasting glucose levels >5.55 mmol/L [>100 mg/dL] or >7.77 mmol/L [>140 mg/dL] 2 hours after glucose load in the oral glucose tolerance test. Potential predictors were selected based on prior research and ease of evaluation. RESULTS: From the original database of 100 758 records, 86 362 women were included in the final cohort. The mean GDM prevalence was 7.6% (95% CI [confidence interval] 7.5%-7.8%), increasing from 4.4% (95% CI 4.0%-4.9%) in 2002 to 13.0% (95% CI 12.0%-13.9%) in 2015. Age, education, marital status, parity, family history of type 2 diabetes, personal history of GDM, hypertension and pre-eclampsia, alcohol consumption, smoking, and pre-gestational nutritional status performed well in the prediction of GDM. CONCLUSION: One out of eight Chilean pregnant women of medium- to low socio-economic status were found to develop GDM. We identified a set of easy-to-capture predictors in the primary health care system that may allow for the early identification of women at high-risk for the development of GDM.

Alarming weight gain in women of a post-transitional country.

OBJECTIVE: In post-transitional countries, obesity disproportionally affects women. Longitudinal studies can detect high-risk groups in whom to target actions. We investigated the magnitude and velocity of BMI changes in Chilean women of reproductive age and evaluated whether these trends vary in specific groups. DESIGN: Longitudinal study. We measured weight and height in 2007 (baseline) and again in 2010 (follow-up); we estimated change in BMI (weight/height2) within the 3-year period and assessed its relationship with age, years of education and parity, collected at baseline and follow-up using a questionnaire. SETTING: Population-based cohort of low- to middle-income Chilean women. SUBJECTS: Seven hundred and sixty-one women of reproductive age (mean 32·0 (sd 7·0) years), mothers of children who participate in the Growth and Obesity Cohort Study (GOCS). RESULTS: At baseline, 61 % of women had BMI ≥ 25·0 kg/m2. After 3 years, women gained on average 2·6 kg and obesity (BMI ≥ 30·0 kg/m2) increased by 23 % (12 % new obesity cases). Women with normal nutritional status gained more BMI than obese women (1·4 v. 0·6 kg/m2, P < 0·001). An increase in parity was positively associated with BMI change, independently of age, nutritional status and education (P < 0·05). Age and education were not associated with BMI change after controlling for other factors (P > 0·05). CONCLUSIONS: In Chile, a post-transitional country, we observed an alarming increase in obesity among women of reproductive age. Our results indicate that in this population actions need to be targeted at all women irrespective of their nutritional status. A key component of these policies should be avoiding excessive weight gain during pregnancy.

Increased skin cancer mortality in Chile beyond the effect of ageing: Temporal analysis 1990 to 2005.

Chile has a medium-to-high skin cancer mortality rate. Previous studies have shown an increasing rate of skin cancer mortality. We evaluated skin cancer mortality characteristics and their temporal evolution in Chile from 1990 to 2005 in a mixed ecological study using death certificate databases. Age, sex, year and region of residence were obtained for melanoma and non-melanoma deaths. Crude and age-sex-adjusted rates were calculated using the national projections and WHO 2000 standard population data. Descriptive and temporal analyses, using a Prais-Winsten regression, were computed. A total of 3588 deaths were registered, of which 55% were melanoma and 54% occurred in men (median age 71 years; women were older). The adjusted rate was 1.75 deaths per 100,000 inhabitants (2.22 in men vs. 1.39 in women). Melanoma skin cancer and non-melanoma skin cancer mortality had a tendency to increase. In conclusion, skin cancer mortality is rising beyond the rate predicted by ageing. An increased incidence due to changes in modifiable factors, such as exposure to ultraviolet radiation and arsenic, might explain the increase in skin cancer mortality.