Macronutrient Composition or Social Determinants? Impact on Infant Outcomes With Gestational Diabetes Mellitus.

The purpose of this study was to examine, through a randomized, controlled trial, the effects of a maternal carbohydrate-restricted diet on maternal and infant outcomes in gestational diabetes mellitus (GDM). Women diagnosed with GDM were randomly allocated into one of two groups: an intervention group that was placed on a lower-carbohydrate diet (35-40% of total calories) or a control group that was placed on the usual pregnancy diet (50-55% carbohydrate). A convenience sample of participants diagnosed with GDM (ages 18-45 years) was recruited from two different sites: one urban and low-income and the other suburban and more affluent. Individual face-to-face diet instruction occurred with certified diabetes educators at both sites. Participants tested their blood glucose four times daily. Specific socioeconomic status indicators included enrollment in the Supplemental Nutrition Program for Women, Infants and Children or Medicaid-funded health insurance, as well as cross-sectional census data. All analyses were based on an intention to treat. Although there were no differences found between the lower-carbohydrate and usual-care diets in terms of blood glucose or maternal-infant outcomes, there were significant differences noted between the two sites. There was a lower mean postprandial blood glucose (100.59 ± 7.3 mg/dL) at the suburban site compared to the urban site (116.3 ± 15 mg/dL) (P <0.01), even though there was no difference in carbohydrate intake. There were increased amounts of protein and fat consumed at the suburban site (P <0.01), as well as lower infant complications (P <0.01). Further research is needed to determine whether these disparities in outcomes were the result of macronutrient proportions or environmental conditions.

Inclusion of disability-related content in nurse practitioner curricula.

PURPOSE: To examine the integration of disability-content in a national sample of nurse practitioner curricula. DATA SOURCES: Responses of National Organization of Nurse Practitioner Faculties (NONPF) members to an online 34-item survey designed to assess disability-related content included in nurse practitioner (NP) curricula; populations of people with disabilities addressed; models of disability; and resources used to teach about disability, facilitators and barriers to inclusion of disability, and respondents' assessment of the adequacy of coverage of disability in their programs. A survey used previously to assess integration of disability content in undergraduate nursing programs was modified to make it relevant to NP curricula. Nursing faculty and people with disability validated the survey to ensure its completeness and sensitivity to the disability community. Participating programs represent 111 (33.6%) NP programs. CONCLUSIONS: Lack of disability-related content reported by NP faculty in the majority of programs suggests that there is considerable room for improvement in efforts to address this often vulnerable population. Because people with disabilities can be found in any setting where health care is provided, all NPs need to be prepared to care for people with disabilities across the life span. IMPLICATIONS FOR PRACTICE: Strategies need to be developed and implemented to increase the awareness of NP faculty about the health issues of people with disabilities and integration of disability-related content without disrupting existing overloaded NP curricula.

Flavor learning in utero and its implications for future obesity and diabetes.

The concept of prenatal flavor learning can be used to motivate women to eat healthy foods. The flavors of the foods in the maternal diet are found in the amniotic fluid swallowed by the fetus, with the fetus developing a preference for those flavors that is shown to persist in infancy. Furthermore, flavor preferences in infancy can persist into childhood and even into adulthood. Thus, the intrauterine environment may have a life-long influence on flavor preferences and healthy eating. This is an empowering concept for a pregnant woman: her baby will develop a preference for what she eats. However, education alone about this concept may not be sufficient to motivate behavior change. The evidence for health promotion strategies demonstrated to be effective in pregnancy is presented here, along with associated implications for prenatal flavor learning and the prevention of obesity and diabetes.