Effect of the Dietary Approaches to Stop Hypertension (DASH) diet on the development of preeclampsia and metabolic outcomes in pregnant women with pre-existing diabetes mellitus: a randomised, controlled, single-blind trial.

Preeclampsia (PE) affects up to five times more women with pre-existing diabetes mellitus (PDM) than women without it. The present study aimed to identify the effect of the DASH diet on PE incidence (primary outcome) and blood pressure, glycated haemoglobin (GH), serum lipids, glutathione peroxidase (GP), C-reactive protein (CRP - secondary outcomes) in pregnant with PDM. This randomised, controlled, single-blind trial studied sixty-eight pregnant women with PDM throughout prenatal care until delivery (18 weeks) at a public maternity hospital, Brazil. The standard diet group (SDG) received a diet containing 45-65 % carbohydrates, 15-20 % protein and 25-30 % lipids. The DASH diet group (DDG) received the adapted DASH diet with a similar macronutrient distribution, but with a higher concentration of fibres, unsaturated fats, calcium, magnesium and potassium as well as lower saturated fat. Student's t, Mann-Whitney U and the Chi-square tests were used to compare outcomes. PE incidence was 22⋅9 % in the SDG and 12⋅1 % in the DDG (P = 0⋅25). GP levels significantly increased in the DDG (intra-group analysis; mean difference = 1588 [CI 181, 2994], P = 0⋅03) and tended to be different from the variation in the SDG (mean difference = -29⋅5 [CI -1305; 1⋅365]; v. DDG: 1588 [CI 181; 2994], P = 0⋅09). GH levels decreased significantly and similarly between groups (SDG: -0⋅61 [CI -0⋅26, -0⋅96], P = 0⋅00) v. DDG: -1⋅1 [CI -0⋅57, -1⋅62], P = 0⋅00). There was no evidence of a difference in PE incidence at the end of the intervention between the two diets. The DASH diet seems to favour PE-related biochemical markers.

Lower daily carbohydrate consumption than recommended by the Institute of Medicine is common among women with type 2 diabetes in early pregnancy in Denmark.

AIMS: To secure adequate carbohydrate supply in pregnancy, the Institute of Medicine (IOM) recommends a minimum amount of carbohydrates of 175 g daily. Currently a low carbohydrate diet is a popular health trend in the general population and this might also be common among overweight and obese pregnant women with type 2 diabetes (T2D). Thus, we explored carbohydrate consumption among pregnant women with T2D including women with type 1 diabetes (T1D) for comparison. METHODS: A retrospective cohort study of consecutive women with T2D (N = 96) and T1D (N = 108), where dietary records were collected at the first antenatal visit. RESULTS: Among women with T2D and T1D, bodyweight at the first visit was 90.8 ±â€¯22 (mean ±â€¯SD) and 75.5 ±â€¯15 kg (P < 0.001) while HbA1c was 6.6 ±â€¯1.2% (49 ±â€¯13 mmol/mol) and 6.6 ±â€¯0.8% (48 ±â€¯8 mmol/mol), P = 0.8, respectively. The average daily carbohydrate consumption from the major carbohydrate sources was similar in the two groups (159 ±â€¯56 and 167 ±â€¯48 g, P = 0.3), as was the level of total daily physical activity (median (interquartile range)): 215 (174-289) and 210 (178-267) metabolic equivalent of task-hour/week (P = 0.9). A high proportion of women with T2D and T1D (52% and 40%, P = 0.08) consumed fewer carbohydrates than recommended by the IOM. The prevalence of ketonuria (≥4 mmol/L) was 1% in both groups. CONCLUSIONS: In early pregnancy, a lower daily carbohydrate consumption than recommended by the IOM was common among women with T2D. The results were quite similar to women with T1D, despite a markedly higher bodyweight in women with T2D. Reassuringly, ketonuria was rare in both groups.

Effect of eicosapentaenoic acid and docosahexaenoic acid supplementation on C-peptide preservation in pregnant women with type-1 diabetes: randomized placebo controlled clinical trial.

BACKGROUND/OBJECTIVES: Type-1 diabetes mellitus (T1DM) is caused by autoimmune insulitis. There are evidences that pregnancy and n-3 fatty acids exhibit suppressive effect on human inflammatory system. SUBJECTS/METHODS: Ninety pregnant women with T1DM were included in the prospective randomized placebo controlled clinical trial. Forty-seven of them were put on standard diabetic diet enriched with EPA and DHA twice a day (EPA 120 mg and DHA 616 mg; Study group) and 43 pregnant diabetic women were on standard diabetic diet with placebo (Control group). Duration of T1DM in all participants was between 5 to 30 years. Blood samples were analyzed from all pregnant women for fasting C-peptide (FC-peptide), fasting plasma glucose (FPG) and HbA1c in each trimester throughout pregnancy and after delivery. Umbilical vein blood was analyzed for fetal C-peptide level, glucose concentration and insulin resistance. RESULTS: In the Study group FC-peptide concentration raised from 59.6±103.9 pmol/l in first trimester, to 67.7±101.3 pmol/l in the second trimester and to 95.1±152.7 pmol/l in the third trimester. Comparing the FC-peptide values during first and third trimester a statistically significant increase in third trimester was found (P<0.001). In the Control group FC-peptide concentration ranged from 41.7±91.6 pmol/l in the first trimester to 41.2±70.9 mmol/l in the second trimester while in the third trimester it reached 52.4±95.3 pmol/l. Comparing the FC-peptide values during first and third trimester the statistical difference was not significant. CONCLUSION: Combining of LC n-3 PUFAs and pregnancy yields immunological tolerance and stimulates the production of endogenous insulin in women with T1DM.

Nutritional beliefs and practices among diabetic pregnant mothers in a tertiary care hospital in Bangladesh.

BACKGROUND & AIM: Pregnant mothers with diabetes, especially in developing countries, are particularly prone to suffer from dietary imbalances due to superstitions and irrational beliefs and practices. The study aimed to explore the existing beliefs and practices related to food intake among Bangladeshi diabetic pregnant mothers. MATERIAL & METHODS: A cross-sectional study was conducted among 200 diabetic pregnant mothers (age in yrs, M±SD, 30±4), selected purposively from outpatient department of Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine & Metabolic Disorders. An interviewer-administered questionnaire was used to collect data. SPSS 16.0 were used for data analysis. RESULTS: About 40% mothers had uncontrolled glycaemic status. 43% mothers believed that food should not be taken during the 'call for prayer' and 91% of them practiced it. For 'eclipse' the percentage of such kind of belief was much higher (80%) and 90% of them practiced it. With varying proportion for particular fishes 44-58% respondents believed that some fishes should be avoided due to the increased movement of child, fetal malformation and disease. 93% actually practiced it. 28% had adverse beliefs about duck meat, 78% pineapple and 8% had about coconut. The corresponding percentages for practice were 82%, 99% and 50% respectively. Mentally and physically abnormal child, different kinds of child illness and threat of abortion were among the reasons for misbeliefs about those foods. CONCLUSION: There are a number of nonscientific beliefs and prejudices among this pregnant mother regarding the intake of food.

Gluten-Free Diet Only during Pregnancy Efficiently Prevents Diabetes in NOD Mouse Offspring.

Studies have documented that the pathogenesis of autoimmune diabetes is influenced by the intake of gluten. Aims. To investigate the importance of gluten exposure during pregnancy and the subsequent development of autoimmune diabetes in offspring. Methods. Nonobese diabetic mice were divided into 7 groups to receive combinations of gluten-free and standard diet before, during, or after pregnancy. Diabetes incidence in offspring was followed in each group (n = 16-27) for 310 days. Insulitis score and intestinal expression of T-cell transcription factors (RT-QPCR) were evaluated in animals from the different diet groups. Results. If mothers were fed a gluten-free diet only during pregnancy, the development of autoimmune diabetes in offspring was almost completely prevented with an incidence reduction from 62.5% in gluten-consuming mice to 8.3% (p < 0.0001) in the gluten-free group. The islets of Langerhans were less infiltrated (p < 0.001) and the intestinal expression of RORγt (Th17) (p < 0.0001) reduced in mice whose mothers were Gluten-free during pregnancy. Conclusion. A gluten-free diet exclusively during pregnancy efficiently prevents autoimmune diabetes development in offspring and reduces insulitis and intestinal expression of RORγt (Th17).

Placental antioxidant enzyme status and lipid peroxidation in pregnant women with type 1 diabetes: The effect of vitamin C and E supplementation.

AIM: In view of the increased rates of pre-eclampsia observed in diabetic pregnancy and the lack of ex vivo data on placental biomarkers of oxidative stress in T1 diabetic pregnancy, the aim of the current investigation was to examine placental antioxidant enzyme status and lipid peroxidation in pregnant women with type 1 diabetes. A further objective of the study was to investigate the putative impact of vitamin C and E supplementation on antioxidant enzyme activity and lipid peroxidation in type 1 diabetic placentae. METHODS: The current study measured levels of antioxidant enzyme [glutathione peroxidase (Gpx), glutathione reductase (Gred), superoxide dismutase (SOD) and catalase] activity and degree of lipid peroxidation (aqueous phase hydroperoxides and 8-iso-prostaglandin F2α) in matched central and peripheral samples from placentae of DAPIT (n=57) participants. Levels of vitamin C and E were assessed in placentae and cord blood. RESULTS: Peripheral placentae demonstrated significant increases in Gpx and Gred activities in pre-eclamptic in comparison to non-pre-eclamptic women. Vitamin C and E supplementation had no significant effect on cord blood or placental levels of these vitamins, nor on placental antioxidant enzyme activity or degree of lipid peroxidation in comparison to placebo-supplementation. CONCLUSION: The finding that maternal supplementation with vitamin C/E does not augment cord or placental levels of these vitamins is likely to explain the lack of effect of such supplementation on placental indices including antioxidant enzymes or markers of lipid peroxidation.

Intrauterine programming of lipid metabolic alterations in the heart of the offspring of diabetic rats is prevented by maternal diets enriched in olive oil.

SCOPE: Maternal diabetes can program metabolic and cardiovascular diseases in the offspring. The aim of this work was to address whether an olive oil supplemented diet during pregnancy can prevent lipid metabolic alterations in the heart of the offspring of mild diabetic rats. METHODS AND RESULTS: Control and diabetic Wistar rats were fed during pregnancy with either a standard diet or a 6% olive oil supplemented diet. The heart of adult offspring from diabetic rats showed increases in lipid concentrations (triglycerides in males and phospholipids, cholesterol, and free fatty acids in females), which were prevented with the maternal diets enriched in olive oil. Maternal olive oil supplementation increased the content of unsaturated fatty acids in the hearts of both female and male offspring from diabetic rats (possibly due to a reduction in lipoperoxidation), increased the expression of Δ6 desaturase in the heart of male offspring from diabetic rats, and increased the expression of peroxisome proliferator activated receptor α in the hearts of both female and male offspring from diabetic rats. CONCLUSION: Relevant alterations in cardiac lipid metabolism were evident in the adult offspring of a mild diabetic rat model, and regulated by maternal diets enriched in olive oil.

Dietary advices on carbohydrate intake for pregnant women with type 1 diabetes.

The impact of the quality and quantity of carbohydrate intake on glycaemic control and pregnancy outcome was evaluated with focus on pregnant women with type 1 diabetes. For women with type 1 diabetes, a gestational weight gain within the lower range of the guidelines of the Institute of Medicine (IOM) is generally recommended. A low-glycaemic index diet is considered safe, and has shown, positive effects on the glycaemic control and pregnancy outcomes for both healthy women, those with type 2 diabetic and gestational diabetes (GDM). In general, carbohydrate counting does improve glycaemic control in type 1 diabetes. A moderately low carbohydrate diet with a carbohydrate content of 40% of the calories results in better glycaemic control and comparable obstetric outcomes in type 2 diabetes and GDM when compared to a diet with a higher carbohydrate content, and is regarded safe in diabetic pregnancy. In type 1 diabetes pregnancy, a moderately low carbohydrate diet with 40% carbohydrates has been suggested; however, a minimum intake of 175 g carbohydrate daily is recommended. Despite limited evidence the combination of a low-glycaemic index diet with a moderately low carbohydrate intake, using carbohydrate counting can be recommended for pregnant women with type 1 diabetes.

Effect of docosahexaenoic acid-enriched fish oil supplementation in pregnant women with Type 2 diabetes on membrane fatty acids and fetal body composition--double-blinded randomized placebo-controlled trial.

AIMS: To test if docosahexaenoic acid-enriched fish oil supplementation rectifies red cell membrane lipid anomaly in pregnant women with Type 2 diabetes and their neonates, and alters fetal body composition. METHODS: Women with Type 2 diabetes (n = 88; 41 fish oil, 47 placebo) and healthy women (n = 85; 45 fish oil, 40 placebo) were supplemented from the first trimester until delivery. Blood fatty acid composition, fetal biometric and neonatal anthropometric measurements were assessed. RESULTS: A total of 117 women completed the trial. The women with Type 2 diabetes who took fish oil compared with those who received placebo had higher percentage of docosahexaenoic acid in red cell phosphatidylethanolamine in the third trimester (12.0% vs. 8.9%, P = 0.000) and at delivery (10.7% vs. 7.4%, P = 0.001). Similarly, the neonates of the women with Type 2 diabetes supplemented with the fish oil had increased docosahexaenoic acid in the red cell phosphatidylethanolamine (9.2% vs. 7.7%, P = 0.027) and plasma phosphatidylcholine (6.1% vs. 4.7%, P = 0.020). Docosahexaenoic acid-rich fish oil had no effect on the body composition of the fetus and neonates of the women with Type 2 diabetes. CONCLUSIONS: A daily dose of 600 mg of docosahexaenoic acid was effective in ameliorating red cell membrane docosahexaenoic acid anomaly in pregnant women with Type 2 diabetes and neonates, and in preventing the decline of maternal docosahexaenoic acid during pregnancy. We suggest that the provision of docosahexaenoic acid supplement should be integrated in the antenatal care of pregnant women with Type 2 diabetes.

A maternal diet rich in fish oil may improve cardiac Akt-related signaling in the offspring of diabetic mother rats.

OBJECTIVE: Newborns of diabetic mothers have abnormal circulatory organs, so in this study, we explore insulin signaling in the newborn rat heart. METHODS: Pregnant rats were divided into streptozotocin-induced diabetic groups (DM) and control groups (CM). Rats were fed lard (21% fat), fish oil (21% fat), or a control diet (7% fat). To examine changes in insulin signaling in the hearts of infants of diabetic mothers (IDM) in relation to diet, we isolated the hearts from the IDM and control infants and determined the phosphorylation levels of Akt308, Akt473, p38, c-jun-NH2-terminal protein kinase (JNK), and extracellular signal-regulated protein kinase (ERK), and the expression levels of phosphoinositide-dependent protein kainase1 (PDK1) and mammalian target of rapamycin (mTOR). RESULTS: The mean blood glucose levels in the DM group and their infants were significantly higher than those in the CM group (P < 0.05) and their infants (P < 0.05), but the mean blood glucose levels of all infants was normal on postnatal d 4. Phosphorylation levels of Akt (Thr 308) (P < 0.05) and Akt (Ser 473) and the expression levels of PDK1 and mTOR were lower in infants of diabetic mothers (IDM) than in control infants. The phosphorylation level of Akt (Ser 473) and the expression level of mTOR increased in IDM fed the fish oil diet compared with those fed the lard diet (P < 0.05). CONCLUSION: A maternal diet rich in fish oil improves cardiac Akt-related signaling in the offspring of diabetic rats.

Severe superimposed preeclampsia with obesity, diabetes and a mild imbalance of angiogenic factors.

Preeclampsia may be due to an excess of circulating anti-angiogenic growth factors derived from the placenta, but metabolic syndrome-like disorders may also set off a cascade of placental and systemic inflammation and oxidative stress. We present a case of severe superimposed preeclampsia with obesity, diabetes and a mild imbalance of angiogenic factors, in which diet therapy ameliorated the preeclamptic signs while improving the adiponectin level. A 41-year-old pregnant woman with obesity and diabetes was referred to our hospital because of severe proteinuria and hypertension at 22 weeks of gestation. After administration of insulin and hydralazine with diet therapy, her hypertension and proteinuria were ameliorated with a 15-kg weight loss. Her adiponectin level was low and her leptin level was high, but her angiogenic factor levels were within the normal ranges for pregnant women at admission. The diet therapy ameliorated her hypertension and proteinuria while improving her adiponectin level as she achieved weight loss. This case suggests that diet therapy for obese preeclampsia patients with a mild imbalance of anti-and pro-angiogenic factors may play an important role in managing preeclampsia. Measurements of maternal adipocytokines and angiogenic factors may be important to distinguish the main cause of preeclampsia, i.e., poor placentation or maternal constitutional factors, for managing preeclampsia in patients with obesity.

Dietary treatments enriched in olive and safflower oils regulate seric and placental matrix metalloproteinases in maternal diabetes.

OBJECTIVES: Matrix metalloproteinases (MMPs) are proteolytic enzymes involved in placental development and function, although related to the pro-inflammatory environment when produced in excess. Previous studies have identified MMP-2 and MMP-9 overactivities in the placenta from diabetic rats. In this study, we aimed to determine whether diets supplemented with olive and safflower oil, enriched in natural PPAR ligands, are able to regulate MMP-2 and MMP-9 activities in the placenta and serum from diabetic rats. STUDY DESIGN: Diabetes was induced in rat neonates by streptozotocin administration (90mg/kg s.c.). Control and diabetic rats were fed with 6% olive oil- or 6% safflower oil-supplemented diets from days 0.5-13.5 of gestation. MAIN OUTCOME MEASURES: On day 13.5 of gestation, placentas and sera were isolated for further determination of matrix metalloproteinases (MMPs) 2 and 9 activities by zymography. Placental MMP-2 and MMP-9 protein concentration and immunolocalization were also determined. RESULTS: Sera from diabetic pregnant animals showed MMP-2 and MMP-9 overactivities when compared to controls. Serum MMP-9 activity was significantly decreased when the diabetic animals received the olive and safflower oil dietary treatments. Placentas from diabetic rats showed increased MMP-2 and MMP-9 activities and protein concentrations, and both were decreased when diabetic rats received the olive and safflower dietary treatments. CONCLUSIONS: This study demonstrates that both olive and safflower oil-supplemented diets were able to prevent MMPs overactivities in the placenta from diabetic rats, and that these beneficial effects are reflected in rat sera.

[Effect of betamethasone in blood glucose levels in pregnant diabetic women at risk of preterm birth]. / Efecto de la betametasona en la glucemia de diabéticas embarazadas en riesgo de nacimiento pretérmino.

BACKGROUND: The bethametasone (BTM) induced hyperglycemia is not adequately known and managed in diabetic pregnant women. OBJECTIVE: To compare the betamethasone-induced hyperglycemia in pregnant women either healthy or with gestational or type 2 diabetes mellitus (diabetes mellitus). MATERIAL AND METHODS: Forty volunteer pregnant women at risk of premature rupture of membranes who received betamethasone (12 mg i.m. every 24 hours, 2 doses) were divided in four groups (10 women each): G1, healthy; G2, Diet treated diabetes mellitus; G3, Diet plus insulin treated diabetes mellitus; G4, type 2 diabetes mellitus treated with diet (n=6) or diet and insulin (n=4). Pre (p) and 2h-postprandial (pp) capillary blood glucose was measured throughout the day during 5 days of hospitalization. Student't test for independent and dependent samples was used. RESULTS: G1 had no significant changes in p or pp glucose. In G2 four women required de novo insulin administration while insulin dose was increased 39 to 112% and 26 to 64% in all women in G3 and G4, respectively to maintain p and pp glucose levels <95 mg/dL and < 120 mg/dL, respectively. The greatest changes occurred between days 2 to 4 after betamethasone. CONCLUSION: Betamethasone-induced hyperglycemia was greater in insulin treated women with gestational or type 2 diabetes and should not be administrated on an out-patient basis.

Dietary polyunsaturated fatty acid prevents hyperlipidemia and hepatic oxidant status in pregnant diabetic rats and their macrosomic offspring.

A considerable amount of clinical and experimental evidence now exists and suggests the involvement of fatty acids and free radical-mediated oxidative processes in the pathogenesis of diabetic complications. Fetuses from diabetic mothers are at increased risk of developing neonatal macrosomia and oxidative stress. We investigated the modulation of antioxidant status and liver biochemical parameters in normal and diabetic pregnant rats and their offspring. Animals were randomly allocated into three groups of six rats each: a control group, a diabetic group and diabetic rats fed with flax and sesame seeds mixture group. The time course of changes in lipid metabolism and antioxidant status by dietary rich in ω3- and ω6-polyunsaturated fatty acids in alloxan-induced diabetic pregnant rats and their macrosomic offspring was studied. Glucose and insulin levels were also assessed in order to characterize the diabetic state of dams and their offspring. The diabetic rats presented a significant increase in glycemia, plasma and liver lipid parameters compared with those of control group. In addition, liver malonaldialdehyde levels significantly increased. Antioxidant enzyme activities such as catalase and superoxide dismutase and reduced glutathione levels significantly decreased in the liver of diabetic rats when compared with controls. Diet supplemented with flax and sesame seeds mixture in pregnant diabetic rats ameliorated lipid parameters, antioxidant enzyme activities, level of reduced glutathione and significantly decreased malonaldialdehyde levels. These ameliorations were also observed in pups whose pregnant diabetic mothers were fed seeds mixture. Our results suggested that flax and sesame seeds mixture supplemented to diet of pregnant diabetic rats might be helpful in preventing diabetic complications in adult dams and their offspring.

[The diet of pregnant women with type 1 diabetes]. / Alimentation de la femme enceinte diabétique de type 1.

Nutritional recommendations for pregnant women with type 1 diabetes are similar to those for non-diabetic pregnant woman. However, the risks of hypoglycaemia, ketosis and hyperglycaemia require specific and personalised nutritional care. The aim is to cover the nutritional needs of the mother and foetus, as well as to maintain correct glycaemia levels throughout the pregnancy.