The risk of gestational diabetes reduced with a Mediterranean diet

A simple Mediterranean diet during pregnancy does not reduce the overall risk of adverse complications to the mother and offspring, but could reduce weight gain during pregnancy and the risk of gestational diabetes, according to a clinical trial conducted by the United States. Queen Mary University of London. and the University of Warwick.

The results, published in the journal PLOS Medicine and funded by Barts Charity, show that a Mediterranean diet (comprising 30 g of mixed nuts a day and extra virgin olive oil) reduces 35% the risk of developing diabetes during pregnancy. and on average 1.25 kg less weight gain during pregnancy compared with women who received routine antenatal care.

The study suggests that a Mediterranean-type diet could be an effective intervention for pregnant women with pre-existing obesity, chronic hypertension or high lipid levels.

"Women at risk must act early"

Professor Shakila Thangaratinam, of the Queen Mary Institute's Blizard, said, "This is the first study showing that pregnant women at high risk of complications may benefit from a Mediterranean type diet to reduce weight gain and risk of gestational diabetes.

"The implementation of this scheme seems to be effective and acceptable to women. Current national dietary guidelines do not include key elements of the Mediterranean diet in their recommendations. Women at risk for gestational diabetes should be encouraged to act early in pregnancy by consuming more nuts, olive oil, unrefined fruits and grains, while reducing their fat intake. animal and sugar. "

One in four mothers enters pregnancy with pre-existing obesity, chronic hypertension, or elevated fat levels. These can lead to complications during pregnancy, including gestational diabetes (when a high blood sugar level occurs during pregnancy) and pre-eclampsia – the onset of pregnancy. high blood pressure during pregnancy, which can sometimes develop into more serious conditions affecting multiple organs. These mothers and their babies are also at risk for long-term diabetes and cardiovascular complications.

A Mediterranean diet, rich in unsaturated fatty acids, reduces the incidence of cardiovascular disease in the non-pregnant population. During pregnancy, such a diet can potentially improve outcomes for the mother and offspring, but has not been widely evaluated so far.

More than 1,200 women participate in clinical trials

The ESTEEM study involved 1,252 women from five UK maternity hospitals (four in London, including NHS Trust hospitals in Barts Health and the NHS Foundation Trust, and one in Birmingham).

Downtown multiethnic pregnant women with metabolic risk factors, including obesity and chronic hypertension, were randomized to receive routine antenatal care or a Mediterranean-type diet, in addition to their antenatal care. The diet included a high consumption of nuts, extra virgin olive oil, fruits, vegetables, unrefined grains and legumes; moderate to high fish consumption, low to moderate consumption of poultry and dairy products; and low consumption of red meat and processed meat; and avoid sugary drinks, fast foods and foods high in animal fat.

Despite improvements in gestational diabetes and weight gain during pregnancy, no other significant complication of pregnancy, such as high blood pressure, pre-eclampsia, stillbirth, small fetus or l? admission to a neonatal care unit was not observed.

Participants in the Mediterranean diet group reported a better overall quality of life than the control group and a bloated feeling during pregnancy, but no other symptoms such as nausea, vomiting or indigestion were observed.

When the study data were combined with published data from a Spanish study of 874 pregnant women undergoing a Mediterranean diet, the team observed an equally significant reduction in gestational diabetes (reduction 33%), but no effect on the other results.

Important benefits of a Mediterranean diet

Dr. Bbadel Wattar of the University of Warwick and Queen Mary University of London said: "Although it has been proven that a Mediterranean diet reduces the risk of type 2 diabetes and cardiovascular complications in the general population, we did not know the effects. such a diet among high-risk pregnant women, and whether it could be culturally adapted to an ethnically diverse population.

"We now know that pregnant women from a high-risk multiethnic population and living in the city center are able to adapt their diet to a Mediterranean style, which can bring them greater benefits." important benefits, including reduced weight gain and reduced risk. to develop gestational diabetes. "

Fiona Miller Smith, Executive Director of Barts Charity, said, "In response to the growing problems of diabetes and obesity among pregnant women, we are very proud to support this study to prevent these risks. We are pleased that funding from the Barts Women's Health Research Center is being used to improve the health of mothers in East London and help future generations. "

Increased consumption of nuts and olive oil

To promote their consumption during pregnancy, participants in the Mediterranean diet received a complementary blend of walnuts (30 g / day of nuts, hazelnuts and almonds) and extra virgin olive oil (0 ∙ 5 liter / week), main source of cooking fat. Participants also received individualized dietary advice at 18, 20 and 28 weeks of gestation.

The diet was sensitized to the culture by providing cooking tips in a bespoke cookbook (see Notes to Editors), which incorporates elements of the Mediterranean diet into local cuisine, elaborated with local community teams.

The work was done at the Barth Women's Research Center, based at Queen Mary University in London, funded by Barts Charity.

The study has limitations, including relying on participant feedback to measure adherence to the intervention, without using objective biomarkers to measure nutritional intake. The team also obtained food intake information from only about 40% of participants in both groups, which limits the interpretation of data on this intake.

Reference
Bbadel H. Al Wattar, Julie Dodds, Anna Placzek, Lee Beresford, Eleni Spyreli, Amanda Moore, Francisco J. Gonzalez Carreras, Frances Austin, Nilaani Murugesu, Tessa J. Roseboom, Maira Bes-Rastrollo, Graham A. Hitman, Richard Hooper , Khalid S. Khan, Shakila Thangaratinam. Mediterranean diet in pregnant women with metabolic risk factors (ESTEEM): multicenter randomized pragmatic trial. PLOS Medicine, 2019; 16 (7): e1002857 DOI: 10.1371 / journal.pmed.1002857.

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