Assaf-Balut Carla, Garcia de la Torre Nuria, Durán Alejandra, Fuentes Manuel, Bordiú Elena, Del Valle Laura, Valerio Johanna, Familiar Cristina, Jiménez Inés, Herraiz Miguel Angel, Izquierdo Nuria, Torrejón Maria José, Runkle Isabelle, de Miguel Maria Paz, Moraga Inmaculada, Montañez Maria Carmen, Barabash Ana, Cuesta Martín, Rubio Miguel A, Calle-Pascual Alfonso Luis
Endocrinology and Nutrition Department, Hospital Clínico San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain.
Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain.
BMJ Open Diabetes Res Care. 2018 Oct 11;6(1):e000550. doi: 10.1136/bmjdrc-2018-000550. eCollection 2018.
To assess whether Mediterranean Diet (MedDiet)-based medical nutrition therapy facilitates near-normoglycemia in women with gestational diabetes mellitus (GDMw) and observe the effects on adverse pregnancy outcomes.
This is a secondary analysis of the St Carlos GDM Prevention Study, conducted between January and December 2015 in Hospital Clínico San Carlos (Madrid, Spain). One thousand consecutive women with normoglycemia were included before 12 gestational weeks (GWs), with 874 included in the final analysis. Of these, 177 women were diagnosed with gestational diabetes mellitus (GDM) and 697 had normal glucose tolerance. All GDMw received MedDiet-based medical nutrition therapy with a recommended daily extra virgin olive oil intake ≥40 mL and a daily handful of nuts. The primary goal was comparison of hemoglobin A1c (HbA) levels at 36-38 GWs in GDMw and women with normal glucose tolerance (NGTw).
GDMw as compared with NGTw had higher HbA levels at 24-28 GWs (5.1%±0.3% (32±0.9 mmol/mol) vs 4.9%±0.3% (30±0.9 mmol/mol), p=0.001). At 36-38 GWs values were similar between the groups. Similarly, fasting serum insulin and homeostatic model assessment insulin resitance (HOMA-IR) were higher in GDMw at 24-28 GWs (p=0.001) but became similar at 36-38 GWs. 26.6% of GDMw required insulin for glycemic control. GDMw compared with NGTw had higher rates of insufficient weight gain (39.5% vs 22.0%, p=0.001), small for gestational age (6.8% vs 2.6%, p=0.009), and neonatal intensive care unit admission (5.6% vs 1.7%, p=0.006). The rates of macrosomia, large for gestational age, pregnancy-induced hypertensive disorders, prematurity and cesarean sections were comparable with NGTw.
Using a MedDiet-based medical nutrition therapy as part of GDM management is associated with achievement of near-normoglycemia, subsequently making most pregnancy outcomes similar to those of NGTw.
评估基于地中海饮食（MedDiet）的医学营养疗法是否有助于妊娠糖尿病女性（GDMw）实现接近正常的血糖水平，并观察其对不良妊娠结局的影响。
这是对圣卡洛斯GDM预防研究的二次分析，该研究于2015年1月至12月在西班牙马德里的圣卡洛斯临床医院进行。1000名妊娠12周前血糖正常的女性被纳入研究，最终分析纳入874名。其中，177名女性被诊断为妊娠糖尿病（GDM），697名葡萄糖耐量正常。所有GDMw均接受基于MedDiet的医学营养疗法，建议每日特级初榨橄榄油摄入量≥40 mL，并每日食用一把坚果。主要目标是比较GDMw和葡萄糖耐量正常女性（NGTw）在妊娠36 - 38周时的糖化血红蛋白（HbA）水平。
与NGTw相比，GDMw在妊娠24 - 28周时HbA水平更高（5.1%±0.3%（32±0.9 mmol/mol）对4.9%±0.3%（30±0.9 mmol/mol），p = 0.001）。在妊娠36 - 38周时，两组的值相似。同样，GDMw在妊娠24 - 28周时空腹血清胰岛素和稳态模型评估胰岛素抵抗（HOMA - IR）更高（p = 0.001），但在妊娠36 - 38周时变得相似。26.6%的GDMw需要胰岛素来控制血糖。与NGTw相比，GDMw体重增加不足、小于胎龄儿、新生儿重症监护病房收治的发生率更高（分别为39.5%对22.0%，p = 0.001；6.8%对2.6%，p = 0.009；5.6%对1.7%，p = 0.006）。巨大儿、大于胎龄儿、妊娠高血压疾病、早产和剖宫产的发生率与NGTw相当。
将基于MedDiet的医学营养疗法作为GDM管理的一部分与实现接近正常的血糖水平相关，随后使大多数妊娠结局与NGTw相似。
