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Background and Objective: GDM is associated with life-long adverse outcomes for mother and baby, and its incidence is increasing. Markers beyond clinical factors are needed to identify women at high risk and catalyze early preventive interventions. Our aim was to develop a risk assessment algorithm that integrates genetic and clinical variables. Methods: We analyzed a retrospective cohort of 711 women from Hospital Clínico San Carlos (HCSC, Madrid, Spain) , with 425 control pregnancies and 286 GDM cases diagnosed per IADPSG criteria. The HCSC cohort was randomly divided into a training/development dataset (70% of cohort) for algorithm development and a test dataset (30% of cohort) for validation. In addition, we tested the model in a cohort of 157 women (89 controls, 68 cases diagnosed per NDDG criteria from Hospital Cruces (Bilbao, Spain) and in a cohort of 416 women (346 controls, 70 cases per IADPSG criteria from HMPMPS, México) . A total of 114 SNPs were selected for this analysis after exhaustive exploration of the databases published to date of SNPs associated with GDM. The SNPs were selected based on their predictive power and population frequency, with the following criteria: OR>1.2, RAF>0.20, p Results: The algorithm provided a risk score for GDM, integrating 10 SNPs, maternal age, and pregestational BMI. In the training dataset the AUC was 0.74, sensitivity of 77% and specificity of 64%. AUCs in the HCSC, UAEM and Cruces validation sets were 0.71, 0.70 and 0.62 respectively. Conclusions: This new tool for GDM risk assessment suggests that the utilization of genetic markers in combination with clinical characteristics may improve GDM risk evaluation and accelerate adoption of prevention interventions. Our study also highlights the importance of applying consensus criteria for the diagnosis of GDM. Disclosure L. Mendizabal: Employee; Patia Biopharma S. A. L. Castano: None. M. M. Martínez: None. E. Camarillo-romero: None. H. Mendieta zerón: None. J. Garduno-garcia: Speaker's Bureau; Boehringer Ingelheim International GmbH. R. Corcoy: None. L. Simon: Board Member; Nelum Corp., Oncomatryx Biopharma SL, Patia Biopharma S. A., Quimatryx, SunRock Biopharma S. L., Other Relationship; Precsion Diabetes, Inc. M. Zulueta: None. A. L. Calle: None. M. Arregi: Employee; Patia Biopharma S. A. J. Valerio deogracia: None. A. M. Ramos levi: None. A. Barabash: None. N. García de la torre: Other Relationship; Ferrer. E. Arana: None. I. Urrutia: None. S. Gaztambide: None.

Gestational diabetes mellitus (GDM) increases the risk of adverse events in pregnancy and jeopardizes long-term health of the mother and offspring. There is currently no consensus as to what screening strategies improve the efficiency of GDM diagnosis. Which criteria should be used? Is the one-step or two-step procedure better? There is no agreement as to what the best dietary approach in the treatment of GDM is. In addition, different nutritional interventions have been studied in the prevention of GDM. The Mediterranean diet seems to be effective in preventing GDM and other maternofoetal outcomes. We review herein our experience using the one-step criteria for GDM screening; the treatment and prevention strategies used; and the overall impact of nutrition on maternofoetal health.

Aims: The aim of the study was to evaluate the effect of a Mediterranean diet (MedDiet), enhanced with extra virgin olive oil (EVOO) and nuts, on a composite of adverse maternofoetal outcomes of women with normoglycemia during pregnancy. Methods: This was a sub-analysis of the St Carlos gestational diabetes mellitus Prevention Study. Only normoglycemic women were analysed (697). They were randomized (at 8–12th gestational weeks) to: standard-care control group (337), where fat consumption was limited to 30% of total caloric intake; or intervention group (360), where a MedDiet, enhanced with EVOO and pistachios (40–42% fats of total caloric intake) was recommended. The primary outcome was a composite of maternofoetal outcomes (CMFOs): at least having 1 event of emergency C-section, perineal trauma, pregnancy-induced hypertension and preeclampsia, prematurity, large-for-gestational-age and small-for gestational-age. Results: Crude relative risk showed that the intervention was associated with a significant reduction in the risk of CMFOs (0.48 [0.37–0.63]; p = 0.0001), with a number-needed-to-treat = 5. Risk of urinary tract infections, emergency C-sections, perineal trauma, large-for-gestational-age and small-for gestational age new-borns were also significantly reduced. Conclusion: A MedDiet, enhanced with EVOO and nuts, was associated with a risk reduction of CMFOs in over 50% in normoglycemic pregnant women. Therefore, it might be a potentially adequate diet for pregnant women. Trial registration: Identifier ISRCTN84389045. The study was registered on September 27, 2013. Last edited on September 26, 2018

Objective: There is sparse evidence for the impact of gene-diet interaction on gestational diabetes mellitus (GDM) onset. Recent findings have shown that late first-trimester high adherence to a Mediterranean diet (MedDiet) pattern is associated with a GDM risk reduction. The aim of this study was to investigate if this effect could be modulated by TCF7L2 rs7903146 polymorphism.Research design and methods: A total of 874 pregnant women participants in the St Carlos GDM prevention study, were stratified into three groups defined as “High,5–6 on targets”, “Moderate, 2–4 on targets” or “Low, 0–1 on targets” adherence to Mediterranean diet according to late first-trimester compliance with six food targets: >12 servings/week of vegetables, >12 pieces/week of fruits, 3 servings/week of nuts, >6 days/week and >40 mL/day consumption of extra virgin olive oil. All patients were genotyped for rs7903146 using Taqman technology. Results: Logistic regression analysis revealed that the risk of developing GDM in those with high adherence versus low adherence was significantly reduced only in carriers of the T-allele (CT + TT), with an adjusted odds ratio of 0.15 (95% CI:0.05–0.48). This effect was not observed in CC carriers. Interaction analysis yielded significant rs7903146-MedDiet interaction in GDM risk (p

The intrauterine environment may be related to the future development of chronic diseases in the offspring. The St. Carlos gestational diabetes mellitus (GDM) prevention study, is a randomized controlled trial that evaluated the influence of the early (before 12th gestational week) Mediterranean diet (MedDiet) on the onset of GDM and adverse gestational outcomes. Out of 874 women assessed after delivery (440 control group (CG)/434 intervention group (IG)), 703 children were followed (365/338, CG/IG), with the aim to assess whether the adherence to a MedDiet during pregnancy induces health benefits for the offspring during the first two years of life. Logistic regression analysis showed that the IG in children of mothers with pre-gestational body mass index (BMI) &lt, 25 kg/m2 and normal glucose tolerance (NGT), was associated with a lower risk (RR(95% CI)) of suffering from severe events requiring hospitalization due to bronchiolitis/asthma (0.75(0.58&ndash, 0.98) and 0.77(0.59&ndash, 0.99), respectively) or other diseases that required either antibiotic (0.80(0.65&ndash, 0.98) and 0.80(0.65&ndash, 0.99), respectively), corticosteroid treatment (0.73(0.59&ndash, 0.90) and 0.79(0.62&ndash, 1.00) respectively) or both (all p &lt, 0.05). A nutritional intervention based on the MedDiet during pregnancy is associated with a reduction in offspring&rsquo, s hospital admissions, especially in women with pre-gestational BMI &lt, 25 kg/m2 and NGT.

Gestational diabetes mellitus (GDM) is the most common metabolic disorder during pregnancy. Its prevalence has been rapidly increasing in the latest years. It entails short- and long-term complications for both the mother and her offspring. Maternal dietary habits have been found to be associated with GDM development. A westernized diet is associated with an increased risk, and a plant-based diet seems to have a protective effect. Abundant evidence indicates that adherence to a Mediterranean diet is effective in preventing and treating type 2 diabetes mellitus. Features like its antioxidant and antiinflammatory capacity, along with its association with improved insulin sensitivity, make it ideal in the prevention of GDM. This chapter will summarize current knowledge of the role of the Mediterranean diet in the prevention and management of GDM.

Background: A high adherence (adh.) to a MedDiet pattern was associated with a reduced GDM risk. Studies have shown associations between MTNR1B rs10830963, TCF7L2 rs7903146, MC4R rs17782313 SNPs and GDM risk. The conferring risk could be modified by a MedDiet. This study’s aim was to investigate if the association between the degree of adh. to a MedDiet and GDM incidence is modulated by MTNR1B rs10830963 C>G, TCF7L2 rs7903146 C>T and MC4R rs17782313 T>C polymorphisms. Methods and Findings: 874 women were stratified into 3 groups defined as high, moderate or low adh. according to late first-trimester (>12 gestational weeks) compliance with 6 food targets: vegetables >12 s/w, fruits >12 s/w, juice 3 s/w, consumption of extra virgin olive oil (EVOO) >6 d/w and 40 mL/d EVOO. High adh. was defined as complying with 5-6 targets; moderate 2-4 targets and low 0-1 targets. Patients were genotyped for rs10830963, rs7903146 and rs17782313. Logistic regression analysis was adjusted for ethnicity, age, parity and BMI. Results: There was a significant association between rs10830963 risk allele G and GDM risk (OR) 1.87(1.29-2.73); and fasting 1.77(0.88-2.66) and 1 h glycaemia 6.27 (1.72-10.83) during 75g OGTT (all p Conclusions: MTNR1B, TCF7L2, MC4R genes modulate the effect of a DietMed on the development of impaired glucose metabolism and GDM. Disclosure A. Barabash: None. J. Valerio Deogracia: None. C. Assaf-Balut: None. L. Del Valle: None. N. Garcia de la Torre: None. E. Bordiu: None. A. Duran: None. M. Fuentes: None. J. Ines: None. M. Cuesta: None. M.A. Rubio: None. A.L. Calle: None. Funding Instituto de Salud Carlos III of Spain; Fondo Europeo de Desarrollo Regional; Sociedad de Endocrinolog?a Nutrici?n y Diabetes de la Comunidad de Madrid (IPI/2017/NR2)

A prenatal diet affects materno-foetal outcomes. This is a post hoc analysis of the St. Carlos gestational diabetes mellitus (GDM) Prevention Study. It aims to evaluate the effect of a late first-trimester (&gt, 12 gestational weeks) degree of adherence to a MedDiet pattern&mdash, based on six food targets&mdash, on a composite of materno-foetal outcomes (CMFCs). The CMFCs were defined as having emergency C-section, perineal trauma, pregnancy-induced hypertension and preeclampsia, prematurity, large-for-gestational-age, and/or small-for-gestational-age. A total of 874 women were stratified into three groups according to late first-trimester compliance with six food targets: &gt, 12 servings/week of vegetables, &gt, 12 servings/week of fruits, &lt, 2 servings/week of juice, &gt, 3 servings/week of nuts, &gt, 6 days/week consumption of extra virgin olive oil (EVOO), and &ge, 40 mL/day of EVOO. High adherence was defined as complying with 5&ndash, 6 targets, moderate adherence 2&ndash, 4 targets, low adherence 0&ndash, 1 targets. There was a linear association between high, moderate, and low adherence, and a lower risk of GDM, CMFCs, urinary tract infections (UTI), prematurity, and small-for-gestational-age (SGA) newborns (all p &lt, 0.05). The odds ratios (95% CI) for GDM and CMFCs in women with a high adherence were 0.35((0.18&ndash, 0.67), p = 0.002) and 0.23((0.11&ndash, 0.48), p &lt, 0.001), respectively. Late first-trimester high adherence to the predefined six food targets is associated with a reduction in the risk of GDM, CMFCs, UTI, prematurity, and SGA new-borns.

BackgroundThe consumption of dairy products in pregnancy is widely extended. However, whether the consumption of low or high fat dairy produce is more beneficial for maternofetal health has yet to be established.Research design and methodsThis prospective cohort study evaluated the effect of consumption of dairy products during pregnancy on the frequency of gestational diabetes mellitus (GDM) and a composite of adverse maternofetal outcomes (CMFO). Pregnant women receiving obstetric care between 2014 and 2017 were eligible. Those who consumed ≥3 servings/day of dairy products at 24–28 gestational weeks (GWs) were included and analyzed (n=2004). The population was stratified into three groups according to intake of fat-free dairy products—skimmed milk and fat-free yoghurt and cheese—(days/week): infrequent (1–2), average (3–6) and regular (7). Logistic regression analysis compared ORs (95% CI) for GDM and CMFO between the three groups (where the group of reference was the ‘infrequent’ intake group).ResultsAfter adjusting for confounding factors, no significant associations were found between the degree of consumption of fat-free dairy products and the risk of GDM and a CMFO. Moreover, when categorized by the degree of adherence to the Mediterranean diet (above or below the median score), associations were found between the ‘regular’ intake group and an increased risk of having a CMFO in women with a high adherence to the Mediterranean diet (OR: 1.50; 95% CI: 1.01 to 2.22; pConclusionsThe consumption of fat-free dairy products during pregnancy does not seem to be beneficial for maternofetal health.

An early antenatal dietary intervention could play an important role in the prevention of metabolic diseases postpartum. The aim of this study is to evaluate whether an early, specific dietary intervention reduces women&rsquo, s cardiovascular risk in the &ldquo, fourth trimester&rdquo, This prospective cohort study compares 1675 women from the standard-care group (ScG/n = 676), who received standard-care dietary guidelines, with the intervention group (IG/n = 999), who received Mediterranean diet (MedDiet)-based dietary guidelines, supplemented with extra-virgin olive oil and nuts. Cardiovascular risk was determined by the presence of metabolic syndrome (MetS) and insulin resistance syndrome (IrS) (HOMA-IR 3.5) at 12&ndash, 14 weeks postpartum. MetS was less frequent in the IG (11.3 vs. 19.3%, p &lt, 0.05). The intervention was associated with a reduction in the relative risk of having MetS: 0.74 (95% CI, 0.60&ndash, 0.90), but not in the risk of IrS. When analyzing the presence of having one or more components of the MetS, the IG had significantly higher rates of having 0 components and lower rates of having &ge, 1 (p-trend = 0.029). An early MedDiet-based nutritional intervention in pregnancy is associated with reductions in postpartum rates of MetS.

ObjectivesTo 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.Research design and methodsThis 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 (HbA1c) levels at 36–38 GWs in GDMw and women with normal glucose tolerance (NGTw).ResultsGDMw as compared with NGTw had higher HbA1c 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.ConclusionsUsing 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.