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Position Paper Pregnancy based on Literature Review
- 1. POSITION PAPER: PREGNANCY M S . R O M E LY N L A N G U I D O
- 2. CAN A PL ANT-BASED DIET REDUCE THE RISK OF GESTATIONAL DIABETES?
- 3. G D M - R E F E R S T O A B N O R M A L G L U C O S E T O L E R A N C E A N D E X H I B I T S A B N O R M A L B L O O D G L U C O S E L E V E L S W I T H O N S E T O R F I R S T R E C O G N I T I O N D U R I N G P R E G N A N C Y (Sweeting et al., 2022)
- 4. CAN A PLANT-BASED DIET REDUCE THE RISK OF GESTATIONAL DIABETES?
- 5. They found that 19% reduction in risk for gestational diabetes in those who had followed a richer overall plant-based diet before pregnancy after adjusting for age, parity, race, family history of diabetes, smoking, physical activity, alcohol, total energy, margarine intake, and body mass index (Medscape Medical News, 2020).
- 6. BENEFICIAL INFLUENCES OF A PLANT-BASED DIET ON GESTATIONAL DIABETES MELLITUS • A plant-based diet is rich in fibers, magnesium, potassium, and antioxidants but presents a lower intake of saturated fatty acids. • A plant-based diet can exert its role in the prevention of GDM via multiple mechanisms of action Schiattarell, A., Lombardo, M., Morlando, M., & Rizzo, G. ( 2021). The Impact of a Plant-Based Diet on Gestational Diabetes: A Review. Antioxidants.; 10(4):557. https://doi.org/10.3390/antiox10040557
- 8. (SCHIATTARELL ET AL ., 2021)
- 9. -Animal origin increased the risk of GDM by 50%, whereas an intake of protein sourced from vegetables was protective by 30%. -Replacing 5% energy of animal protein for a protein of plant origin reduced GDM risk by 51%.
- 10. • Meta-analyses further showed that the risk of GDM was about halved amongst women with the highest score of Mediterranean diet compared to those with the lowest score. The results suggest that dietary patterns rich in polyphenols may reduce the risk of GDM.
- 11. Among dietary components, polyphenols are getting increasing attention due to their putative role in the beneficial effects of plant foods and plant-based diets (Rodriguez-Mateos, 2021).
- 14. • Gut microbiota contribute to gestational metabolic changes through different mechanisms (Ponzo et al., 2019).
- 15. POSITION STATEMENT Based on the reviewed literature, it is concluded that plant-based diet can reduce the risk of gestational diabetes. The adoption of a healthy lifestyle, with adherence to a healthy dietary pattern, has positive effects on the prevention and management of gestational diabetes mellitus.
- 16. REFERENCES Mack, L., & Tomich, P. (2017). Gestational Diabetes: Diagnosis, Classification, and Clinical Care, Obstetrics and Gynecology Clinics of North America, Volume 44, Issue 2, Pages 207-217. ISSN 0889-8545, ISBN 9780323530194. https://doi.org/10.1016/j.ogc.2017.02.002. http://ndl.ethernet.edu.et/bitstream/123456789/56885/1/15.pdf#page=131 Medscape Medical News. (2020). Gestational Diabetes Cut with Plant-Based Diet Before Pregnancy. https://www.medscape.com/viewarticle/932548 Mijatovic-Vukas, J., Capling, L., Cheng, S., Stamatakis, E., Louie, J., Cheung, N.W., Markovic, T., Ross, G., Senior, A., Brand-Miller, J.C., & Flood, V.M. (2018). Associations of Diet and Physical Activity with Risk for Gestational Diabetes Mellitus: A Systematic Review and Meta-Analysis. Nutrients 10, 698. https://doi.org/10.3390/nu10060698 https://www.mdpi.com/2072-6643/10/6/698#cite Ponzo, V., Fedele, D., Goitre, I., Leone, F., Lezo, A., Monzeglio, C., Finocchiaro, C., Ghigo, E., & Bo, S. (2019). Diet-Gut Microbiota Interactions and Gestational Diabetes Mellitus (GDM). Nutrients 11, 330. https://doi.org/10.3390/nu11020330 https://www.mdpi.com/2072-6643/11/2/330 Pham, N.M., Do, V.V. & Lee, A.H. (2019). Polyphenol-rich foods and risk of gestational diabetes: a systematic review and meta-analysis. Eur J Clin Nutr 73, 647–656. https://doi.org/10.1038/s41430-018-0218-7 https://www.nature.com/articles/s41430-018-0218-7#citeas Pistollato, F., Cano, S., Elio,I., Vergara, M., Giampieri, F., & Battino, M. (2015). Plant-Based and Plant-Rich Diet Patterns during Gestation: Beneficial Effects and Possible Shortcomings, Advances in Nutrition, Volume 6, Issue 5, Pages 581–591, https://doi.org/10.3945/an.115.009126 https://academic.oup.com/advances/article/6/5/581/4558100?login=true Rodriguez-Mateos, A. (2021). Can (poly)phenols lower the risk of gestational diabetes? The Journal of Nutrition, Volume 151, Issue 5, Pages 1057–1058. https://doi.org/10.1093/jn/nxab062 https://academic.oup.com/jn/article-abstract/151/5/1057/6218112?redirectedFrom=fulltext Santangelo, C., Zicari, A., Mandosi, E., Scazzocchio, B., Mari, E., Morano, S., & Masella, R. (2016). Could gestational diabetes mellitus be managed through dietary bioactive compounds? Current knowledge and future perspectives. British Journal of Nutrition,115(7), 1129-1144. doi:10.1017/S0007114516000222 https://www.cambridge.org/core/journals/british-journal-of-nutrition/article/could-gestational-diabetes-mellitus-be-managed-through-dietary-bioactive- compounds-current-knowledge-and-future-perspectives/448B1060ECA4A8A6E6F98416CFA56914 Schiattarell, A., Lombardo, M., Morlando, M., & Rizzo, G. (2021). The Impact of a Plant-Based Diet on Gestational Diabetes: A Review. Antioxidants.; 10(4):557. https://doi.org/10.3390/antiox10040557 https://www.mdpi.com/2076-3921/10/4/557 Sweeting, A., Wong, J., Murphy, H., & Ross, G. (2021). A clinical update on Gestational Diabetes Mellitus, Endocrine Reviews. bnac003. https://doi.org/10.1210/endrev/bnac003https://academic.oup.com/edrv/advance-article-abstract/doi/10.1210/endrev/bnac003/6511028
Editor's Notes
- Gestational diabetes mellitus or GDM is a growing problem of pregnant women worldwide. Traditionally it refers to abnormal glucose tolerance and exhibits abnormal blood glucose levels with onset or first recognition during pregnancy. Gestational diabetes mellitus (GDM) affects approximately 6% of pregnant women, and an estimated 5 to 7% of pregnancies are complicated by diabetes, and almost 80% is GDM. The prevalence is increasing in parallel with the obesity epidemic (Sweeting et al., 2022; Mack & Tomich, 2017; Schiattarell, 2021). Gestational diabetes mellitus (GDM) is a condition where women without a previous diagnosis of diabetes exhibit abnormal blood glucose levels during pregnancy. In normal pregnancy pancreatic B-cell hyperplasia occurs from the stimulation of human placental lactogen and prolactin, resulting in higher insulin levels. Placental secretion of diabetogenic hormones, such as growth hormone, corticotropin- releasing hormone, placental lactogen, and progesterone, leads to increasing insulin resistance. The inability to overcome the insulin resistance of pregnancy despite B-cell hyperplasia leads to GDM. GDM in turn carries increased risks for the mother and neonate to include preeclampsia, birth weight over 4000 grams, and shoulder dystocia. Therefore, the identification and management of GDM is important (Mack & Tomich, 2017).
- Medscape Medical News (2020) reported that according to Frank Qian, MD, from the Harvard T.H. Chan School of Public Health, Boston, Massachusetts, said that a pre-pregnancy plant-based diet, particularly one that also limits unhealthful plant-based foods such as refined grains, potatoes, and sugar-sweetened foods and beverages, may be associated with a lower risk of gestational diabetes. They found that 19% reduction in risk for gestational diabetes in those who had followed a richer overall plant-based diet before pregnancy after adjusting for age, parity, race, family history of diabetes, smoking, physical activity, alcohol, total energy, margarine intake, and body mass index (BMI). Consumption of certain animal-based foods, particularly red and processed meats, is reduced which seems particularly adverse in terms of increasing gestational diabetes risk.
- In the study conducted by Schiattarell et al. (2021), nutritional patterns enriched with plant-derived foods, such as a low glycemic or Mediterranean diet, favorably impact the incidence of GDM. A plant-based diet is rich in fibers, magnesium, potassium, and antioxidants but presents a lower intake of saturated fatty acids. A plant-based diet can exert its role in the prevention of GDM via multiple mechanisms of action. Antioxidant compounds decrease inflammation by a high intake of vegetables, fibers, and fruits. This aspect contributes to improving insulin efficacy and metabolic control and provides maternal and neonatal health benefits. Microbiome Interaction- diet plays a large role in determining what kinds of microbiota live in the colon. [2] All of these factors create a unique microbiome from person to person. A high-fiber diet in particular affects the type and amount of microbiota in the intestines. Anti-oxidant - Supplementation with antioxidants and the medicinal plants which possess antioxidants activity have been reported their hypoglycemic activity. Lower intake of saturated fatty acid- Accumulation of saturated fat increases the amount of diacylglycerol in the muscles, which has been demonstrated to have a potent effect on muscle insulin resistance Anti- infalmmatory effect- As type 2 diabetes starts to develop, the body becomes less sensitive to insulin and the resulting insulin resistance also leads to inflammation. A vicious cycle can result, with more inflammation causing more insulin resistance and vice versa. higher potassium and magnesium intake- High blood sugar damages the kidneys, which normally remove extra potassium from your body. People with diabetes and high potassium are more likely to have heart problems and other complications. Non heme iron- plant-based eaters can still meet their daily iron needs by eating plenty of non-heme rich plant foods, like dark leafy greens, whole grains, legumes, dried fruits, nuts, and seeds. Low glycemic pattern- The low-glycemic food will help counter the effect of the high-glycemic food, so your blood sugar may rise more slowly.
- Bao and colleagues reported that an intake of protein from animal origin increased the risk of GDM by 50%, whereas an intake of protein sourced from vegetables was protective by 30%. Replacing 5% energy of animal protein for a protein of plant origin reduced GDM risk by 51%. A Mediterranean Diet is protective and reduces the risk of GDM by 15–38%. The protective association may extend to reducing future risk of type 2 diabetes (by 19–23%), increasing the chance of remission (by 49%), and protection against cardiovascular diseases with extra virgin olive oil and plant-based dietary components in the diet (Mijatovic-Vukas et al., 2018).
- Meta-analyses further showed that the risk of GDM was about halved amongst women with the highest score of the Mediterranean diet and that dietary patterns rich in polyphenols reduce the risk of GDM (Pham et al., 2019).
- Studies have investigated the potential role of polyphenols in the prevention or management of gestational diabetes mellitus (GDM). Among dietary components, polyphenols are getting increasing attention due to their putative role in the beneficial effects of plant foods and plant-based diets (Rodriguez-Mateos, 2021).
- Growing evidence indicates that polyphenols, contained in fruits and vegetables, might influence glucose homoeostasis by several mechanisms such as by (i) inhibiting carbohydrate digestion and glucose absorption in the intestine, (ii) stimulating insulin secretion from pancreatic β-cells, (iii) modulating glucose release from liver and (iv) activating insulin receptors and glucose uptake in insulin-sensitive tissues indicate that almost all subclasses of flavonoids, as well as the stilbene RSV and some olive oil phenolic compounds, interact and modulate several molecular pathways regulating insulin sensitivity in pancreatic β-cell, adipocyte, liver and muscle. Polyphenols drive activation and/ or silencing of transcription factors and consequently influence genes expression. Moreover, the fact that miRNA are the target of polyphenols action is to be taken into account in the future studies aimed at improving the understanding of the biological effects of polyphenols(Santangelo et al., 2016)
- This was also supported by the study of Pistollato et al. (2015), diets characterized by low intakes of fiber and a high glycemic load are associated with an increased risk of GDM. On the contrary, the high intake of fiber reduces the risk of GDM.
- increased Proteobacteria/Actinobacteria abundance, Roseburia intestinalis and Faecalibacterium prausnitzii reduction, and α-diversity decrease.Gestational weight gain has been associated with higher concentrations of Bacteroides species , Staphylococcus, Enterobacteriaceae and Escherichia coli , reduced abundance of Bifidobacterium and Akkermansia muciniphila, and lower α-diversity Many correlations among specific taxa and gestational metabolic variables have been found, such as direct relationships between Collinsella and circulating levels of insulin, triglycerides, and very-low-density lipoproteins; Sutterella and C-reactive protein; Ruminococcaceae/Lachnospiraceae and leptin; Bacteroidaceae and ghrelin; Coprococcus and gastrointestinal polypeptide (GIP). Moreover, inverse relationships between Blautia and insulin values; Faecalibacterium/Fusobacterium ratios and blood glucose; Odoribacter and arterial blood pressure; Ruminococcaceae and GIP, and Prevotellaceae and ghrelin have been reported. Therefore, gut microbiota might contribute to gestational metabolic changes through different mechanisms, although further studies on this topic are necessary The physiological insulin resistance of late-pregnancy is accentuated in women developing GDM, thus their insulin secretion is not sufficient to maintain euglycemia, leading to glucose intolerance Overall, insulin resistance has been found to be associated with a higher Firmicutes/Bacteroidetes ratio and a reduced abundance of butyrate-producing bacteria such as Roseburia and Faecalibacterium prausnitzii
- Based on the reviewed literature, a plant-based diet can reduce gestational diabetes mellitus. The adoption of a healthy lifestyle, with adherence to a healthy dietary pattern, has positive effects on the prevention and management of gestational diabetes mellitus. The wide variety of benefits from a plant-based diet is evident from the different cohort studies showing the wonder of nature which is very convenient and is accepted by the body. Among the reviewed studies, improving gut health hooked me the most. It is important to every person regardless of their health condition. Pregnancy is a crucial time where the mother should strengthen her immunity for her and her child. Healthy food is useless if we do not have a healthy gut that is responsible for the absorption of the nutrients the body needs and other gestational metabolic mechanisms that provide immunity to have a healthier body. The percentage result of the reduction of the risk of gestational diabetes mellitus of different studies is also significant. It is only showing the efficacy of a plant-based diet in pregnant women in reducing the risk of GDM.