Abstract
Gestational diabetes mellitus (GDM) is a common complication of pregnancy that adversely affects maternal and offspring health. Maternal obesity, oxidative stress, and inflammation have been implicated in GDM. In non-pregnant adults, intakes of dietary bioactive compounds inversely associate with insulin resistance and inflammation. However, associations of dietary bioactive compounds with biomarkers of adiposity, antioxidant vitamin and mineral status, oxidative stress, and inflammation in GDM have not been fully elucidated. We addressed this gap by conducting a semi-quantitative review of observational studies and randomized controlled trials published between 2010 and 2020 and retrieved from Google Scholar, Medline, and PubMed. Our analysis revealed that women with GDM are more likely to consume a pro-inflammatory diet before pregnancy and tend to consume fewer antioxidant vitamins and minerals during pregnancy than healthy pregnant women. Women with GDM also have lower blood levels of vitamins A, C, and D and certain adipokines. Several dietary bioactive compounds were noted to improve antioxidant status and biomarkers of inflammation. The Dietary Approaches to Stop Hypertension (DASH) diet and soybean oligosaccharides increased antioxidant enzyme levels. Supplementing n-3 fatty acids, probiotics, synbiotics, and trace elements increased antioxidant enzymes and reduced hs-CRP and MDA. Improvements in inflammation by vitamin D may be contingent upon co-supplementation with other dietary bioactive compounds.
Gestational diabetes mellitus (GDM) is a common complication of pregnancy that adversely affects maternal and offspring health. Maternal obesity, oxidative stress, and inflammation have been implicated in GDM. In non-pregnant adults, intakes of dietary bioactive compounds inversely associate with insulin resistance and inflammation. However, associations of dietary bioactive compounds with biomarkers of adiposity, antioxidant vitamin and mineral status, oxidative stress, and inflammation in GDM have not been fully elucidated. We addressed this gap by conducting a semi-quantitative review of observational studies and randomized controlled trials published between 2010 and 2020 and retrieved from Google Scholar, Medline, and PubMed. Our analysis revealed that women with GDM are more likely to consume a pro-inflammatory diet before pregnancy and tend to consume fewer antioxidant vitamins and minerals during pregnancy than healthy pregnant women. Women with GDM also have lower blood levels of vitamins A, C, and D and certain adipokines. Several dietary bioactive compounds were noted to improve antioxidant status and biomarkers of inflammation. The Dietary Approaches to Stop Hypertension (DASH) diet and soybean oligosaccharides increased antioxidant enzyme levels. Supplementing n-3 fatty acids, probiotics, synbiotics, and trace elements increased antioxidant enzymes and reduced hs-CRP and MDA. Improvements in inflammation by vitamin D may be contingent upon co-supplementation with other dietary bioactive compounds.
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Key points
Modifying the diet is a key target in the prevention and treatment of GDM. Studies have linked diets with greater intakes of fiber, fruits, green leafy vegetables, and protein from nuts and lean animal proteins such as poultry and fish (all characteristic of the Mediterranean diet) associate with reductions in the risk of GDM. Overall, available data suggest a promising role of dietary bioactive compounds in reducing the risk of GDM. What remains to be elucidated is how these compounds impact biomarkers of adiposity, antioxidant vitamin and mineral status, oxidative stress, and inflammation in women who already have GDM.
The present review synthesized and described the latest data from observational studies and randomized controlled trials (RCTs) on the effects of dietary bioactive compounds on biomarkers of maternal adiposity, antioxidant vitamin and mineral status, oxidative stress, and inflammation in GDM.
Three RCTs supplemented n-3 fatty acids in women with GDM. Jamilian et al. (2020) reported that n-3 fatty acids from flaxseed oil containing alpha-linolenic acid decreased hs-CRP (β = −1.27, p = 0.006) and MDA (β = −0.47, p < 0.001), and increased GSH (β = +116.55, p = 0.006) and total nitrite (β = +5.42, p < 0.001) compared to placebo group. Jamilian et al. (2018) reported that fish oil containing docosapentaenoic acid (DHA) and eicosapentaenoic acid (EPA) decreased hs-CRP by 49% (p = 0.01). Collectively, that n-3 fatty acids reduced hs-CRP and MDA and increased GSH and TAC. The antioxidant effects of n-3 fatty acids were previously demonstrated in adults with hypertriglyceridemia. A 2018 meta-analysis reported decreased biomarkers of inflammation and lipemia in patients with T2DM who ingested n-3 fatty acids, demonstrating that these dietary bioactive compounds may mitigate inflammation.
This review found women with GDM consume more energy, carbohydrates, and fats but smaller amounts of antioxidant vitamins and minerals (vitamin E, selenium, and zinc) than healthy pregnant women. This dietary pattern is undesirable because it promotes maternal obesity, oxidative stress, and inflammation. Data also reveal that a pro-inflammatory diet in the year preceding conception is associated with double the risk of GDM compared to a low-inflammatory diet. Women who develop GDM tend to have lower blood levels of n-3 fats. Supplementing n-3 fatty acids, probiotics, synbiotics, and trace elements also enhances blood antioxidant defenses while reducing inflammation, indicated by lower levels of hs-CRP and MDA.