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What is Gestational Diabetes and how to prevent it ? A new clinical randomized trial reveals it all

Gestational diabetes is a form of diabetes that occurs during pregnancy usually being diagnosed between 24-28 weeks, resulting in the mother having elevated blood glucose levels than normal. Treatment is vital. A study was conducted to determine whether a Mediterannean diet( a form of medical nutrition therapy) consumed by pregnant women diagnosed with gestational diabetes would be beneficial in establishing normal blood glucose levels thereby benefiting both the mother in not developing further complications and the baby not being negatively impacted by potential complications associated with gestational diabetes. This study is likely to spark strong interest in attempting to evaluate whether or not a Mediterranean diet serves as a positive factor in helping women with gestational diabetes to normalize their blood glucose to levels comparable to that of women with normal blood glucose. A Mediterranean diet is considered rich in fat, antioxidants and anti-inflammatory ingredients. It  encourages the intake of more fats and less carbohydrates as well as foods that prolong blood glucose levels from rising quickly (low glycemic foods). This study emphasized the consumption of extra virgin olive oil and nuts being implemented in the diet to determine whether pregnant women with gestational diabetes would establish normal levels of hemoglobin A1c. 
  A secondary analysis based on a clinical randomized trial that consisted of pregnant women at twelve weeks of gestation who consented to participation was investigated. The final total participants totaled 874. There were two groups: an intervention group involving pregnant women with gestational diabetes who were placed on the Mediterranean diet having to consume 40 or more mL of extra virgin olive oil and 25-30g(a handful) of pistachio nut in their daily diet and a control group involving women who were not administered any specific dietary/nutritional treatment or therapy. In addition, this analysis also consisted of an inclusion criteria (those who can participate) being pregnant women 18 years or older at their first gestation time-between 8-12 in pregnancy- with a fasting glucose less than 92 mg/dL and an exclusion criteria (who cannot participate) consisting of those having a fasting glucose level of 92 mg/dL or greater at their first gestation time, previously diagnosed with diabetes, had more than one pregnancies, allergies (nut) and additional medical concerns. Screening tests were administered to both groups to test for gestational diabetes and indicated that both groups did have gestational diabetes. Blood glucose levels had to be monitored and the Mediterranean diet intervention began for the purposes of treatment. Insulin was administered as needed if glucose levels were uncontrolled. The two groups were compared on the basis of clinical treatment, lifestyle habits, body weight and gestational age of the newborn (small OR large gestation age) and various post delivery complications.
Based on various statistical analyses, final results indicated that of the 874 participants, 177 pregnant developed gestational diabetes and 697 maintained normal blood glucose levels. However, with the implementation of the Mediterranean diet intervention for three months, women diagnosed with gestational diabetes experienced positive changes  in the remaining 36-38 weeks of pregnancy including: lower gestational weight, lower need for insulin, pregnancy-induced hypertension, urinary tract infections (UTIs), perineal trauma and newborn small gestation age (SGA), lower rate of macrosomia, and lower rate of caesarean section delivery. 
This study indicated that the Mediterranean diet was effective in managing gestational diabetes in that, by the conclusion of the treatment time period, women were able to establish glycemic control similar to those with normal glucose tolerance. In addition, the implementation of this diet decreased the potential of undesirable, excessive weight gain. Despite these findings, the authors suggest conducting continued studies to confirm the results of their study. Their study did find limitations such as follows: data was more qualitative than quantitative since pregnant women are not encouraged to implement strict diets but rather nutritional counseling. Furthermore, women were placed in the intervention group prior to diagnosis and had already engaged in the Mediterranean diet. However, the final conclusion based on the study indicated that the Mediterranean diet was beneficial in managing gestational diabetes in many aspects as shown by results.

Reference
Assaf-Balut, Carla,Garcia de la Torre, Nuria, Duran, Alejandra, et al. 2018.  Medical nutrition therapy for gestational diabetes mellitus based on Mediterranean Diet principles: a subanalysis of the St Carlos GDM Prevention Study. BMJ Open Diabetes Research & Care, (6), 1-11.
doi:10.1136/bmjdrc-2018-000550

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