PLoS ONE (Jan 2017)

A Mediterranean diet with additional extra virgin olive oil and pistachios reduces the incidence of gestational diabetes mellitus (GDM): A randomized controlled trial: The St. Carlos GDM prevention study.

  • Carla Assaf-Balut,
  • Nuria García de la Torre,
  • Alejandra Durán,
  • Manuel Fuentes,
  • Elena Bordiú,
  • Laura Del Valle,
  • Cristina Familiar,
  • Ana Ortolá,
  • Inés Jiménez,
  • Miguel A Herraiz,
  • Nuria Izquierdo,
  • Noelia Perez,
  • María J Torrejon,
  • María I Ortega,
  • Francisco J Illana,
  • Isabelle Runkle,
  • Maria P de Miguel,
  • Carmen Montañez,
  • Ana Barabash,
  • Martín Cuesta,
  • Miguel A Rubio,
  • Alfonso L Calle-Pascual

DOI
https://doi.org/10.1371/journal.pone.0185873
Journal volume & issue
Vol. 12, no. 10
p. e0185873

Abstract

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BACKGROUND:Gestational diabetes mellitus (GDM) prevalence is increasing and becoming a major public health concern. Whether a Mediterranean diet can help prevent GDM in unselected pregnant women has yet to be studied. METHODS:We conducted a prospective, randomized controlled trial to evaluate the incidence of GDM with two different dietary models. All consecutive normoglycemic (<92 mg/dL) pregnant women at 8-12 gestational weeks (GW) were assigned to Intervention Group (IG, n = 500): MedDiet supplemented with extra virgin olive oil (EVOO) and pistachios; or Control Group (CG, n = 500): standard diet with limited fat intake. Primary outcome was to assess the effect of the intervention on GDM incidence at 24-28 GW. Gestational weight gain (GWG), pregnancy-induced hypertension, caesarean section (CS), preterm delivery, perineal trauma, small and large for gestational age (SGA and LGA) and admissions to neonatal intensive care unit were also assessed. Analysis was by intention-to-treat. RESULTS:A total of 874 women completed the study (440/434, CG/IG). According to nutritional questionnaires and biomarker analysis, women in the IG had a good adherence to the intervention. 177/874 women were diagnosed with GDM, 103/440 (23.4%) in CG and 74/434(17.1%) in IG, p = 0.012. The crude relative risk (RR) for GDM was 0.73 (95% CI: 0.56-0.95; p = 0.020) IG vs CG and persisted after adjusted multivariable analysis, 0.75(95% CI: 0.57-0.98; p = 0.039). IG had also significantly reduced rates of insulin-treated GDM, prematurity, GWG at 24-28 and 36-38 GW, emergency CS, perineal trauma, and SGA and LGA newborns (all p<0.05). CONCLUSIONS:An early nutritional intervention with a supplemented MedDiet reduces the incidence of GDM and improves several maternal and neonatal outcomes.