Effectiveness of Following Mediterranean Diet Recommendations in the Real World in the Incidence of Gestational Diabetes Mellitus (GDM) and Adverse Maternal-Foetal Outcomes: A Prospective, Universal, Interventional Study with a Single Group. The St Carlos Study

We reported that a Mediterranean Diet (MedDiet), supplemented with extra-virgin olive oil (EVOO) and pistachios, reduces GDM incidence and several other adverse outcomes. In order to assess its translational effects in the real world we evaluated the effect of MedDiet from 1st gestational visit in GDM rate compared with control (CG) and intervention (IG) groups from the previously referred trial. As secondary objective we also compared adverse perinatal outcomes between normoglycemic and diabetic women. This trial is a prospective, clinic-based, interventional study with a single group. 1066 eligible normoglycaemic women before 12 gestational weeks were assessed. 932 women (32.4 ± 5.2 years old, pre-gestational BMI 22.5 ± 3.5 kg/m2) received a motivational lifestyle interview with emphasis on daily consumption of EVOO and nuts, were followed-up and analysed. Binary regression analyses were used to examine the risk for each pregnancy outcome, pregnancy-induced hypertension, preeclampsia, gestational weight gain (GWG), caesarean-section, perineal trauma, preterm delivery, small (SGA) and large for gestational age (LGA), and Neonatal Intensive Care Unit admissions. GDM was diagnosed in 13.9%. This rate was significantly lower than the CG: RR 0.81 (0.73–0.93), p < 0.001 and no different from the IG: RR 0.96 (0.85–1.07), p = 0.468. GWG was lower in diabetic women (10.88 ± 6.46 vs. 12.30 ± 5.42 Kg; p = 0.013). Excessive weight gain (EWG) was also lower in GDM [RR 0.91 (0.86–0.96); p < 0.001] without a significant increase of insufficient weight gain. LGA were also lower (1 (0.8%) vs. 31 (3.9%); p < 0.05)), and SGA were similar (5 (3.8%) vs. 30 (3.7%)). LGA were associated to EWG (RR 1.61 (1.35–1.91), p < 0.001). Differences in other maternal-foetal outcomes were not found. In conclusions an early MedDiet nutritional intervention reduces GDM incidence and maternal-foetal adverse outcomes and should be universally applied as 1st line therapy. GDM might not be consider as a high risk pregnancy any longer

Prevalencia de las disfunciones en los movimientos sacádicos, habilidades perceptuales visuales e integración visomotora en niños emétropes entre seis y siete años de estratos 1 y 2 de la ciudad de Bogotá

Objective: to determine the prevalence of dysfunctions in saccadic movements, visual perceptual skills and visual-motor integration in emmetropic children between the ages of six and seven from socio-economic levels 1 and 2 in Bogota. This study is part of the macroproject Influence of visual perceptual skills, visual-motor integration and saccadic movements in the reading and writing process. Methodology: An observational descriptive study was conducted. Patients between the ages of six and seven were assessed. Clinically emmetropic patients underwent TVPS-3 testing (visual-perceptual skills), Beery VMI (visual motor integration) and DEM (saccadic movements). For statistical analysis, a database in Excel was used to record the results of the test, and correlation tests were used in the SPSS program for the bivariate analysis. Results: Results revealed a prevalence of visoperceptual dysfunction by 42.89% (41/91), visual-motor dysfunction by 97.39% (89/91) and saccadic movements dysfunction by 80.14% (73/91) in the group of six-year-old children. They also revealed visoperceptual dysfunction by 36.74% (43/117), visual-motor dysfunction by 100% (117/117) and saccadic movements dysfunction by 61.19% (81/117) in the group of seven-year-old children. Conclusions: Children of six and seven years of age have a low prevalence of visoperceptual skill alterations, a high prevalence of dysfunctions in visual-motor integration and a high prevalence of saccadic movement dysfunctions measured by the DEM, where types 3 and 4 are predominant.Objetivo: determinar la prevalencia de disfunciones en los movimientos sacádicos, habilidades perceptuales visuales e integración visomotora en niños emétropes entre seis y siete años de estratos 1 y 2 de la ciudad de Bogotá. Este estudio hace parte del macro proyecto Influencia de las habilidades perceptuales visuales, la integración visomotora y los movimientos sacádicos en el proceso de lectoescritura. Metodología: se realizó un estudio descriptivo observacional. Se evaluaron pacientes con edades entre seis y siete años. A los clínicamente emétropes se les aplicaron las pruebas TVPS-3 (habilidades visoperceptuales), Beery VMI (integración visomotora) y DEM (movimientos sacádicos). Para el análisis estadístico se utilizó una base de datos en Excel para registrar los resultados de los test, y para el análisis bivariado se utilizaron pruebas de correlación en el programa SPSS. Resultados: en los niños de seis años se encontró prevalencia en disfunción visoperceptual en un 42,89 % (41/91), disfunción visomotora en 97,39 % (89/91) y disfunción en los movimientos sacádicos en 80,14 % (73/91). En los niños de siete años se encontró disfunción visoperceptual en 36,74 % (43/117), disfunción visomotora en un 100 % (117/117) y disfunción en los movimientos sacádicos en 61,19 % (81/117). Conclusiones: los niños de seis y siete años tienen una baja prevalencia de alteraciones de habilidades visoperceptuales, una alta prevalencia de disfunciones en la integración visomotora y una alta prevalencia de disfunciones en los movimientos sacádicos medidos por el DEM, donde predominan los tipos 3 y 4.

Modifiable Risk Factors and Trends in Changes in Glucose Regulation during the First Three Years Postdelivery: The St Carlos Gestational Diabetes Mellitus Prevention Cohort

Author Contributions: M.A.-R., A.B., A.L.C.-P., A.D., P.M.-M., M.A.R., P.d.M., J.A.D., L.d.V., V.M., J.V., I.R., M.P. and R.M.O. were involved in conceptualization and design, data curation, analysis, and interpretation of data. A.L.C.-P. was responsible for funding acquisition. A.L.C.-P., C.F., I.M., I.J., M.A.-R., M.J.T., M.M.-N., M.P., A.D., P.d.M., A.B., L.d.V., V.M., J.V. and R.M.O. were involved in supervision, validation, and visualization of researched data, and contributed to discussion and investigation. M.C., M.P., P.M.-M., M.A.-R. and M.A.R. were involved in data research and reviewed and edited the manuscript. Writing—original draft: A.L.C.-P., M.A.-R., V.M., I.R. and P.M.-M. wrote the first draft of the manuscript. Writing—review & editing: M.A.-R., A.L.C.-P., P.M.-M., V.M., and I.R. A.L.C.-P. is the guarantor of this work and, as such, had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. All authors have read and agreed to the published version of the manuscript.Objective: Evaluation of the influence of potential risk factors (RFs) on glycemic changes at 3 years postpartum. Methods: The glycemic status of 1400 women, in absence of a new pregnancy, was evaluated at 3 months (3 m) and 3 years (3 y) postpartum, after participation in the St. Carlos Gestational Study (2228 normoglycemic pregnant women followed from before gestational week 12 to delivery, from 2015–2017). Abnormal glucose regulation (AGR) was defined as fasting serum glucose ≥ 100 mg/dL and/or HbA1c ≥ 5.7% and/or 2 h 75 g OGTT glucose ≥ 140 mg/dL. In total, 12 modifiable and 3 unmodifiable RFs were analyzed. Results: 3 m postpartum, 110/1400 (7.9%) women had AGR; 3 y postpartum, 137 (9.8%) women exhibited AGR (110 with 3 m normal glucose tolerance [NGT]); 1263 (90.2%) had NGT (83 with 3 m AGR). More women with gestational diabetes mellitus (GDM) progressed to AGR at 3 y (OR: 1.60 [1.33–1.92]) than women without GDM. Yet, most women with 3 m and/or 3 y AGR had no GDM history. Having ≥2 unmodifiable RFs was associated with increased risk for progression to AGR (OR: 1.90 [1.28–2.83]) at 3 y postpartum. Having >5/12 modifiable RFs was associated with increased progression from NGT to AGR (OR: 1.40 [1.00–2.09]) and AGR persistence (OR: 2.57 [1.05–6.31]). Pregestational BMI ≥ 25 kg/m2 (OR: 0.59 [0.41–0.85]), postdelivery weight gain (OR: 0.53 [0.29–0.94]), and waist circumference > 89.5 cm (OR: 0.54 [0.36–0.79]) reduced the likelihood of NGT persisting at 3 y. Conclusions: 3-month and/or 3-year postpartum AGR can be detected if sought in women with no prior GDM. Modifiable and unmodifiable RF predictors of AGR at 3 y postpartum were identified. Universal screening for glycemic alterations should be considered in all women following delivery, regardless of prior GDM. These findings could be useful to design personalized strategies in women with risk factors for 3 y AGR.Ministerio de Ciencia, Innovación y Universidades (España)Depto. de MedicinaFac. de MedicinaTRUEpu

An Early, Universal Mediterranean Diet-Based Intervention in Pregnancy Reduces Cardiovascular Risk Factors in the “Fourth Trimester”

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’s cardiovascular risk in the “fourth trimester”. 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 12–14 weeks postpartum. MetS was less frequent in the IG (11.3 vs. 19.3%, p < 0.05). The intervention was associated with a reduction in the relative risk of having MetS: 0.74 (95% CI, 0.60–0.90), 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 ≥1 (p-trend = 0.029). An early MedDiet-based nutritional intervention in pregnancy is associated with reductions in postpartum rates of MetS