Home Effect of dietary pattern on pregnant women with gestational diabetes mellitus and its clinical significance
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Effect of dietary pattern on pregnant women with gestational diabetes mellitus and its clinical significance

  • Jianping Wang EMAIL logo , Zuoliang Xie , Peipei Chen , Yuhuan Wang , Baoqing Li and Fen Dai
Published/Copyright: March 19, 2022
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Open Life Sciences
From the journal Open Life Sciences Volume 17 Issue 1

Abstract

Gestational diabetes mellitus (GDM) is a common obstetric disease among pregnant women. This study aimed to explore the effect of dietary pattern management to reduce the incidence of GDM. Here, we, retrospectively, analyzed the influence of dietary patterns on the occurrence of GDM and the correlation between dietary patterns and intestinal microbiome distribution and inflammation in pregnant women. Moreover, patients were assigned to the dietary pattern management group and the nondietary pattern management group, and the effects of dietary patterns on the intestinal microbiome distribution and inflammatory factors were investigated. We found that the intestinal microbiome was changed in GDM patients compared with the healthy controls. The relative abundance of probiotics Lactobacillus and Bifidobacterium significantly decreased in patients with GDM. Moreover, compared with the control group, the expression levels of interleukin-6 and tumor necrosis factor-α were significantly increased. Furthermore, dietary pattern management led to intestinal microbiome changes in patients with GDM. In conclusion, dietary pattern management could alleviate GDM via affecting the intestinal microbiome as well as inflammatory conditions in patients.

Keywords: GDM; dietary pattern management; intestinal microbiome; inflammation

1 Introduction

Gestational diabetes mellitus (GDM) is a common obstetric disease with a high incidence rate among pregnant women [1,2,3]. According to the epidemiological investigation in China, the prevalence of GDM is about 20% [4,5,6]. Unfortunately, at present, the exact pathogenesis of GDM has not been fully elucidated, and in some cases, GDM can progress to type 2 diabetes mellitus [2,7]. Therefore, further exploration of the underlying mechanism of the disease is of great importance for discovering new biomarkers and therapeutic targets.

Earlier studies have pointed out the potential role of the gut microbiome in different diseases [8,9,10]. For example, intestinal dysbacteriosis means the abnormal changes of the intestinal microbiome might result in aberrant immune response in the colorectal tissue, which further induces the chronic inflammatory condition and consequentially induces the epithelial–mesenchymal transition of the epithelial cells and finally leads to the incidence of different disease. The roles of the gut microbiome in GDM have also been discussed previously [11,12]. Therefore, alleviating the intestinal dysbacteriosis condition may be an alternative approach for treating different GDM.

However, the effect of dietary patterns on GDM has also been discussed previously [13,14]. It was found that smart dietary patterns and vegetable dietary patterns had a protective effect against GDM and could reduce the risk of GDM [15,16]. The above two dietary patterns are rich in dietary fiber and trace elements, reducing glucose absorption and plasma insulin level and improving pancreatic function Island element sensitivity, reducing the production of reactive oxygen species, and reducing the inflammatory condition. Zareei et al. [17] studied the correlation between dietary status and GDM in 208 pregnant women at 24–28 weeks of gestation through a food frequency questionnaire. The results showed that a healthy diet rich in fruits, vegetables, and low-fat dairy products could effectively reduce the risk of GDM. At the same time, other studies [18,19,20] also confirmed that excessive intake of refined cereals, lipids, sugars compared to a small amount of fruits and vegetables before and during pregnancy will increase the incidence of GDM, suggesting that adverse dietary patterns and lifestyle can affect the production of intestinal flora and inflammatory factors, such as C-reactive protein, thus promoting the rise of fasting blood glucose and abnormal glucose tolerance.

The purpose of this study is to explore good dietary pattern management to reduce the incidence of GDM, adjust the distribution of intestinal microbiome, protect intestinal mucosa, reduce inflammatory exudation, and reduce insulin resistance, therefore, to find a new way to treat GDM and reduce the risk of GDM to mothers and infants.

2 Materials and methods

2.1 Patients

From January 2019 to May 2020, GDM pregnant women (n = 54) with a gestational period of 24–28 weeks and healthy controls (n = 117) in the obstetrics department of the Department of Obstetrics and Gynecology, the Second Affiliated Hospital of Wenzhou Medical University were enrolled in the present study. Inclusion criteria were (1) pregnant women meeting GDM diagnostic criteria (edited by Lejie, 8th edn.) and (2) age: 18–40 years old; exclusion criteria: (1) multiple pregnancies, (2) history of hypertension and diabetes, (3) other complications during pregnancy, such as polyhydramnios, oligohydramnios, and preeclampsia, (4) patients with infectious diseases, (5) taking hormone drugs before screening, and (6) unable to cooperate. GDM pregnant women were randomly allocated into two groups, and the specific randomized assignment was completed by medical statistics professionals. According to the results of sample size estimation, the subjects were randomly assigned into two groups by simple randomization (by random number generator using SPSS). The experimental group and the control group, the dietary pattern management group (the dietary pattern extracted from the pregnant women meeting GDM diagnostic criteria), and the nondietary pattern management group. The dietary pattern management group included in this study refers to that pregnant women have visited the nutrition department clinic at least twice after determining GDM. Therefore, under the guidance of professionals, they can follow it well. The balanced dietary structure is as follows: carbohydrates account for 50–60%, appropriately increasing protein intake accounts for 20–30%, and controlling fat intake accounts for 15–20%.

  1. Informed consent: Informed consent has been obtained from all individuals included in this study.

  2. Ethical approval: The research related to human use has been complied with all the relevant national regulations, institutional policies, and in accordance with the tenets of the Helsinki Declaration and has been approved by the authors’ institutional review board or equivalent committee.

2.2 Sample collection and calculation of the relative abundance of the fecal bacteria

An appropriate amount of fresh feces of the objects were collected and sent for inspection within half an hour. A total of 0.1 g fecal sample and 0.9 mL normal saline were added into a disposable centrifuge tube for mixing, and after mixing, they were diluted in series. The relative abundance of the fecal bacteria in stool samples has been calculated by quantitative polymerase chain reaction (qPCR) methods. Briefly, RNAs were isolated from the stool samples, and PCR was performed using the qPCR Green Master Mix kit (Takara, Dalian, China). The thermocycling conditions have been set as 95°C for 3 min, followed by 40 cycles of 95°C for 15 s, and 72°C for 30 s. Relative abundance of the bacteria were calculated as follows:

( DNA concentration (ng/μL) × [ 6.022 × 10 23 ] ) / (Length of template (bp) × [ 1 × 10 9 ] × 650 ) .

2.3 Enzyme linked immunosorbent (ELISA) assay

The expression levels of interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) were examined by ELISA method. The ELISA was conducted with the kits purchased from Beyotime (Shanghai, China). All procedures were strictly followed by the protocol of the manufacturer.

2.4 Statistical analysis

All experiments were carried out in triplicate. All data were analyzed using SPSS 19.0 software (SPSS Inc., Chicago IL, USA). The values were presented as mean ± SD. Statistical significance was analyzed using unpaired student’s t-test. p-value of less than 0.05 was considered statistically significant.

3 Results

3.1 Demographic characteristic of the patients and controls

The demographic characteristic of the patients and controls were as follow. The age of the GDM and control group is 27.97 ± 4.09  vs 30.24 ± 5.25, p = 0.0005; gravidity is 2.09 ± 1.23  vs 2.17 ± 1.33, p > 0.05; gestational weeks is 25.80 ± 0.88  vs 25.96 ± 0.91, p > 0.05; and fasting blood glucose is 4.40 ± 0.32  vs 4.76 ± 0.49, p < 0.001.

3.2 Elevated expression of IL-6 and TNF-α in serum of the GDM patients

First, the expression levels of IL-6 and TNF-α in the serum of the GDM patients and healthy controls were compared. As shown in Figure 1, compared with the control group, the expression level of IL-6 (1.062 ± 0.4897  vs 1.265 ± 0.7115, *p < 0.05) and TNF-α (260.9 ± 520.0  vs 452.0 ± 645.4, *p < 0.05) were both significantly increased.

Figure 1 Elevated expression of IL-6 and TNF-α in serum of the GDM patients: (a) comparison of the serum level of IL-6 between control and GDM group and (b) comparison of the serum level of TNF-α between control and GDM groups. *p < 0.05, **p < 0.01.
Figure 1

Elevated expression of IL-6 and TNF-α in serum of the GDM patients: (a) comparison of the serum level of IL-6 between control and GDM group and (b) comparison of the serum level of TNF-α between control and GDM groups. *p < 0.05, **p < 0.01.

3.3 Analysis of the relative abundance of probiotics in GDM and control groups

Furthermore, the relative abundance of probiotics Lactobacillus and Bifidobacterium in the stool of the GDM and control patients were determined by real-time quantitative polymerase chain reaction (RT-qPCR) method. As shown in Figure 2, the relative abundance of Lactobacillus (7.643 ± 4.981  vs 5.726 ± 2.019, **p < 0.01) and Bifidobacterium (7.515 ± 5.421  vs 1.955 ± 1.408, ***p < 0.001) significantly decreased in patients with GDM in comparison with the controls.

Figure 2 The relative abundance of Lactobacillus and Bifidobacterium in stools of patients with GDM in comparison with the controls: (a) the relative abundance of Lactobacillus and (b) the relative abundance of Bifidobacterium. **p < 0.01, ***p < 0.001.
Figure 2

The relative abundance of Lactobacillus and Bifidobacterium in stools of patients with GDM in comparison with the controls: (a) the relative abundance of Lactobacillus and (b) the relative abundance of Bifidobacterium. **p < 0.01, ***p < 0.001.

3.4 Effect of dietary pattern on the relative abundance of fecal microbiota in GDM patients

Finally, the patients were randomly divided into nondietary and dietary pattern management groups, and the relative abundance of fecal microbiota was examined. As shown in Figure 3, after pattern management, the relative abundance of probiotics Lactobacillus (5.996 ± 2.024  vs 7.070 ± 1.667, **p < 0.01) and Bifidobacterium (2.156 ± 1.569  vs 2.670 ± 1.338, *p < 0.05) markedly increased, whereas the relative abundance of probiotics Lactobacillus (5.456 ± 2.016  vs 5.886 ± 2.238, p > 0.05) and Bifidobacterium (1.754 ± 1.222  vs 1.897 ± 0.9502, p > 0.05) did not significantly change in the nondietary pattern management group.

Figure 3 Effect of dietary pattern on the relative abundance of fecal microbiota in GDM patients: (a) the relative abundance of Lactobacillus and (b) the relative abundance of Bifidobacterium. **p < 0.01, ***p < 0.001.
Figure 3

Effect of dietary pattern on the relative abundance of fecal microbiota in GDM patients: (a) the relative abundance of Lactobacillus and (b) the relative abundance of Bifidobacterium. **p < 0.01, ***p < 0.001.

4 Discussion

In the present study, we focused on the roles of dietary patterns on pregnant women with GDM. We found that dietary patterns could alleviate the GDM condition by decreasing the inflammatory condition and affecting the fecal microbiota.

At present, the pathogenesis of GDM is not completely clear. The levels of insulin-antagonistic hormones such as prolactin, estrogen, progesterone, and cortisol in the placenta of pregnant women increase during pregnancy, which leads to physiological insulin resistance [21]. The increase of glucose intake and body weight of pregnant women aggravates insulin resistance during pregnancy. In recent years, studies have found that GDM is caused by the changes of hormones in pregnancy, the decrease of insulin sensitivity, and the antagonism of hormones related to insulin level regulation [22]. With the deepening of research, researchers found that the human body produces a variety of cytokines, such as TNF-α and IL-6, which play an important role in the pathogenesis of GDM. IL-6 can promote the production of TNF-α in the inflammatory response, whereas TNF-α from adipose tissue and placenta can promote insulin resistance in pregnant women, which is closely related to the pathogenesis of GDM [23,24]. In the present study, we found that the expression level of IL-6 and TNF-α were significantly increased in the GDM group, which was consistent with earlier findings, suggesting that inflammation plays a vital role in the occurrence and development of GDM.

However, studies have confirmed that excessive energy storage caused by intestinal microbiota imbalance and metabolic endotoxemia play an important role in the pathogenesis of GDM [25]. Results of earlier studies suggested that the levels of intestinal microbiota were positively correlated with the serum levels of TNF-α and IL-6. Probiotics such as Bifidobacterium can affect the imbalance of intestinal microbiota and prevent the occurrence of GDM [26]. In the present study, we found that the relative abundance of the probiotics Lactobacillus and Bifidobacterium were significantly decreased, which further confirmed the roles of intestinal microbiota in GDM.

Dietary pattern refers to the combination of various foods in the daily diet, including the relative composition of the types and quantity of foods. It analyzes the interaction between certain or several kinds of foods and nutrients, comprehensively evaluates the impact of dietary nutrition on disease or health, and reflects the dietary habits of different groups. The overall dietary pattern can better reflect the impact of food on disease [27,28]. Dietary pattern adjustment can regulate the distribution of intestinal flora. Good dietary patterns can promote the growth of beneficial intestinal bacteria. It can stimulate the growth of one or a few kinds of flora to have a beneficial effect on the host, protect the intestinal mucosa, and reduce inflammatory exudation. Therefore, it is widely used in the treatment of metabolic syndrome such as diabetes and obesity [29]. In current study, we found that dietary pattern management markedly increased the abundance of probiotics Lactobacillus and Bifidobacterium. Considered together, these results confirmed the protective roles of dietary pattern management in the treatment of GDM; however, the underlying mechanism still requires further investigation.

Here, we first reported the roles of dietary pattern management that might alleviate the condition of GDM via affecting the inflammatory condition and intestinal microbiota. Our results provided a new way for the management of GDM.

  1. Funding information: This study was supported by funds from Wenzhou Science and Technology Project (y20180023)

  2. Conflict of interest: Authors state no conflict of interest.

  3. Data availability statement: The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Received: 2021-04-13
Revised: 2021-12-14
Accepted: 2022-01-03
Published Online: 2022-03-19

© 2022 Jianping Wang et al., published by De Gruyter

This work is licensed under the Creative Commons Attribution 4.0 International License.

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  94. Characterization of the structural, oxidative, and immunological features of testis tissue from Zucker diabetic fatty rats
  95. Effects of glucose and osmotic pressure on the proliferation and cell cycle of human chorionic trophoblast cells
  96. Investigation of genotype diversity of 7,804 norovirus sequences in humans and animals of China
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  98. Aggravated renal fibrosis is positively associated with the activation of HMGB1-TLR2/4 signaling in STZ-induced diabetic mice
  99. Distribution characteristics of SARS-CoV-2 IgM/IgG in false-positive results detected by chemiluminescent immunoassay
  100. SRPX2 attenuated oxygen–glucose deprivation and reperfusion-induced injury in cardiomyocytes via alleviating endoplasmic reticulum stress-induced apoptosis through targeting PI3K/Akt/mTOR axis
  101. Aquaporin-8 overexpression is involved in vascular structure and function changes in placentas of gestational diabetes mellitus patients
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  103. Effects of growth hormone on lipid metabolism and sexual development in pubertal obese male rats
  104. Cloning and identification of the CTLA-4IgV gene and functional application of vaccine in Xinjiang sheep
  105. Antitumor activity of RUNX3: Upregulation of E-cadherin and downregulation of the epithelial–mesenchymal transition in clear-cell renal cell carcinoma
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  109. A novel association between Bmi-1 protein expression and the SUVmax obtained by 18F-FDG PET/CT in patients with gastric adenocarcinoma
  110. The role of erythrocytes and erythroid progenitor cells in tumors
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  113. Silencing TLR4 using an ultrasound-targeted microbubble destruction-based shRNA system reduces ischemia-induced seizures in hyperglycemic rats
  114. Plant Sciences
  115. Seasonal succession of bacterial communities in cultured Caulerpa lentillifera detected by high-throughput sequencing
  116. Cloning and prokaryotic expression of WRKY48 from Caragana intermedia
  117. Novel Brassica hybrids with different resistance to Leptosphaeria maculans reveal unbalanced rDNA signal patterns
  118. Application of exogenous auxin and gibberellin regulates the bolting of lettuce (Lactuca sativa L.)
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  120. Genome-wide identification and characterization of NBS-encoding genes in the sweet potato wild ancestor Ipomoea trifida (H.B.K.)
  121. Alleviative effects of magnetic Fe3O4 nanoparticles on the physiological toxicity of 3-nitrophenol to rice (Oryza sativa L.) seedlings
  122. Selection and functional identification of Dof genes expressed in response to nitrogen in Populus simonii × Populus nigra
  123. Study on pecan seed germination influenced by seed endocarp
  124. Identification of active compounds in Ophiopogonis Radix from different geographical origins by UPLC-Q/TOF-MS combined with GC-MS approaches
  125. The entire chloroplast genome sequence of Asparagus cochinchinensis and genetic comparison to Asparagus species
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  127. Selection and validation of reference genes for RT-qPCR analysis of different organs at various development stages in Caragana intermedia
  128. Cloning and expression analysis of SERK1 gene in Diospyros lotus
  129. Integrated metabolomic and transcriptomic profiling revealed coping mechanisms of the edible and medicinal homologous plant Plantago asiatica L. cadmium resistance
  130. A missense variant in NCF1 is associated with susceptibility to unexplained recurrent spontaneous abortion
  131. Assessment of drought tolerance indices in faba bean genotypes under different irrigation regimes
  132. The entire chloroplast genome sequence of Asparagus setaceus (Kunth) Jessop: Genome structure, gene composition, and phylogenetic analysis in Asparagaceae
  133. Food Science
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  135. Binge eating disorder during COVID-19
  136. Potential of honey against the onset of autoimmune diabetes and its associated nephropathy, pancreatitis, and retinopathy in type 1 diabetic animal model
  137. FTO gene expression in diet-induced obesity is downregulated by Solanum fruit supplementation
  138. Physical activity enhances fecal lactobacilli in rats chronically drinking sweetened cola beverage
  139. Supercritical CO2 extraction, chemical composition, and antioxidant effects of Coreopsis tinctoria Nutt. oleoresin
  140. Functional constituents of plant-based foods boost immunity against acute and chronic disorders
  141. Effect of selenium and methods of protein extraction on the proteomic profile of Saccharomyces yeast
  142. Microbial diversity of milk ghee in southern Gansu and its effect on the formation of ghee flavor compounds
  143. Ecology and Environmental Sciences
  144. Effects of heavy metals on bacterial community surrounding Bijiashan mining area located in northwest China
  145. Microorganism community composition analysis coupling with 15N tracer experiments reveals the nitrification rate and N2O emissions in low pH soils in Southern China
  146. Genetic diversity and population structure of Cinnamomum balansae Lecomte inferred by microsatellites
  147. Preliminary screening of microplastic contamination in different marine fish species of Taif market, Saudi Arabia
  148. Plant volatile organic compounds attractive to Lygus pratensis
  149. Effects of organic materials on soil bacterial community structure in long-term continuous cropping of tomato in greenhouse
  150. Effects of soil treated fungicide fluopimomide on tomato (Solanum lycopersicum L.) disease control and plant growth
  151. Prevalence of Yersinia pestis among rodents captured in a semi-arid tropical ecosystem of south-western Zimbabwe
  152. Effects of irrigation and nitrogen fertilization on mitigating salt-induced Na+ toxicity and sustaining sea rice growth
  153. Bioengineering and Biotechnology
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  155. Development of alkaline phosphatase-scFv and its use for one-step enzyme-linked immunosorbent assay for His-tagged protein detection
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  157. Agriculture
  158. Effects of chemical-based fertilizer replacement with biochar-based fertilizer on albic soil nutrient content and maize yield
  159. Genome-wide identification and expression analysis of CPP-like gene family in Triticum aestivum L. under different hormone and stress conditions
  160. Agronomic and economic performance of mung bean (Vigna radiata L.) varieties in response to rates of blended NPS fertilizer in Kindo Koysha district, Southern Ethiopia
  161. Influence of furrow irrigation regime on the yield and water consumption indicators of winter wheat based on a multi-level fuzzy comprehensive evaluation
  162. Discovery of exercise-related genes and pathway analysis based on comparative genomes of Mongolian originated Abaga and Wushen horse
  163. Lessons from integrated seasonal forecast-crop modelling in Africa: A systematic review
  164. Evolution trend of soil fertility in tobacco-planting area of Chenzhou, Hunan Province, China
  165. Animal Sciences
  166. Morphological and molecular characterization of Tatera indica Hardwicke 1807 (Rodentia: Muridae) from Pothwar, Pakistan
  167. Research on meat quality of Qianhua Mutton Merino sheep and Small-tail Han sheep
  168. SI: A Scientific Memoir
  169. Suggestions on leading an academic research laboratory group
  170. My scientific genealogy and the Toronto ACDC Laboratory, 1988–2022
  171. Erratum
  172. Erratum to “Changes of immune cells in patients with hepatocellular carcinoma treated by radiofrequency ablation and hepatectomy, a pilot study”
  173. Erratum to “A two-microRNA signature predicts the progression of male thyroid cancer”
  174. Retraction
  175. Retraction of “Lidocaine has antitumor effect on hepatocellular carcinoma via the circ_DYNC1H1/miR-520a-3p/USP14 axis”
https://doi.org/10.1515/biol-2022-0006
Keywords for this article
GDM; dietary pattern management; intestinal microbiome; inflammation
Creative Commons
BY 4.0

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  139. Supercritical CO2 extraction, chemical composition, and antioxidant effects of Coreopsis tinctoria Nutt. oleoresin
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  153. Bioengineering and Biotechnology
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  160. Agronomic and economic performance of mung bean (Vigna radiata L.) varieties in response to rates of blended NPS fertilizer in Kindo Koysha district, Southern Ethiopia
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  169. Suggestions on leading an academic research laboratory group
  170. My scientific genealogy and the Toronto ACDC Laboratory, 1988–2022
  171. Erratum
  172. Erratum to “Changes of immune cells in patients with hepatocellular carcinoma treated by radiofrequency ablation and hepatectomy, a pilot study”
  173. Erratum to “A two-microRNA signature predicts the progression of male thyroid cancer”
  174. Retraction
  175. Retraction of “Lidocaine has antitumor effect on hepatocellular carcinoma via the circ_DYNC1H1/miR-520a-3p/USP14 axis”
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