Dietary adherence to medical nutrition therapy and assessment of some biochemical parameters of women with gestational diabetes mellitus

This study conducted to determine the gravids' dietary adherence to medical nutrition therapy and whether they meet their nutritional requirements during gestational period. To determine the contribution of factors such as age, family history, medical and gestational history to the development of gestational diabetes mellitus. The study conducted on 108 patients (81 with gestational diabetes mellitus and 27 healthy pregnant) without known history of diabetes and complications of diabetes and multiple pregnancies aged between 25-43 at Department of Nutrition and Diet Therapy of Acıbadem Health Group Kadıköy Hospital between February 2014 and October 2014. Gestational diabetes mellitus was diagnosed by their physician. Personal and medical information were obtained with a questionnaire and the nutritional status of pregnant women was determined by questionnaire and 3 days food record. Anthropometric measurements and some biochemical parameters were also obtained. In the first visit medical nutrition therapy of pregnant women was planned and they were given nutrition education. In the second visit their adherence to medical nutrition therapy and 3 days food records were evaluated. At the end of the pregnancy, information about weight in which the pregnancy was completed, birth weight, height, sex of baby and type of delivery was obtained. The mean age of individuals was 32.63±4.00 years (women with GDM 32.95±3.8 years, women without GDM 31.67±3.96). Of the women with GDM % 76.5 was first pregnancy, 17.3 % second pregnancy, 6.2 % third pregnancy; of the women without GDM 77.8 % was first pregnancy, 22.2 % second pregnancy. Of the women with GDM 21.1 % had diagnosed with GDM in their previous pregnancies; Of the women without GDM 16.7 % had diagnosed with GDM in their previous pregnancy. Mean weight gain in their previous pregnancy 15.40±8.44 kg in the first, 10.87±6.17 kg in the second pregnancy of women with GDM; 15.90±6.88 kg in women without GDM. In women with GDM mean birth weight was 3586.25±673.68 g in the first pregnancy, 3276.25±429.25 g in the second pregnancy; in women without GDM it was 3586.25±673.68 g. 74.1 % of women with GDM had history of chronic disease in their first degree relatives, 59.3 % of them had Type 2 DM, 24.7 % hypertension, 14.8 % cardiovascular disease and 3.7 % cancer. 51.9 % of women without GDM had history of chronic disease in their first degree relatives, 29.6 % of them had Type 2 DM, 22.2 % hypertension, 22.2 % cardiovascular diseases. Total weight gain was lower in GDM group (p=0.003; p<0.05). 37.0 % of women in GDM group and 40.7 % of control group reported having some problems about compliance to medical nutrition therapy (MNT) (p>0.05). Dietary energy intake was similar between two groups (p>0.05). Total dietary carbohydrate intake was similar between groups (p>0.05). Percentage of calories come from carbohydrate was lower in GDM group (p=0.051; p>0.05). Dietary fiber, protein, total fat intake and percentage of calories come from fatty acids except SFA were similar between groups (p>0.05). SFA intake in GDM group was significantly more than control group (p<0.01). Micronutrient intakes (vitamin A, B1, B2, B6, B12, C, E, niacin, folic acid, potassium, calcium, magnesium, phosphorus, iron and zinc) were also similar between two groups (p>0.05). Hematologic parameters and urine analysis results were similar between two groups except MCV, RDW and MCHC (p>0.05). MCV and RDW levels were higher (p=0.023, p=0.016; p<0.05), MCHC was lower in GDM group (p=0.018; p<0.05). At the beginning of the MNT and at the end of the pregnancy fasting blood glucose levels were similar between two groups (p>0.05). In terms of mean birth weight the results were also similar between groups (p>0.05). Type of delivery was also similar between two groups; 81.5 % of them cesarean section. As a conclusion, in terms of pregnancy outcomes such as weight gain, glycemic control, birth weight without macrosomic baby or ketonuria, results were similar between two groups. However, it may be important to educate women with GDM about the risks of low carbohydrate and excessive fat intake –especially SFA intake- during pregnancy and postpartum period in order to prevent later onset of Type 2 DM and CVD. Key words: gestational diabetes mellitus, medical nutrition therapy, risk factors, dietary habits, nutritional status, dietary adherence