الفهرس 
EpidemiologyOnly 14 pages are availabe for public view
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Abstract
Gestational diabetes mellitus (GDM) is defined as any degree of glucose intolerance with onset or first recognition during pregnancy. Obesity before and weight gain during pregnancy predispose women to GDM and early onset T2DM, so prevalence of GDM has increased overtime, along with the increase in the prevalence of obesity.
GDM is associated with an increase in maternal and neonatal complications of pregnancy. A range of factors have been found to increase the risk of developing GDM. Having a low-fibre and high glycemic load diet is considered one of the modifiable risk factors for GDM. It has been also reported that higher total fat intake, higher proportion of saturated fat in diet as well as increase in cholesterol intake are associated with increased risk of GDM.
Medical nutrition therapy for gestational diabetes should focuse on food choices for appropriate weight gain, normoglycemia, and absence of ketones. MNT includes not only the total daily caloric intake and its carbohydrate content, but also the number of meals throughout the day. An evening snack may be needed to prevent accelerated ketosis overnight. Many women need to decrease the amount of carbohydrates ingested at breakfast to as low as 15 to 30 g, and then divide the remaining carbohydrates evenly throughout the day.
The general aim of the present study is to assess nutrient intake of both pregnant women with gestational diabetes mellitus and normoglycemic pregnant women focusing on dietary fat. The specific objectives are to delineate the social and gynecologic characteristics of both cases and controls, to assess food habits, dietary and nutrient intake of both groups with concentration on fatty acid, cholesterol and insulinogenic nature of diet. Also, to assess anthropometric status of both groups.
A case control study was conducted in obstetric outpatient clinic of El-Shatby hospital. All gestational diabetic women and normoglycemic pregnant women aged 20-40 years, between 28-36 gestational weeks, primi or multigravida, singleton pregnancy were included in our study. The purposive samples were collected till sample size (45 cases, 45 controls) was reached.
The study groups were interviewed to answer a pre-designed questionnaire which included sociodemographic, family, past and present obstetric history, life style pattern, meal pattern, food habits, frequency of food consumption and dietary intake using 24 hour food recall. The dietary intake was analyzed using the Egyptian Food Composition tables into energy and macronutrients (protein, carbohydrates and fats). Fats were subdivided into Fatty acids (saturated, monounsataurated, polyunsaturated fats) and cholesterol content. Nutrient density of the diet was calculated. Glycemic index and glycemic load of consumed meals were calculated. Physical examination was carried out including blood pressure measurement. Anthropometric measurements were recorded including weight, height and BMI. Biceps, triceps, subscapular, and midthigh skinfold thickness measurement were done, then sum of skin fold thickness was calculated to estimate body density, and then Siri equation was used to estimate body fat percentage. Record review was taken from files of patients including: haemoglobin level, urine analysis and random blood sugar.
The results of the present study can be summarized as follows:
• The mean age among cases was 31.6±4.9 years which was significantly higher than that of controls (26.9±4.9 years).
• About half of cases (51.1%) and one third of controls (37.8%) didn’t have job and just completed their secondary education
• About half of cases (55.6%) had positive family history of DM. Those with family history of gestational diabetes were 26 times more likely to have gestational diabetes
• Majority of cases (80%) had significantly higher previous obstetric complications than controls, as those with previous obstetric complications were 8 times more likely to have gestational diabetes
• Mean prepregnancy weight among cases was 79±15.6 kg which was significantly higher than that of controls (68.4±11.9 kg). As increase in prepregnancy weight 1 kg was associated with 7% increase risk to gestational diabetes.
• Higher percentage of cases had previous history of macrosomia which was present only among cases (27.5%).
• Saturated and polyunsaturated fat intake was higher in cases than controls.
• Cholesterol intake among cases (268.9±351.2mg) was higher than among controls (243.5±236.3mg).
• The mean energy intake among cases (1306.30 ±540.65kcal) was lower than that of controls which was 1520.40±547.26 kcal.
• The mean meal glycemic load of cases was 100.1 ± 63g and this was significantly lower than that of controls (125.6 ± 66.2g)
• Mean BMI of cases was 38.3±24.4 kg/m2 which was significantly higher than that of controls (30.6±4.8 kg/m2).
• The mean body fat percentage was significantly higher in cases (31.8±3.2%) than that of controls (29.2±3%).
• The mean systolic blood pressure among cases was 120±18.4 mmHg which was significantly higher than that of controls (103.2±10.4mmHg) and the mean diastolic blood pressure among cases was 79.8±12.9 mmHg which was also significantly higher than that of controls (69.1±6.8mmHg).
• It was found that prepregnancy weight, previous obstetric complications, gravidity, family history of diabetes mellitus were all significant risk factors for gestational diabetes.
from our study the most important conclusions:
GDM occurs at higher age and higher parity.
Overweight and obesity are associated with increased incidence of GDM through accentuating diabetogenic effect of pregnancy. Also family history of DM raises the risk of GDM.
Saturated fat and cholesterol intake was high in GDM patients.
The most important recommendations:
Preconceptional weight control must be encouraged as prepregnancy overweight and obesity are leading factors to gestational diabetes.
A structured program that emphasizes life style changes should include nutrition education to physicians of family health units and obstetricians who deal with gestational diabetic patients.
Life style modification is corner stone in prevention and management of GDM and should include both dietary and physical activity pattern changes to improve insulin resistance.