Browsing by Subject "raskausdiabetes"
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(2016)Diabetes first time detected during pregnancy is called gestational diabetes (GDM). Diagnostic criteria for gestational diabetes differ from those of diabetes outside of pregnancy. In the year 2014 16 % of Finnish pregnant women had abnormal OGTT (oral glucose tolerance test) result. OGTT is the standard method for diagnosing GDM. GDM prevalence is increasing and it is mainly accounted for increasing body mass index among pregnant women. GDM predisposes both mother and child for perinatanal complications as well as health problems in their later life. In Finland GDM is diagnosed during early pregnancy or in general at the turn of the second and third trimester. There is no worldwide consensus of the justification of the early GDM diagnosis. Little is known about the patients with early GDM. The main goal of my master´s thesis was to describe lifestyle (nutrition and physical activity) and health of the early (pregnancy week 8−12) GDM study subjects and to compare these to other study subjects´ lifestyle and health. In addition the study examined which factors were accounted for the early GDM. The data of the master´s thesis came from the NELLI intervention study (Neuvonta, elintavat ja liikunta neuvolassa) which covered years 2007–10. The inclusion criteria of the study were factors known to increase the risk of GDM. The exclusion criteria included for example abnormal OGTT result during early pregnancy. Study subjects´ nutrition and leisure time physical activity (valid surveys) and health (anthropometric measures, blood pressure, blood tests) were followed during pregnancy. One year after delivery follow-up study was carried out. Master´s thesis data consisted of the records of the study subjects participating in the NELLI intervention study and subjects excluded from the study due to the abnormal early pregnancy OGTT. Data relative to early GDM subjects existed only for before bregnancy (lifestyle) or early pregnancy (health) and one year after delivery (lifestyle, health). In these time points variables representing early GDM and NELLI study subjects´ lifestyle and health were compared. Statistical methods used were Pearson´s chi-square test, Fisher´s exact test, independent samples T-test and Mann-Whitney U test, linear regression analysis, ordinal logistic regression analysis and logistic regression analysis. The factors accounting for risk of early GDM were increasing body mass index before pregnancy, age of at least 35 years before pregnancy and GDM or macrosomic newborn during previous pregnancies. High-density lipoprotein concentration of early GDM subjects during early pregnancy was lower than that of other study subjects. In addition total fat contributed more of the daily energy intake (E%) and low-fat dairy products and cheeses smaller portion of the diet before pregnancy of early GDM subjects than of other study subjects. Furthermore the nutritional goals (≥ 4/5) were fulfilled less frequently before pregnancy in the diet of early GDM subjects than in the diet of other study subjects. The group of early GDM subjects participating in the follow-up study was assorted hence the results of follow-up study have to consider cautiously. Mainly the same factors which are known to increase GDM risk at the turn of the second and third trimester accounted also for the risk of early GDM. Weight management before pregnancy seems to be the most important way to reduce the risk of early GDM. Some signals were also be noticed according to which early GDM subjects´ lifestyle and health markers differed unfavourably from those of other study subjects. In conclusion strong attention should be paid to counseling on lifestyle factors and follow-up of the health of early GDM patients both during pregnancy and thereafter.
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(2017)Introduction: The incidence of gestational diabetes (GDM) is rising in the Western world along with the increment in young women’s overweight and obesity rates. GDM poses short- and long-term threats to the health of both mother and child, which in turn might add to the economical burden and cause human suffering. Lifestyle counseling and nutritional management are key to managing adverse outcomes in both the woman with GDM and her unborn child. Objective: The aim of this thesis is to study whether the intake of energy, energy nutrients, and fiber change after the diagnosis of GDM. The changes in intakes of energy, energy nutrients, and fiber are compared between women with GDM and women with normal glucose tolerance. In addition, the changes in energy nutrients and fiber in different food sources are studied and compared between groups. Materials and methods: The study was conducted based on data from the control group in The Finnish gestational diabetes prevention study (RADIEL). RADIEL is a prospective, randomized, controlled intervention that was carried out in 2008–2014, and in which women at high risk of GDM pregnant in the first half of pregnancy or planning pregnancy were enrolled. The control group received usual care at antenatal clinics. The data was collected before the initiation of this thesis. Study participants with 3-day food record data from both the first and the third trimester of pregnancy were eligible for this study (n=111). GDM was diagnosed by a 75 g oral glucose tolerance test in 22 of the participants in 22–28 weeks of gestation. Of the participants, 89 remained healthy by their glucose metabolism. The differences between women with GDM and women with normal glucose tolerance were tested using a t-test for normally distributed variables, and Mann-Whitney U test, χ2 test or Fisher’s exact test for non-normally distributed variables. Analysis of covariance was used to test the differences in change in intake of energy, energy nutrients, and fiber between the first and third trimester. GDM, previous GDM, age, body mass index (BMI), education in years, and the intake of the nutrient at baseline (first trimester) were used as covariates. Results: The women with GDM had significantly lower prepregnancy BMI (p=0.025) and a history of GDM (p=0.011) was more common among them compared to women with normal glucose tolerance. Moreover, at baseline, their fasting insulin (p=0.033) and HOMA-IR (p=0.041) were lower and their HbA1c (p=0.038) higher than that of the women with normal glucose tolerance. The intake of energy, and energy nutrients and fiber in relation to energy did not differ between groups (p>0.05). However, as compaired to women with normal glucose tolerance, women with GDM reduced their intake of carbohydrates (adj. p=0.002) and sucrose (adj. p=0.002), and increased their intake of fat (adj. p=0.037) and fiber (adj. p=0.002) in relation to energy from the first trimester to the third. In food sources, the only difference between groups regarded the change of fiber (p=0.049) in relation to the total intake of fiber; this was seen in the food source of bread and flour, in which the proportion of fiber increased in women with GDM. Conclusions: The dietary intake changes significantly differently between women with GDM and women with normal glucose tolerance in regards of carbohydrate, fat, sucrose, and fiber. In women with GDM, the changes in beforementioned nutrients are in line with the Current Care Guidelines of GDM, with the exception of fiber that still changes towards the guidelines. The proportion of fiber changes differently between groups in the food source of bread and flour. Nutrition management of GDM should focus more on the importance of fiber and the composition of fatty acids in the diet, but it should also focus on increasing the proportion of protein to optimize the intake of carbohydrates and fat. The fact that women with GDM in this study had a relatively low energy intake from carbohydrates and a high energy intake from fat, raises the possible need to study how this affects the blood glucose and body composition of the child.
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