masoomeh goodarzi khoigani

As pregnancy progresses, insulin sensitivity (SI) might slowly decrease to 50% of the average value, which could result in gestational diabetes. As weight gain is associated with reduced SI and vice versa, we evaluated the possible correlation between nutritional status and SI, especially in early pregnancy.

This cross-sectional study was conducted on 138 healthy primiparous women between 6 and 10 weeks of gestation. By using a researcher-made questionnaire, the characteristics of the participants were gathered. A digital scale was used to measure participants’ weights. Nutrient intake was estimated based on the 72-hour dietary recall by Nutritionist 4 software. We used the pregnancy physical activity scale to estimate physical activity. In addition, fasting plasma glucose (FPG) and insulin values were included in the relevant formula to calculate the quantitative index of SI.

After adjusting for significant maternal characteristics, the quantitative insulin sensitivity check index (QUICKI) in the first trimester was correlated with participants’ weight and household income. Furthermore, the QUICKI index had a significant inverse relationship with saturated and polyunsaturated fatty acids (PUFAs) intake while total fat intake was positively correlated. Also, consuming vitamin C, glucose, fructose, sugar, and carbohydrates increased the QUICKI index, while vitamin E intake decreased it.

The results showed that weight management may prevent gestational diabetes mellitus (GDM) during the first trimester. Moreover, the significant correlation between the above-mentioned nutrients and household income with the QUICKI index can be further examined in future studies.

Diabetes Self‑Management Education and Support (DSMES) as a framework focuses on seven self‑care behaviors. Moreover, technology‑assisted self‑care education is increasingly suggested for patients with Type 2 Diabetes Mellitus (T2DM). Therefore, we examined the effect of a web‑based program on self‑care behaviors and glycated hemoglobin values in patients with diabetes mellitus. 

This randomized controlled clinical trial was conducted at Alzahra Hospital in Isfahan, Iran, between April and November 2020 and included 70 patients with T2DM. Data were collected using a questionnaire that included a demographic information section and a diabetes self‑management section with 21 questions on a Likert scale. Fasting blood samples (2.50 ml) were collected before and after the interventions to measure HbA1c levels. The study intervention involved a web‑based program that included multimedia educational content (such as videos, lectures, educational motion graphics, text files, posters, and podcasts) presented in seven sections based on DSMES over a 21‑day period with monitoring by an instructor.

The mean scores for healthy eating (F = 3.48, p = 0.034) and medication adherence (F = 6.70, p < 0.001) significantly increased in the interventional group, while the mean scores for being active, monitoring, reducing risks, problem‑solving, and healthy coping did not significantly change. Additionally, the mean differences in HbA1c values significantly improved in the interventional group compared to the control (F = 5,1, p = 0.026).

A web‑based program in accordance with DSMES improved HbA1c levels and increased scores for healthy eating and medication adherence in patients with T2DM. However, further research with larger sample sizes and qualitative interviews is needed.

Progressive insulin resistance is a physiological condition during pregnancy that can lead to gestational diabetes. Given the association between low blood vitamin D levels and insulin resistance, the present meta-analysis evaluated the effect of vitamin D supplementation on serum 25-hydroxyvitamin D (25[OH]D) and the homeostatic model of insulin resistance (HOMA-IR) levels in non-diabetic pregnant women.

A comprehensive literature search was conducted using electronic databases and gateways such as Cochrane Library, Medline, Google Scholar, Science Direct, Web of Sciences, Embase, and Scopus. Articles up to 2020 in both English and Persian were included in the study. The effect of vitamin D supplementation on 25(OH)D and HOMA-IR was determined based on the differences in mean changes from baseline to post-intervention. Weighted mean and 95% confidence intervals (CI) were pooled using a random-effects model. Data were analyzed using STATA software. 

Four studies, including six trials with 380 participants, reported that vitamin D supplementation increased 25(OH)D (mean change: 13.72, 95% CI: 7.28-20.17) and decreased HOMA-IR (mean change: 1.46, 95% CI: 0.56-2.37) levels compared with the placebo group. A high weekly dose of vitamin D further reduced HOMA-IR levels (adjusted R2=77.99, I2 residuals=80.49%, P=0.047). There was no significant association between the dose of vitamin D and 25(OH)D (P=0.974). Intervention duration was not associated with an increase in 25(OH)D (P=0.102), nor with a decrease in HOMA-IR (P=0.623).

Vitamin D supplementation increased 25(OH)D and decreased HOMA-IR levels in non-diabetic pregnant women. Vitamin D in high doses further reduced HOMA-IR, but did not affect 25(OH)D concentrations.

Some studies have shown that Socioeconomic Status (SES) is positively related to insulin resistance among different population groups, except for pregnant women. Therefore, we examined the relationship between SES and Homeostasis Model Assessment‑Insulin Resistance (HOMA‑IR) index as well as mediating variables.

This study was performed on 138 primiparous healthy women at 6–10 weeks of pregnancy. The association between SES and HOMA‑IR was analyzed by regression analysis, and mediating variables were determined by mediation analysis.

SES score was positively correlated with HOMA‑IR index [β </em>= 0.02, t</em>101 = 2.20, p </em>= 0.03, 95% CI: (0.00–0.05]. The higher percentage of mediation was related to maternal weigh (70.80%). Job activity had a protective effect on the association between SES and HOMA‑IR (‑62.50%). The total percentage of two mediators was 25%.

The positive relationship between SES and (HOMA‑IR) in early pregnancy may provide a way to control this condition. 

Follow‑up studies have shown an increased risk of thyroid dysfunction in individuals with normal serum thyroid‑stimulating hormone (TSH) levels. Furthermore, the possible consequences of minor differences in thyroid function (without achieving poor thyroid function) in the risk of weight gain during pregnancy are questionable, too. The production of TSH is under the hypothalamus–pituitary control, and food is one of the most effective environmental agents that control hypothalamic–pituitary– thyroid axis activity. Regarding the few available studies, we assessed the association of minor variations of TSH concentrations and nutritional status in the first trimester of pregnancy.

This cross‑sectional descriptive and analytical study was performed on 150 primiparous healthy women. Demographic and family characteristics were collected using a researcher‑administered questionnaire. Nutrients intake were extracted from a 72‑h recall, and physical activity scores were determined by the pregnancy physical activity scale.

The prepregnancy body mass index (BMI) (β =0.022, P = 0.004) and participants’ weight at 6–10 weeks of gestation (β =0.006, P = 0.024) were positively associated with TSH concentrations, while total physical activity score was negatively correlated (β = ‒0.006, P = 0.047). We did not find any significant association between TSH values and energy‑adjusted nutrients intake (P > 0.05).

We suggest that differences in TSH concentrations within normal range in the first trimester are correlated with gaining weight, physical activity level, and prepregnancy BMI. TSH concentration and consequently thyroid function may influence on gestational weight gain or vice versa.

Progressive insulin resistance (IR) is a physiologic state during pregnancy which could be ended to gestational diabetes. Given the relationship between weight and insulin resistance (IR), the study of the association between nutrients intake and insulin resistance is particularly rational and predictive.

The current descriptive cross-sectional study was performed on 138 nulliparous women with healthy and single pregnancies. Individual characteristics were collected by a researcher-administered questionnaire. At 6th</sup>-10th</sup> weeks of pregnancy, physical activity scores and nutrients intake were determined using the Pregnancy Physical Activity Questionnaire and 24-hour recall for three consecutive days, respectively. At the same time, fasting serum glucose and insulin levels were also measured to calculate IR by the formula.

Square root transformation of IR index at the first trimester was significantly correlated with household income, occupational activity, pre-pregnancy body mass index (BMI), weight, and physical activity at 6th</sup>-10th</sup> weeks of gestation. However, after adjusting the effect of related variables, household income and maternal weight were significantly associated with IR, and occupational activity had a trend toward the significant association. Moreover, vitamin D, linolenic acid, beta-carotene, vitamin E, and carbohydrate intake were significantly correlated with IR index. However, after adjusting for the related variables, vitamin E had a direct significant relationship with IR, and glucose and maltose intakes were inversely associated with IR.</div>

Significant association between household income and maternal weight at the first trimester can be used to control IR, which is a key component for gestational diabetes. The association of vitamin E, glucose, and maltose intakes with IR may be a guide to get new results. We suggest further studies about the association between occupational activity and insulin resistance in pregnant women.

The imbalance between energy intake and consumption has been recognized as an important factor contributing to the gestational weight gain (GWG). Additionally, the determination of the effect of macronutrient composition on GWG has been recommended by researchers. Therefore, we examined the effect of nutrition education on weight gain, energy, and energy-adjusted macronutrients intake during three trimesters of pregnancy which have not been widely studied.

This randomized single-blinded clinical trial was performed on 192 primiparous pregnant women in Isfahan, Iran, from May 2015 to September 2016. Data were collected using a questionnaire completed through interviews with pregnant women and prenatal care-related records. We developed an individualized calorie-appropriate diet for each participant at enrollment and then three 45-60 minute training sessions were held at 6-10, 18, and 26 weeks of pregnancy and the subjects’ weights were measured during these sessions. A consecutive 3-day food intake record at 6-10, 18 and 34-36 weeks was obtained from two groups to determine the macronutrients. Moreover, physical activity scores were estimated before and after the intervention.

The mean weights at 18, 26, and 40 weeks of gestation were significantly lower in the intervention group (P = 0.024, P = 0.040, and P = 0.015, respectively). The total energy, energy-adjusted carbohydrate and protein intake at 6-10, 18, and 34-36 weeks of gestation were not significantly different between the two groups (P > 0.05). However, the mean energy-adjusted fat intake decreased ( P = 0.043). In addition, the mean energy-adjusted dietary fiber intake was significantly higher in the intervention group (P = 0.001).

In the present individualized calorie-appropriate trial, the mean weights decreased during three trimesters in the intervention group. Additionally, calorie, energy-adjusted carbohydrate and protein intake did not change after intervention while energy-adjusted fat intake decreased

In addition to its short‑term effects, low birth weight increases the risk of noncommunicable diseases (NCDs) in adult life. The quality of maternal diet including the macronutrient intake is very important in this regard. This study aims to evaluate the possible associations between maternal zinc and neonatal anthropometric measures.

This cross‑sectional study was conducted on 226 pairs of mothers‑neonates in Isfahan, Iran. Maternal characteristics including the history of the disease, age, preconceptional weight, weight gain during pregnancy, as well as, anthropometric characteristics of neonates such as weight, height, length, and circumferences of head, belly, chest, and thigh were documented. Cord blood zinc was measured by atomic absorption spectrophotometer in three groups of neonates depending on their weights.

The gestational age of neonates was 35 to 38 weeks with a mean weight of 3.13 ± 0.42 kg. The mean of zinc concentration was 0.81 ± 0.18 and it was higher in neonates with appropriate weight than in those with high or low birth weight (0.82 ± 0.18, 0.75 ± 0.19, and 0.65 ± 0.12 ng/ml, respectively). Bivariate correlation analysis showed significant weak correlation between cord blood zinc and neonatal weight (r = 0.16, P = 0.04).

The cord blood zinc concentration of normal‑weight neonates was higher than others. Our findings suggest that maternal zinc may influence neonatal birth weight, and it should be considered in the primordial prevention of NCDs.

Weight gain more than the recommended range by the Institute of Medicine (IOM) is one of the most common complications of pregnancy, which would be ended to gestational diabetes, preeclampsia, cesarean section, or maternal, and child obesity. Few successful studies in this area include nutrition and physical activity. We examined a simple, practical, and cost-effective solution as nutrition training based on the Pender’s model, because this is one of the most effective patterns for nutritional behavior.

This single-blind randomized controlled clinical trial study was performed on 192 nulliparous pregnant women. During training sessions, mothers of intervention group learned how to prevent excessive weight gain over healthy eating habits. Mothers’ weight, nutrients intake, and physical activity levels were estimated before, during, and after intervention.

The constructs of perceived benefits, perceived self-efficacy, behavior-related feelings, interpersonal influences, competing demands and preferences, and commitment to action increased significantly. In the intervention group, 58.6% gained weight within the recommended range compared to 50.0% in control group. Moreover, 28.7% in the intervention group versus 45.6% in the control gained weight more than the IOM limits while 12.6% in the intervention group and 4.4% in the control gained weight less (P = 0.020). The perceived self-efficacy and commitment to the plan constructs were associated with normal weight gaining.

Pender model-based nutrition education considering the national guideline prevented excessive gestational weight gain in pregnant women.

One of the most important determinants of behavior is intention. Numerous factors can contribute to the intention to file a divorce petition. One of the successful conceptual frameworks in explaining the effective factors on the intention to divorce is the theory of planned behavior (TPB). The current study aimed at identifying the factors affecting the determinants of intention to divorce based on TPB. The current cross sectional study was conducted on 140 divorce applicants in Yazd, Iran in 2017 selected by random sampling. Data collection tools were a demographic information checklist and a researcher-made questionnaire including 48 items divided into four constructs, i e, attitude, behavioral control, subjective norms, and intention. The questionnaire was developed based on the constructs of the theory of planned behavior (TPB) and validated in a qualitative study. Data analysis was performed with the AMOS software using goodness-of-fit indices (GFI) of the model, as well as SPSS using ANOVA, post-hoc, and independent t tests. The constructs of the TPB significantly indicated the ability to predict the intention to file a divorce petition (R2 =0.58). The findings showed that the attitude variables (β = 0.69), perceived behavioral control (β = 0.16), and subjective norms (β = 0.13) had the highest effect on the structure, respectively. Model fit indices (GFI, comparative-fit-index, normed-fit-index, root mean-square error of approximation, and normed chi-Square) indicated the goodness of model. The mean score of attitude toward divorce was higher in women than in men (P < 0.001). Attitude toward divorce was the most effective factor in intention to file a divorce petition. Given the important role of attitudes in the intention to divorce, further educational interventions in this field are suggested in order to consider influencing constructs according to TPB.

Since preterm premature rupture of membranes (PPROM) is one of the most important complications of pregnancy and its relationship with nutrition status have not been surveyed comprehensively, we decided to study the relationship of maternal received nutrients (36 macro‑ and micro‑nutrients) in three trimesters and PPROM which could be considered as a unique study.

In this prospective cohort study, data was collected by filling a questionnaire through interviews with 620 pregnant women who had no parameters to affect pregnancy outcome. 48‑hr dietary recalls were completed for eligible women at 11th–15th, 26th, 34th–37th weeks of gestation. Physical activity was also assessed using a standard questionnaire. Also pregnant mother’s reproductive and demographic characteristic and supplementation are considered.

The mean value of received saturated fatty acids, polyunsaturated fatty acids and energy, in the first trimester (P < 0.001, P = 0.007, and P < 0.001 respectively), the mean values of calcium, sodium intake in the second trimester (P = 0.045, P = 0.006, and P = 0.004 respectively), Vitamins C, A (mg), β‑carotene, cartenoids intake in the second trimester (P = 0.03, P = 0.001, P = 0.007, and P = 0.01 respectively), and higher Vitamin C intake during the first trimester (P = 0.02) was significantly greater among subjects with PPROM compared to the others.

The mean value of mentioned received nutrients in subjects who experienced PPROM later in pregnancy was higher than the others, which is independent of demographic and reproductive characteristic, estimated physical activity, and supplementation. Therefore, these findings could be considered in the nutritional programming for pregnant women to manage the risk of PPROM.