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Gestational Diabetes

Article Summary:

  • Gestational diabetes is one of the most common complications of pregnancy and can result in serious maternal and foetal complications and long term health consequences.
  • Compromised omega-3 fatty acid profiles are found in patients with gestational diabetes.
  • Omega-3 fatty acids have anti-inflammatory, insulin-sensitising and lipid-lowering effects and may have therapeutic benefit for gestational diabetes.
  • Findings of a recent meta-analysis demonstrated omega-3 supplementation during pregnancy had beneficial effects on glycaemic control and the inflammatory response in gestational diabetes

 

Prior to conception and throughout pregnancy and while breast feeding, it is essential that the mother’s nutrient levels are adequate to meet both her needs and those of the developing baby.

Omega 3 Essential Fatty acids are just that – essential.  The term ‘essential’ is given to nutrients that our body cannot manufacture and must be obtained from our diet.  The best source of Omega 3 oils are from fish (sardines or anchovies).  Now you may have read that many fish are high in mercury (larger fish like tuna and mackerel) and thus not recommended during pregnancy.  Other fish are farmed (salmon) and thus not nutritionally of benefit due to high levels of antibiotics and other chemicals used in this industry.  So, where does that leave us?  Plant-based sources of Omega 3 oils include flaxseed, chia seeds, pumpkin seeds and soy beans. But in order to reach daily requirements, we need to supplement.  

Fish oils provide the highest source of bio-available Omega 3 fatty acids.  While flaxseed contains Omega 3s, these are poorly converted into the EPA and DHA that our body needs.  In fact, the conversion rate is so low that in order to obtain the minimum daily requirement of 300mg DHA, you would need to consume nearly 3 litres of flax seed oil!

The next very important consideration is quality.  It is human nature to find a bargain.  This is not recommended when it comes to fish oil supplements.  The fish used should ideally be small, arctic fish like sardines or anchovies (as opposed to the larger fish which are high in mercury).  The processing should also ensure quality is maintained and testing should be done by third-parties to ensure absence of harmful chemicals and toxins.  Quality is essential when purchasing Omega 3 fish oils and I highly recommend you avoid the large tubs sold in chemists and supermarkets.

The cleanest brands are Nordic Naturals and Orthoplex (which is a practitioner-only brand available through qualified Naturopaths). Always store your fish oils in the refrigerator!

In addition to assisting in preventing gestational diabetes, Omega 3 oils are needed for development of the foetal brain and nervous tissue.  The oils also help prevent mum suffering from “baby brain” throughout pregnancy.  Essential fatty acids are also required to maintain a healthy cell membrane – the “wall” that surrounds each and every of the trillions of cells in our body.

As with all supplements, it is recommended that you consult a qualified naturopath.  Call us at True Medicine for individualised health care on 07 5530 1863.


Gestational diabetes mellitus (GDM) is one of the most common complications of pregnancy with a prevalence of <1% to 28% among pregnancies globally.1 Individuals with gestational diabetes have impaired glucose metabolism and insulin resistance with high blood sugar level during pregnancy.2 Gestational diabetes can result in serious maternal and foetal complications such as pre-eclampsia, foetal macrosomia, pre-term birth and neonatal hypoglycaemia and long-term health consequences for both mother and child.2,3 Women with a history of GDM have a seven-fold increased risk of developing type 2 diabetes mellitus, whereas children born to mothers with gestational diabetes are at higher risk for metabolic syndrome and obesity during their lifetime.2,4

Omega-3 fatty acid profiles are found to be compromised in patients with gestational diabetes compared to those in healthy pregnant women, thus these patients may benefit from omega-3 supplementation.1,2 Furthermore, placental uptake and transfer of DHA is impaired in women with gestational diabetes, increasing the risk of neuro-developmental deficits in the developing foetus.5Omega-3 polyunsaturated fatty acids (PUFA) possess numerous properties that may be beneficial in the management of gestational diabetes including anti-inflammatory, insulin-sensitising and anti-lipidemic effects.2,4

A recent meta-analysis published in Gynecological Endocrinology assessed the efficacy of omega-3 fatty acid supplementation for the management of gestational diabetes compared to placebo.2 Five randomised, placebo-controlled trials involving 339 participants with gestational diabetes were included in the analysis, with four studies trialling 1000mg-2000mg omega-3 fatty acids daily, containing 180mg-360mg EPA and 120mg-240mg DHA. The remaining RCT used a DHA enhanced supplement consisting of 300mg DHA, 42mg EPA and 8.4mg of arachidonic acid (AA).5

Compared with the control group, omega-3 fatty acid supplementation was found to significantly reduce fasting plasma glucose (FPG) and homeostatic model of assessment for insulin resistance (HOMA-IR) in patients with gestational diabetes. Omega-3 fatty acid supplementation also reduced hs-CRP compared to control. Other pregnancy outcomes including preterm delivery, gestational age, macrosomia and newborn weight showed no statistical difference between the treatment and control groups.2
Gestational diabetes is associated with increased inflammation and oxidative stress. Omega-3 fatty acids may improve insulin metabolism by activating peroxisome proliferator-activated receptor gamma (PPAR-y), thus downregulating the activity of nuclear factor-kβ (NF- kβ) and production of pro-inflammatory mediators. EPA intake is also reported to increase anti-inflammatory molecules such as adiponectin, which also has anti-diabetic and anti-atherosclerotic effects.2

Omega-3 fatty acids improve health outcomes for infants and their mothers, however, many women do not meet recommended daily intakes. In Australia only 10% of women of childbearing age meet the recommended DHA intake6 and supplementation may be required in the general population where dietary intake is inadequate.

References:

  1. Gao, L., Lin, L., Shan, N., Ren, C., Long, X., Sun, Y., & Wang. (2018). The impact of omega-3 fatty acid supplementation on glycemic control in patients with gestational diabetes: a systematic review and meta-analysis of randomized controlled studies. The Journal of Maternal-Fetal & Neonatal Medicine, 1–191.doi:10.1080/14767058.2018.1526916
  2. Zhong, N., & Wang, J. (2019). The efficacy of omega-3 fatty acid for gestational diabetes: a meta-analysis of randomized controlled trials. Gynecological Endocrinology, 35(1), 4–9. https://doi.org/10.1080/09513590.2018.1480716
  3. Middleton P, Gomersall JC, Gould JF, Shepherd E, Olsen SF, Makrides M. (2018)Omega-3 fatty acid addition during pregnancy.Cochrane Database of Systematic Reviews 2018, Issue 11. Art. No.: CD003402. DOI: 10.1002/14651858.CD003402.pub3
  4. Ostadrahimi, A., Mohammad-Alizadeh, S., Mirgafourvand, M., Yaghoubi, S., Shahrisa, E., & Farshbaf-Khalili, A. (2016). Effects of Fish Oil Supplementation on Gestational Diabetes Mellitus (GDM): A Systematic Review. Iranian Red Crescent Medical Journal, 18(11).doi:10.5812/ircmj.24690
  5. Min, Y., Djahanbakhch, O., Hutchinson, J., Eram, S., Bhullar, A. S., Namugere, I., & Ghebremeskel, K. (2016). Efficacy of docosahexaenoic acid-enriched formula to enhance maternal and fetal blood docosahexaenoic acid levels: Randomized double-blinded placebo-controlled trial of pregnant women with gestational diabetes mellitus. Clinical Nutrition, 35(3), 608–614.doi:10.1016/j.clnu.2015.05.020
  6. Meyer, B. (2016). Australians are not meeting the recommended intakes for omega-3 long chain polyunsaturated fatty acids: results of an analysis from the 2011–2012 national nutrition and physical activity survey. Nutrients, 8(3), 111. doi:10.3390/nu8030111