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Department of Medical and Surgical Sciences, U. Medical nutritional therapy is the most important method for normalizing glucose levels in pregnancy. In this setting, there is a new problem to consider relating to migrants, their personal food preferences, and ethnic, cultural, and religious aspects of their diet.

To develop the meal plan, each dish chosen by the women was broken down into its principal ingredients. The quantity of each food was given in tablespoons, teaspoons, slices, and cups, and there were photographs of the complete dish. The group treated with the ethnic meal plan achieved a better metabolic control at the end of the pregnancy and a lower weight gain though the difference was not statistically significant.

As for fetal outcome, the group on the ethnic meal plan had babies with a lower birth weight and there were no cases of macrosomia or LGA babies. This preliminary study indicates the positive effect of an ethnic approach to diet on the outcome of pregnancy. Obesity, family history of diabetes, and belonging to tabeole ethnic groups increase the risk of GDM [ 4 — 11 ].

If the disorder is xomposizione properly monitored and treated, it can cause severe complications in both mother including preeclampsia, cesarean delivery, glucose intolerance, or type 2 diabetes after delivery and child macrosomia, hypoglycemia, hyperbilirubinemia, adolescent obesity, glucose intolerance, and diabetes [ 241213 ]. Some studies have demonstrated a tendency for adverse outcomes of pregnancy among immigrant women from countries with high rates of diabetes [ 5 — 8 ].

The first step in treating GDM is nutrition therapy [ 115 ]. Immigrants differ in their cultural background and eating habits, so we aimed to assess such women’s compliance with dietary restrictions and the possible benefit, in terms of maternal and fetal outcome, of adopting a nonstandard, ethnic-based approach to their diet. The study protocol comoosizione with the Helsinki Declaration and was approved by the local Ethics Committee, and written informed consent was obtained from all participants.

The women enrolled were randomly assigned to slimenti groups: They saw a specialist every two weeks. All GDM women were followed up for metabolic and obstetric purposes until delivery. For fetal outcome, we considered birth weight, infants large or small for gestational age LGA, SGAand fetal composite outcome hypoglycemia, neonatal asphyxia, respiratory distress syndrome, and hyperbilirubinemia, hypocalcemia and fetal malformations.

Babies were LGA if their birth weight was above the 90th percentile and SGA if it was below the 10th percentile according to population-specific standard delgi tables [ 16 ]. A dietary assessment was conducted to determine whether a woman’s intake of essential nutrients was adequate and whether she was eating excessively and to identify foods she avoided, as well as food intolerances or allergies.

A meal plan was then developed, and patient and dietician prepared a sample menu. Food models, using measures in cups, glasses, and bowls, proved helpful props when teaching appropriate serving sizes.


International Journal of Endocrinology

tabellw The two groups received different meal plans: The EMP included foods commonly consumed by patients according to their ethnicity. Dishes were broken down into the various ingredients, shown raw and cooked.

Due ckmposizione difficulties in using kitchen scales, measures such as cups, or spoonfuls handfuls or pinches, were preferred Figure 1. Furthermore, the food pyramids of the specific country of origin were used. The two meal plans had the same nutrient composition SMP: The intake was calculated in individual tables, based on the INRAN nutritional tables, version [ 20 ].

Plasma glucose was evaluated using the glucose-oxidase method [ 21 ]. A P value of less than 0.

Table 2 shows the women’s clinical and metabolic characteristics, and maternal and fetal outcomes. Weight gain was lower, though not significantly, in the EMP group Figure 2. Clinical and metabolic characteristics and pregnancy outcome of the subjects under study. No differences in maternal outcome emerged between the two groups. There were no cases of SGA babies. No fetal complications dj congenital malformations were seen in either group Table 2. Adherence to the meal plans was better in the EMP group, with 7 women scoring 1 or 2 good adherenceas opposed to 2 women in the SMP group.

Immigration flows have increased in Italy, meaning rising numbers of pregnant immigrant women [ 14 ]. Italian data [ 14 ] on pregnancy indicate a relatively poor outcome of such pregnancies due inraj difficulties in accessing care and following medical recommendations for cultural and social reasons.

Some immigrant populations are also at higher risk of type 2 diabetes and gestational diabetes [ 2810 ].

Better standards of living in host countries often have negative effects on the health of immigrant populations, partly because foreign citizens acquire eating habits and lifestyles unsuited to their genetic profile. Regarding GDM, the problem is exacerbated by a genetic predisposition of African, Afro-American, and Hispanic races to develop diabetes [ 489 ]. Nutritional therapy for immigrant degpi should take the social, cultural, and religious value attached to food by the various domposizione groups into account.

In our study, the main problems the women had with their prescribed diet were related to difficulties in changing their eating habits; problems with managing a meal plan and weighing the foods; doubts concerning which foods to choose; difficulties in achieving the right nutritional balance.

On the other hand, many studies have confirmed the important influence of dietary treatment on the outcome of GDM [ 12 ]. The real difference between the two meal plans we used lies in how the diet and examples of typical dishes are presented [ 23 ].


The meal plan containing new elements adapted to different ethnic and cultural composiione, with photos and practical domestic units of measure to illustrate the quantities of each food, plus lists of alternative foods and photos showing the foods raw and cooked proved useful and effective for our immigrant women with GDM, since adherence was better among the patients adopting the EMP. Better adherence coincided with better glycemic control, a more normal weight gain [ 24 ], and a better pregnancy outcome, that is, the birth weights were lower, and there were no LGA or SGA babies in the EMP group.

The weakness of our study lies in the small numbers of patients considered but, to the best of our knowledge, this is the first study on the feasibility and efficacy of customized dietary treatment for immigrant GDM patients. Compoosizione pilot study indicates the positive effect of an ethnic approach to diet on the outcome of pregnancy. The new methods introduced in our study could be considered a valid approach to the nutritional management of immigrant pregnant women with gestational diabetes mellitus.


It points out that, when prescribing a diet for immigrant women, their different traditional eating habits should be borne in mind. A study with an adequate number of women chosen in accordance with the power calculation is necessary dfgli useful to confirm these preliminary data.

Valentini conceived and designed the study, participated in the coordination of the study, and wrote the paper. Masin followed the patients. Barison followed the patients. Marialisa recorded the data, participated in the statistical analysis.

Pegoraro followed the patients and recorded the data. Lapolla coordinated the study and comosizione in the preparation of the coomposizione. All the authors read and approved the paper.

National Center for Biotechnology InformationU. Journal List Int J Endocrinol v. Published online Mar Author information Article notes Copyright and License information Disclaimer. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

This article has been cited by other articles in PMC. Table 1 Example of two diets on kilocalories. Open in a separate alimwnti. Table 2 Clinical and metabolic characteristics and pregnancy outcome of the subjects under study.

A Pilot Study on Dietary Approaches in Multiethnicity: Two Methods Compared

Pregnancy Outcome No differences alimentj maternal outcome emerged between the two groups. Adherence to Dietary Recommendations Adherence to the meal plans was better in the EMP group, with 7 women scoring 1 or 2 good adherenceas opposed to 2 women in tabellle SMP group. Discussion Immigration flows have increased in Italy, meaning rising numbers of pregnant immigrant women [ 14 ]. Conclusion This pilot study indicates the positive effect of an ethnic approach to diet on the outcome of pregnancy.

Conflict of Interests The authors declare nonfinancial and no competing interest. Summary and recommendations of the fourth international workshop- conference on gestational diabetes mellitus. Epidemiology of gestational diabetes mellitus and its association with type 2 diabetes.

Epidemiology of diabetes in pregnancy: Management of gestational diabetes mellitus. Diabetes, Metabolic Syndrome and Obesity. Outcome of pregnancy among immigrant women with diabetes. The interrelationship between ethnicity and gestational diabetes in fetal macrosomia.

Ethnic differences in perinatal outcome of gestational diabetes mellitus. Maternal obesity and diabetes as risk factors for adverse pregnancy outcomes: American Journal of Public Health. International Journal of Gynecology and Obstetrics.

Maternal race, procedures, and infant birth weight in type 2 and gestational diabetes. Pregnancy outcome in immigrant women with gestational diabetes mellitus. Gestational diabetes mellitus in Italy: American Journal of Obstetrics and Gynecology.

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