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Nos conseils sur le diabète gestationnel pendant la grossesse

Our advice on gestational diabetes during pregnancy

What causes gestational diabetes? What are the risks for mother and child? How can gestational diabetes be managed?

Contents

Gestational diabetes is on the rise worldwide, in parallel with the increasing prevalence of obesity and type 2 diabetes.

It affects on average 18% of pregnancies [1]. This makes gestational diabetes the most common complication of pregnancy!

STATS

18% des femmes enceintes font du diabète gestationnel.

What causes gestational diabetes?

Gestational diabetes generally develops towards the end of the second trimester and usually disappears shortly after delivery [2]. During pregnancy, the body undergoes many metabolic changes, which can affect blood glucose levels, particularly in the second and third trimesters. Scientists have shown that blood glucose is expected to be 20% lower during pregnancy [3].

During a normal pregnancy, progressive insulin resistance develops from mid-pregnancy onwards and progresses through the third trimester [4]. Normal pregnancy is characterised by a 50% reduction in insulin-mediated glucose disposal (insulin resistance) and a 200 to 250% increase in insulin secretion to maintain normal blood glucose levels in the mother [5].

For example, the increase in oestrogens, progesterone and cortisol (the stress hormone) during pregnancy contributes to a disruption of the balance between glucose and insulin [2]. Human placental lactogen (a hormone that promotes insulin release) increases thirtyfold throughout pregnancy and induces insulin release by the pancreas during pregnancy, which can cause insulin resistance [5].

To compensate for insulin resistance during pregnancy, insulin secretion by the woman's pancreas increases. Gestational diabetes develops when the woman's pancreas does not secrete enough insulin to compensate for the metabolic stress associated with insulin resistance. 

Why this product?

Pregnant with gestational diabetes? Try our gluten-free Jolly bread, rich in fibre and protein and enriched with magnesium. Ideal in the morning with eggs and a little avocado, for example, to help stabilise your blood sugar levels and start the day on the right foot!

Our recommended product

Jolly Bread

Jolly Bread

Préparation pain nordique au magnésium

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Vegan and gluten-free Nordic bread mix

Enriched with magnesium and a source of protein

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What are the risk factors for gestational diabetes?

The most common risk factors associated with the development of gestational diabetes are obesity, advanced maternal age, a history of gestational diabetes, a family history of diabetes, polycystic ovary syndrome, and persistent hyperglycaemia [6].

A history of delivering a baby with a high birth weight (≥4000 g), a history of recurrent miscarriages, a history of unexplained stillbirths, and a history of hypertension are additional risk factors for gestational diabetes [7].

Furthermore, increased maternal fat deposition (body fat mass), reduced physical activity, and increased caloric intake all contribute to this condition.

There is a way to predict whether gestational diabetes may develop in the first trimester! A high haemoglobin A1c level (reflecting elevated blood sugar over several months) can predict gestational diabetes with reasonable accuracy (in 98.4% of cases) [8].

TIPS

Privilégier les glucides à index glycémique bas (oléagineux, légumineuses, etc).
Faire le plein de protéines et de fibres pour diminuer la glycémie.
Faire un peu d’exercice physique

Did you know?

L’allaitement pourrait avoir un effet protecteur sur le risque de développement de diabète de type 2.

What are the risks associated with gestational diabetes?

During pregnancy, the body does everything it can to maintain low blood sugar levels, as elevated blood glucose is linked to malformations and can affect development in utero, as well as lifelong metabolic health [9].

Women with gestational diabetes have an increased incidence of hypertensive disorders during pregnancy, including gestational hypertension, pre-eclampsia, and eclampsia. There is also an increased risk of premature birth [9].

Excessive foetal growth remains an important perinatal concern in cases of gestational diabetes. Babies may have a high birth weight; studies show that women with a blood glucose level of 90 mg/dl or below had a larger baby in only 10% of cases, whereas those with a level of 100 mg/dl or above had a larger baby in 25–35% of cases [9].
The consequences of excessive foetal growth include birth trauma, maternal morbidity related to caesarean deliveries, and neonatal hypoglycaemia [9]. 

The baby's blood sugar level is a direct reflection of the mother's blood sugar level. When it is high, the baby's pancreas works harder to secrete large amounts of insulin. A side effect of high insulin levels in the baby is a greater fat mass. The baby may also experience hypoglycaemia after birth, because once the umbilical cord is cut, the influx of sugar stops, but the pancreas continues to secrete excess insulin.

Among the other neonatal morbidities that may occur more frequently in infants of women with gestational diabetes are hypocalcaemia and respiratory distress syndrome [9]. 

Long-term complications of gestational diabetes include type 2 diabetes and cardiovascular disease in mothers [10]. Indeed, gestational diabetes is associated with an approximately 7 times higher risk of developing maternal diabetes later in life [11].

In one study, it was shown that women who had been treated with insulin during pregnancy had the highest risk of developing type 2 diabetes: 92.3% of them developed diabetes on average 2.1 years after delivery.
Among those whose gestational diabetes had been managed by diet alone, the risk of diabetes was dependent on body mass index (BMI ≤ 30 or> 30 kg/m²); diabetes occurred in 28.6% and 69.1% of women respectively, with diagnosis made 10.2 and 18.2 years after delivery, even when blood glucose was normal after birth and none of these women developed islet antibodies during the follow-up period. The presence of these autoantibodies in women showed that all but one of those who had them developed diabetes, on average 4.5 months after delivery [12].

In children, the long-term risk is of developing diabetes and obesity [13]. Having been exposed in utero to very high blood sugar levels can activate genes that predispose to obesity, diabetes, or heart disease [8]. Children of mothers who had gestational diabetes have a 6 times higher risk of experiencing blood sugar and weight problems after adolescence [14].

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How can gestational diabetes be managed?

40% of women with gestational diabetes need insulin or medication to lower their blood sugar levels [15], whereas following a low glycaemic index diet reduces the likelihood of needing insulin by 50% [16]!

The goal is to maintain normal blood sugar levels in order to manage gestational diabetes. Nutrition is the cornerstone of gestational diabetes management, as it helps maintain the desired glycaemic targets in 80 to 90% of women with gestational diabetes [2].

The optimal dietary approach would be one that provides adequate nutrition to support the wellbeing of both the foetus and the mother, whilst maintaining normal blood sugar levels and allowing for appropriate weight gain during pregnancy [17].

Furthermore, even if you do not have diabetes, it is advisable to pay attention to your blood sugar levels during pregnancy. It can be helpful to monitor your blood sugar, to avoid over-stressing the pancreas, which is already under considerable demand throughout pregnancy.

Tips: carbohydrate intake should be reduced to 35–45% of total caloric intake, spread across 3 meals and 2 to 4 snacks, including an evening snack, which helps reduce post-meal blood sugar spikes whilst ensuring adequate nutrition for both the mother and the foetus [18].

Favour low glycaemic index carbohydrates [19], such as:
Certain fruits: apple, pear, grapefruit
Nuts and seeds: pecans, cashews
All vegetables
Legumes: lentils, chickpeas, peas

Manger de petites portions de glucides avec des protéines (qui stabilisent le taux de sucre dans le sang) et des gras, ou encore des légumes pauvres en amidon (qui contiennent moins de glucides) peut être très utile. La consommation d’aliments riches en fibres permet également de diminuer l’augmentation de la glycémie.

Notre pancréas, qui produit de l’insuline, a besoin de certains acides aminés en quantités suffisantes pour pouvoir faire son travail (il est sur sollicité durant la grossesse et produit jusqu’à 3 fois l’insuline produite normalement [5]), or les protéines sont les sources d’acides aminés, d’où l’importance d’une consommation adéquate. 

Notre poudre de protéines végétales Purple power vous permettra de consommer 5g de protéines par portion, ce qui aide à stabiliser la glycémie. Elle est sans sucres ajoutés et contient seulement 0.5g de sucres par portion. 

Il a été démontré que l'exercice physique améliore le contrôle de la glycémie dans le cas du diabète gestationnel. En effet, chez les femmes qui font régulièrement de l’exercice physique, le risque de développer un diabète gestationnel est diminué de 49 à 78% [20]. 

Un exercice modéré quotidien pendant 30 minutes ou plus est recommandé pour une femme atteinte de diabète gestationnel, si elle ne présente pas de contre-indications médicales ou obstétriques. Cela peut vraiment aider à réguler le taux de sucre dans le sang, diminuer la résistance à l’insuline et réduire le besoin de prendre des médicaments [21].

Marcher d'un bon pas ou faire des exercices avec les bras tout en restant assis sur une chaise pendant au moins 10 minutes après chaque repas permet de réduire l'augmentation du glucose après le repas et d'atteindre l'objectif glycémique [18].

Pour en savoir plus, retrouvez notre article sport et grossesse.

Pregnancy food challenge

Our step-by-step advice for your diet during pregnancy

Our advice on gestational diabetes during pregnancy

Is it possible to take action from the very start of pregnancy?

Certaines recherches montrent que chez certaines femmes, il existe des facteurs qui peuvent diminuer le risque de faire du diabète gestationnel.

Par exemple, une étude a montré qu’une consommation insuffisante de protéines au premier trimestre pouvait constituer un facteur de risque plus élevé de faire du diabète gestationnel [22].

Les femmes qui boivent beaucoup de jus de fruits (qui n’apportent que du sucre sans les effets bénéfiques des fibres), ou qui prennent trop de céréales industrielles (trop sucrées) ont également plus de risque de développer un diabète gestationnel. En revanche, les femmes qui consomment beaucoup de noix ont un risque moins élevé [23].

D’autre part, une consommation excessive de fruits, particulièrement ceux ayant un index glycémique élevé (dattes, cerises, ananas, etc), ont plus de risque de développer un diabète gestationnel [24].

Certaines carences en nutriments peuvent également favoriser le développement du diabète gestationnel. La carence en vitamine D [25] et en magnésium [26] augmentent la résistance à l’insuline ce qui augmente le risque de survenue du diabète gestationnel. Un bon état nutritionnel en ces nutriments pourrait donc aider à prévenir le risque de développer cette maladie.

Découvrez notre complément magnésium grossesse et notre vitamine D grossesse, pour vous aider à couvrir vos besoins durant la grossesse.

What effect does breastfeeding have on the risk of type 2 diabetes?

Les bienfaits de l’allaitement sont nombreux. Il va notamment abaisser à long terme le risque de diabète de type 2, mais cet impact dépend de la durée de l’allaitement. 

In a study on participants who had developed gestational diabetes, researchers found — exclusively among women who had no anti-islet antibodies and had breastfed for more than 3 months — a type 2 diabetes rate of 42% at 15 years post-delivery, compared with 72% among women who had breastfed for less than 3 months or had not breastfed at all. This effect was greater among women who had breastfed exclusively [12]. 

Breastfeeding has a positive impact on glucose homeostasis (balance) and lipid metabolism. This can be explained by the demands of milk production. The mammary gland requires glucose to produce lactose, and it has been observed that the mammary gland is sensitive to insulin, which acts on glucose and reduces its rise in the blood [27]. 

Lactation also induces the mobilisation of lipid reserves for the synthesis of milk lipids. This redistribution of lipids may reduce insulin resistance. A study conducted on average 3.6 years after delivery in 196 women who had experienced gestational diabetes found that those who had breastfed for more than 3 months had a different metabolomic profile (the study of metabolites in the body) compared to those who had breastfed for a shorter period or had not breastfed at all, reducing the risk of diabetes [27].  

This may also be due to the fact that, on average, women who had gestational diabetes and breastfed find it easier to return to their pre-pregnancy weight. Excess weight and obesity are risk factors for the development of type 2 diabetes.

Jolly Mama products and gestational diabetes

Nos carrés de céréales n’ont pas été conçus spécialement pour le diabète gestationnel, mais nous n'utilisons pas de sucre raffiné et que des ingrédients à indice glycémique bas ou moyen. Certaines mamans ont eu le feu vert pour leur consommation, mais nous vous conseillons d’en parler à votre médecin pour vous en assurer.

Notre granola salé idéal grossesse Tomato croq et notre Porridge sont sans sucres ajoutés et sans gluten, et peuvent constituer une option idéale si vous faites du diabète gestationnel.

La préparation pour pain aux graines sans gluten Jolly Bread peut également être consommée en cas de diabète gestationnel. Le bouillon d'os de poule Mama poule est a priori compatible également.

Baby bump, notre complément alimentaire grossesse multivitamines avec du DHA est sans sucre.

Dans le doute, préférez demander l’avis d’un professionnel de santé. 

Conclusion

The onset of gestational diabetes may be linked to metabolic changes (increased insulin resistance, hyperglycaemia, hormones, etc.). 

Gestational diabetes can affect both maternal and neonatal health. To help manage it, medication or insulin injections may be prescribed, but you can also act through your diet: eating low-glycaemic-index foods, avoiding refined and processed sugars, and taking regular physical exercise.

One of the major consequences of gestational diabetes is the risk of developing type 2 diabetes after pregnancy. Studies suggest that breastfeeding may have a protective effect against diabetes.

Bear in mind that what works for you may not work for another pregnant woman, particularly when it comes to diet. You can monitor your blood sugar levels when you wake up in the morning and 1 to 2 hours after a meal, so you can adjust accordingly.

Source 1 : The HAPO Study: Paving The Way For New Diagnostic Criteria For GDM, 2010

Source 2 : Gestational diabetes mellitus, 2015

Source 3 : Patterns of Glycemia in Normal Pregnancy: Should Therapeutic Targets Be Challenged?, 2011

Source 4 : Longitudinal Changes in Insulin Release and Resistance in Nonobese Pregnant Women, 1991

Source 5 : Cellular Mechanisms for Insulin Resistance in Normal Pregnancy and GDM, 2007

Source 6 : Pregravid Determinants of GDM – Prospective Study, 1997

Source 7 : Early Pregnancy HbA1c ≥5.9% and Risk of Adverse Outcomes, 2014

Source 8 : Maternal Diabetes, GDM and the Role of Epigenetics, 2015

Source 9 : Hyperglycemia and Adverse Pregnancy Outcomes – HAPO, 2008

Source 10 : Gestational Diabetes and the Incidence of Type 2 Diabetes: A Systematic Review, 2002

Source 11 : Type 2 Diabetes Mellitus after Gestational Diabetes: Meta-Analysis, 2009

Source 12 : Long-Term Protective Effect of Lactation on T2D After GDM, 2012

Source 13 : Intrauterine Diabetic Environment and Risk of T2D and Obesity in Offspring, 2001

Source 14 : Low Disposition Index in Offspring of GDM Mothers: Risk Marker, 2014

Source 15 : Glyburide for the Treatment of Gestational Diabetes, 2004

Source 16 : Low-Glycemic Index Diet Reduces Insulin Need in GDM: Randomized Trial, 2009

Source 17 : Nutrition Recommendations and Interventions for Diabetes – ADA, 2008

Source 18 : Diabetes and Pregnancy: Endocrine Society Clinical Guidelines, 2013

Source 19 : Guide des index glycémiques IG et valeurs nutritionnelles, Thierry Souccar, 2011

Source 20 : Physical Activity and Risk of GDM – Case Control Study, 2004

Source 21 : Impact of Exercise on GDM Outcomes – RCT, 2016

Source 22 : Serotonin Regulates Pancreatic β-Cell Mass during Pregnancy, 2010

Source 23 : Lifestyle Patterns in Early Pregnancy and GDM – St Carlos Study, 2016

Source 24 : Excessive Fruit Consumption and GDM Risk: Prospective Study, 2017

Source 25 : Vitamin D Status and Adverse Pregnancy Outcomes – Meta-Analysis, 2013

Source 26 : Abdominal Obesity, GDM and Magnesium: Interactive Role, 2015

Source 27 : Insulin Receptor Activity in Mammary Gland of Lactating Rats, 1990

[1] COUSTAN, Donald R, Lynn P LOWE, Boyd E METZGER, et Alan R DYER. 2010. « The HAPO Study: Paving The Way For New Diagnostic Criteria For GDM ». American journal of obstetrics and gynecology 202 (6): 654.e1-654.e6. https://doi.org/10.1016/j.ajog.2010.04.006.

[2] Alfadhli, Eman M. 2015. « Gestational diabetes mellitus ». Saudi Medical Journal
36 (4): 399‑406. https://doi.org/10.15537/smj.2015.4.10307.

[3] Hernandez, Teri L., Jacob E. Friedman, Rachael E. Van Pelt, et Linda A. Barbour. 2011. « Patterns of Glycemia in Normal Pregnancy: Should the Current Therapeutic Targets Be Challenged? » Diabetes Care 34 (7): 1660‑68. https://doi.org/10.2337/dc11-0241.

[4] Catalano, P. M., E. D. Tyzbir, N. M. Roman, S. B. Amini, et E. A. Sims. 1991. « Longitudinal Changes in Insulin Release and Insulin Resistance in Nonobese Pregnant Women ». American Journal of Obstetrics and Gynecology 165 (6 Pt 1): 1667‑72. https://doi.org/10.1016/0002-9378(91)90012-g.

[5] Barbour, Linda A., Carrie E. McCurdy, Teri L. Hernandez, John P. Kirwan, Patrick M. Catalano, et Jacob E. Friedman. 2007. « Cellular Mechanisms for Insulin Resistance in Normal Pregnancy and Gestational Diabetes ». Diabetes Care 30 (Supplement 2): S112‑19. https://doi.org/10.2337/dc07-s202.

[6] Solomon, C. G., W. C. Willett, V. J. Carey, J. Rich-Edwards, D. J. Hunter, G. A. Colditz, M. J. Stampfer, F. E. Speizer, D. Spiegelman, et J. E. Manson. 1997. « A Prospective Study of Pregravid Determinants of Gestational Diabetes Mellitus ». JAMA 278 (13): 1078‑83.

[7] Hughes, Ruth C. E., M. Peter Moore, Joanna E. Gullam, Khadeeja Mohamed, et Janet Rowan. 2014. « An Early Pregnancy HbA1c ≥5.9% (41 Mmol/Mol) Is Optimal for Detecting Diabetes and Identifies Women at Increased Risk of Adverse Pregnancy Outcomes ». Diabetes Care 37 (11): 2953‑59. https://doi.org/10.2337/dc14-1312.

[8] Ma, Ronald C.W., Greg E. Tutino, Karen A. Lillycrop, Mark A. Hanson, et Wing Hung Tam. 2015. « Maternal Diabetes, Gestational Diabetes and the Role of Epigenetics in Their Long Term Effects on Offspring ». Progress in Biophysics and Molecular Biology 118 (1‑2): 55‑68. https://doi.org/10.1016/j.pbiomolbio.2015.02.010.

[9] HAPO Study Cooperative Research Group, Boyd E. Metzger, Lynn P. Lowe, Alan R. Dyer, Elisabeth R. Trimble, Udom Chaovarindr, Donald R. Coustan, et al. 2008. « Hyperglycemia and Adverse Pregnancy Outcomes ». The New England Journal of Medicine 358 (19): 1991‑2002. https://doi.org/10.1056/NEJMoa0707943.

[10] Kim, Catherine, Katherine M. Newton, et Robert H. Knopp. 2002. « Gestational Diabetes and the Incidence of Type 2 Diabetes: A Systematic Review ». Diabetes Care 25 (10): 1862‑68. https://doi.org/10.2337/diacare.25.10.1862.

[11] Bellamy, Leanne, Juan-Pablo Casas, Aroon D. Hingorani, et David Williams. 2009. « Type 2 Diabetes Mellitus after Gestational Diabetes: A Systematic Review and Meta-Analysis ». Lancet (London, England) 373 (9677): 1773‑79. https://doi.org/10.1016/S0140-6736(09)60731-5.

[12] Ziegler, Anette-G., Maike Wallner, Imme Kaiser, Michaela Rossbauer, Minna H. Harsunen, Lorenz Lachmann, Jörg Maier, Christiane Winkler, et Sandra Hummel. 2012. « Long-Term Protective Effect of Lactation on the Development of Type 2 Diabetes in Women With Recent Gestational Diabetes Mellitus ». Diabetes 61 (12): 3167‑71. https://doi.org/10.2337/db12-0393.

[13] Dabelea, D., et D. J. Pettitt. 2001. « Intrauterine Diabetic Environment Confers Risks for Type 2 Diabetes Mellitus and Obesity in the Offspring, in Addition to Genetic Susceptibility ». Journal of Pediatric Endocrinology & Metabolism: JPEM 14 (8): 1085‑91. https://doi.org/10.1515/jpem-2001-0803.

[14] Holder, Tara, Cosimo Giannini, Nicola Santoro, Bridget Pierpont, Melissa Shaw, Elvira Duran, Sonia Caprio, et Ram Weiss. 2014. « A Low Disposition Index in Adolescent Offspring of Mothers with Gestational Diabetes: A Risk Marker for the Development of Impaired Glucose Tolerance in Youth ». Diabetologia 57 (11): 2413‑20. https://doi.org/10.1007/s00125-014-3345-2.

[15] Kremer, Carrie J., et Patrick Duff. 2004. « Glyburide for the Treatment of Gestational Diabetes ». American Journal of Obstetrics and Gynecology 190 (5): 1438‑39. https://doi.org/10.1016/j.ajog.2004.02.032.

[16] Moses, Robert G., Megan Barker, Meagan Winter, Peter Petocz, et Jennie C. Brand-Miller. 2009. « Can a Low-Glycemic Index Diet Reduce the Need for Insulin in Gestational Diabetes Mellitus? A Randomized Trial ». Diabetes Care 32 (6): 996‑1000. https://doi.org/10.2337/dc09-0007.

[17] American Diabetes Association, John P. Bantle, Judith Wylie-Rosett, Ann L. Albright, Caroline M. Apovian, Nathaniel G. Clark, Marion J. Franz, et al. 2008. « Nutrition Recommendations and Interventions for Diabetes: A Position Statement of the American Diabetes Association ». Diabetes Care 31 Suppl 1 (janvier): S61-78. https://doi.org/10.2337/dc08-S061.

[18] Blumer, Ian, Eran Hadar, David R. Hadden, Lois Jovanovič, Jorge H. Mestman, M. Hassan Murad, et Yariv Yogev. 2013. « Diabetes and Pregnancy: An Endocrine Society Clinical Practice Guideline ». The Journal of Clinical Endocrinology & Metabolism 98 (11): 4227‑49. https://doi.org/10.1210/jc.2013-2465.

[19] Thierry Souccar. “Guide des index glycémiques IG et valeurs nutritionnelles : charge glycémique, calories, graisses, fibres, …”. 2011.

[20] Dempsey, Jennifer C., Carole L. Butler, Tanya K. Sorensen, I.-Min Lee, Mary Lou Thompson, Raymond S. Miller, Ihunnaya O. Frederick, et Michelle A. Williams. 2004. « A Case Control Study of Maternal Recreational Physical Activity and Risk of Gestational Diabetes Mellitus ». Diabetes Research and Clinical Practice 66 (2): 203‑15. https://doi.org/10.1016/j.diabres.2004.03.010.

[21] Kokic, Iva Sklempe, Marina Ivanisevic, Gianni Biolo, Bostjan Simunic, Tomislav Kokic, et Rado Pisot. 2016. « P-68 The Impact of Structured Aerobic and Resistance Exercise on the Course and Outcomes of Gestational Diabetes Mellitus: A Randomised Controlled Trial ». British Journal of Sports Medicine 50 (Suppl 1): A69‑A69. https://doi.org/10.1136/bjsports 2016-097120.121.

[22] Kim, Hail, Yukiko Toyofuku, Francis C. Lynn, Eric Chak, Toyoyoshi Uchida, Hirok i Mizukami, Yoshio Fujitani, et al. 2010. « Serotonin Regulates Pancreatic β-Cell Mass during Pregnancy ». Nature medicine 16 (7): 804‑8. https://doi.org/10.1038/nm.2173.

[23] Ruiz-Gracia, Teresa, Alejandra Duran, Manuel Fuentes, Miguel A. Rubio, Isabelle Runkle, Evelyn F. Carrera, María J. Torrejón, et al. 2016. « Lifestyle Patterns in Early Pregnancy Linked to Gestational Diabetes Mellitus Diagnoses When Using IADPSG Criteria. The St Carlos Gestational Study ». Clinical Nutrition (Edinburgh, Scotland) 35 (3): 699‑705. https://doi.org/10.1016/j.clnu.2015.04.017.

[24] Huang, Wu-Qing, Ying Lu, Ming Xu, Jing Huang, Yi-Xiang Su, et Cai-Xia Zhang. 2017. « Excessive Fruit Consumption during the Second Trimester Is Associated with Increased Likelihood of Gestational Diabetes Mellitus: A Prospective Study ». Scientific Reports 7 (mars): 43620. https://doi.org/10.1038/srep43620.

[25] Wei, Shu-Qin, Hui-Ping Qi, Zhong-Cheng Luo, et William D. Fraser. 2013. « Maternal Vitamin D Status and Adverse Pregnancy Outcomes: A Systematic Review and Meta-Analysis ». The Journal of Maternal-Fetal & Neonatal Medicine: The Official Journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians 26 (9): 889‑99. https://doi.org/10.3109/14767058.2013.765849.

[26] Mostafavi, Ebrahim, Arash Aghajani Nargesi, Firoozeh Akbari Asbagh, Zaniar Ghazizadeh, Behnam Heidari, Hossein Mirmiranpoor, Alireza Esteghamati, Claude Vigneron, et Manouchehr Nakhjavani. 2015. « Abdominal Obesity and Gestational Diabetes: The Interactive Role of Magnesium ». Magnesium Research 28 (4): 116‑25. https://doi.org/10.1684/mrh.2015.0392.

[27] Burnol, A. F., M. Loizeau, et J. Girard. 1990. « Insulin Receptor Activity and Insulin Sensitivity in Mammary Gland of Lactating Rats ». The American Journal of Physiology 259 (6 Pt 1): E828-834. https://doi.org/10.1152/ajpendo.1990.259.6.E828.

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Jolly Bread

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£7.65

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Enriched with magnesium and a source of protein

2 slices of bread cover nearly 50% of the daily magnesium intake

Ready in 2 mins before cooking!

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