22 August 2025 : Review article
A Review of Modulation of Gut Microbiota to Mitigate Gestational Diabetes: Implications for Maternal and Child Health
Olimpia Mora-Janiszewska
ABCDEF 1, Kinga Bialic ABCDEF 1*, Anna Faryniak BF 1, Dorota Darmochwał-Kolarz BF 1
DOI: 10.12659/MSM.948897
Med Sci Monit 2025; 31:e948897
Introduction
Insights Into the Pathophysiology of GDM
Gut Microbiota and Metabolic Health
Effects of Physiological and GDM-Complicated Pregnancy on Gut Microbiota
Fetal Programming and Transgenerational Transmission of Metabolic Disorders
Gut Microbiota Modulation During Pregnancy
Glycome–Microbiome Interaction
The potential Role of Dietary Interventions Targeting Microbiota in Healthy and GDM Mothers
Future Directions
Conclusions
References
Table 3 Studies on influence of diet regarding bacterial taxonomies in the group of women with and without GDM. In this table, a summary is given of studies in which the impact has been investigated of dietary interventions on the gut microbiota composition of pregnant women with and without gestational diabetes mellitus (GDM). It includes the type of diet, the participants’ demographics, methods used for microbiota analysis and the outcomes related to bacterial taxonomies, insulin resistance and metabolic markers. In these studies, various nutritional components are highlighted, such as fiber intake, fat content and carbohydrate levels, as well as their effects on specific bacterial taxa.
| Author | Participating women | Nutritional component | Method | Outcome |
|---|---|---|---|---|
| Gomez-Arango et al (2018) []129 | 57 overweight and 73 obese pregnant women at 16 weeks gestation or less | Participants were ranked based on fiber intake and only the top and bottom 10% of dietary fiber intake (30.8 (29.4–35.9) g/day) (n=13) and (10.3 (9.3–10.5) g/day) (n=13), respectively) were included in the analysis.To ensure that the differences in bacterial networks were not due to differences in overall energy intake, fiber consumption was corrected for total energy intake in all women. The women were ranked again and only the top (0.23 (0.21–0.25) g/kJ) and bottom (0.32 (0.29–0.43) g/kJ) 10% were included in the network analysis | Gut microbiota profiles were assessed via 16S rRNA | Collinsella abundance showed positive correlations with circulating insulin (P=0.0006), independent of maternal BMI, and with C-peptide levels and HOMA-IR but negative with dietary fiber intake (p=0.025).Direct associations between Roseburia and fiber intake were found (β=0.09; 95% CI 0.02 0.16; P=0.01).Collinsella and Blautia were directly and inversely, respectively, associated with insulin and HOMA-IR values; Blautia was inversely correlated with HbA1c |
| Röytiö et al (2017) []130 | 100 overweight and obese pregnant women at less than 18 weeks gestation | Patients were divided into 3 groups. Group 1 was the low-fiber/moderate-fat group (n 57) and consisted of women whose fiber intake was below the reference value (<25 g/d) and whose total fat intake was within the reference intakes (25–40 E%). Group 2 was the high-fiber/moderate-fat group (n18), and these women consumed the recommended level of fiber (≥25 g/d), and the total fat intake was within the reference intake level.Group 3 was the low-fiber/high-fat group (n 13), and their fat intake exceeded the referenced level of total fat intake – that is ≥40% of total energy | Fecal microbiota composition was analyzed using 16S rRNA gene sequencing | The high-fiber/moderate-fat group had a lower relative abundance of Bacteroidaceae (25.6 (SD 10.6)%) in comparison to the low-fiber/high-fat group (42·4 (SD 14.6)%, P=0·01) and the low-fiber/moderate-fat group (33.2 (SD 11.9)%, P=0.02). Similar differences were detected in the Bacteroides genus, for which differences were observed between the high-fiber/moderate-fat and low-fiber/moderate-fat (25.6 (SD 10.6) v. 33.2 (SD 11.9)%, P=0.02) and between high-fiber/moderate-fat and low-fiber/high-fat groups (25.6 (SD 10.6) v. 42.4 (14.6)%, P=0.01) |
| Ferrocino I et al (2018) []131 | 41 GDM patients (assessment at 24–28 weeks and at 38 weeks of gestational age) | All the patients with GDM routinely received dietary counselling and nutritional recommendations in line with guidelines (carbohydrates 45% total energy, rapidly absorbed sugars <10% total energy, proteins 18–20% total energy, fats 35% total energy, at least 20–25 g/day fiber intake, no alcohol). Out of all participants, 34.1% (14/41) declared to be adherent to the given dietary recommendations | The fecal microbiota was assessed via 16S amplicon-based sequencing | Reduced intake of sugars and increased consumption of fiber, oligosaccharides and polyunsaturated fatty acids (PUFA) caused an impressive decrease in Bacteroides in adherents, and higher abundance of Faecalibacterium and L-Ruminococcus together with minor Operational Taxonomic Units (OTUs) in non-adherents.Direct associations between Roseburia and fiber intake were noted (β=0.09; 95% CI 0.02 0.16; P=0.01), and between L-Ruminococcus and oligosaccharides (β=0.02; 95% CI 0.01 0.03; P=0.006),In multiple regression models, Faecalibacterium was significantly associated with fasting glucose; Collinsella (directly) and Blautia (inversely) with insulin, and with Homeostasis-Model Assessment Insulin-Resistance, while Sutterella correlated with C-reactive protein levels |
| Vavreckova M. et al (2022) []79 | 104 pregnant women including obese individuals (first trimester body mass index median was 26.73); Samples were taken during the first and the third trimesters of pregnancy | The total group of pregnant women was divided into 4 subgroups: healthy, pregnant women with impaired FPG in the first trimester, pregnant women with impaired FPG in the third trimester, and pregnant women with impaired oGTT in the third trimester. The authors correlated microbiota changes with basic biochemical parameters and SCFA levels in plasma. They did not assess correlations with diet components | Stool samples were assessed for bacterial 16S rRNA gene sequencing via the Illumina MiSeq Approach | Gut microbiota of normoglycemic women was associated with increased abundance of the Prevotellaceae family, Fusobacteriales order and Sutterella genus. Women who developed impaired insulin resistance later in pregnancy had a higher abundance of the Enterococcus or Erysipelotrichaceae UCG-003 genera A positive correlation between Roseburia and Bacteroides was found in healthy women but not in the GDM group. In the groups of pregnant women with impaired FPG/o GTT in the third trimester, negative correlations were observed between Holdemanella with Blautia and with yeast Candida, respectively. A positive correlation between Collinsella and Bifidobacterium was noted in pregnant women with impaired FPG in the third trimester. In normoglycemic women, a very strong negative correlation was found between the Subdoligranulum genus and serum levels of LDL, non-HDL, and cholesterol. In women with later onset of GDM, a positive correlation between the Escherichia/Shigella group abd LDL, non-HDL, and triglycerides and negative correlation between the Prevotella genus and total cholesterol were observed. Positive correlations were indicated between valerate and the Akkermansia genus in pregnant women with impaired FPG in the first and third trimesters, respectively. In the GDM2 group, the Phascolarctobacterium genus positively correlated with 2-hydroxybutyrate levels |
| Wu N et al 2022 [132] | 27 GDM patients and 30 healthy controls in the third trimester, The BMI value of the GDM group was significantly higher than the value of the healthy group (24.2±4.4, versus was 21.4±2.8)Stool samples were taken 2 times: at the enrolment and at the end of the study after the two-week duration | GDM participants received 2 weeks of dietary management and nutritional recommendations 35–45% carbohydrates (80% complex carbohydrates with a low glycemic index and 20% simple carbohydrates), 18–20% protein (50% animal and 50% vegetable) and 35% fat (16% mono-unsaturated, 10% polyunsaturated and 9% saturated with moderately low saturated fat levels and fiber intake of at least 20–25 g/day | DNA was extracted from stool samples using the QIAamp DNA Stool Mini kit protocol (Qiagen, Germany) | After the dietary intervention, decreases in the abundance of Acidothermus, Granulicella, Bryobacter, and Candidatus Solibacter were observed in most women with GDM. In women with GDM who followed the diet, the Firmicutes/Bacteroidetes (F/B) ratio did not change from baseline. An increase in F/B ratio was noted in women without GDM who did not follow the diet.After 2 weeks of diet therapy, the relative abundance of Bacteroidetes in GDM samples showed an increased trend, and the abundance of Firmicutes slightly decreased, while the ratio of Firmicutes/Bacteroidetes did not increase. A decreased abundance in pathogenic taxa (Acidaminococcaceae, Enterobacteriaceae and Bacteroidaceae) and increased Bifidobacteriaceae and butyric acid-producing bacteria (Prevotellaceae and Lachnospiraceae) were seen compared to the GDM microbial samples at enrolment |
| GDM – gestational diabetes mellitus; BMI – body mass index; FPG – fasting plasma glucose; oGTT – oral glucose tolerance test; LDL – low-density lipoprotein cholesterol; HDL – high-density lipoprotein cholesterol; PUFA – polyunsaturated fatty acids; HOMA-IR – homeostatic model assessment for insulin resistance; SCFA – short-chain fatty acids; OTU – operational taxonomic unit; F/B – Firmicutes to Bacteroidetes ratio. | ||||