Adherence to dietary and lifestyle measures and glycemic control in Moroccan women with gestational diabetes: A cross-sectional study
Keywords:
gestational diabetes, therapeutic adherence, dietary and lifestyle measures, glycemic control, cross-sectional study, MoroccoAbstract
Background and aim: Gestational diabetes (GD) represents a frequent complication of pregnancy, affecting approximately 7-10% of pregnant women in Morocco. This study examined the relationships among therapeutic adherence, glycemic control, and weight changes in pregnant Moroccan women with GD.
Methods: A cross-sectional study was conducted among 120 pregnant women diagnosed with GD. Sociodemographic, clinical, anthropometric data, and glycemic measurements were collected. Adherence to dietary and lifestyle measures (DLM) was assessed by standardized questionnaire, and participants were categorized based on adherence levels.
Results: Initially, all participants (100%) had uncontrolled glycemia. After intervention, 53.3% of participants achieved glycemic balance. Adherence varied considerably: high for vegetable consumption (78.3%) and limiting sugars (75.8%), moderate to high for choosing low glycemic index foods (68.3%), moderate for controlling starchy foods (57.5%), and low for raw vegetables (40.8%). Significant correlations were identified between pre-gestational BMI and weight gain (r=-0.218; p=0.017), between weight gain and evening blood glucose (r=0.249; p=0.006), and between weight gain and overall adherence score (r=-0.236; p=0.009). Notably, 15% of participants experienced weight loss during pregnancy, raising concerns about inadequate nutritional intake.
Conclusions: This study demonstrates that DLM alone can achieve glycemic balance in 53.3% of Moroccan women with GD. However, the 15% prevalence of gestational weight loss highlights the need for comprehensive monitoring that includes both glycemic and weight surveillance. These findings support culturally-adapted interventions, integrated weight monitoring protocols, and personalized nutritional counseling in GD management. Healthcare providers should maintain heightened vigilance for weight loss as a warning signal of inadequate nutritional status, even in women achieving apparent glycemic control.
References
1. American Diabetes Association Professional Practice Committee. 2. Diagnosis and classification of diabetes: Standards of Care in Diabetes-2025. Diabetes Care. 2025;48(1 Suppl 1):S27-49. doi:10.2337/dc25-S002
2. Yuen L, Hannah W, Hare M, Simmons D. Hyperglycaemia in pregnancy: the role of ethnicity and geography in risk and outcomes. Diabetologia. 2025;68(11):2340-61. doi:10.1007/s00125-025-06510-7
3. Paulo MS, Abdo NM, Bettencourt-Silva R, Al-Rifai RH. Gestational diabetes mellitus in Europe: a systematic review and meta-analysis of prevalence studies. Front Endocrinol (Lausanne). 2021;12:691033. doi:10.3389/fendo.2021.691033
4. Meykiechel T, Bourcigaux N, Christin-Maitre S. Le diabète gestationnel: diagnostic et prise en charge. Anesthésie & Réanimation. 2023;9(3):268-76. doi:10.1016/j.anrea.2023.05.002
5. Wu X, Tiemeier H, Xu T. Trends in gestational diabetes prevalence in China from 1990 to 2024: a systematic review and meta-analysis. Rev Endocr Metab Disord. 2025;26(6):1009-21. doi:10.1007/s11154-025-09987-0
6. Abera DA, Larbie C, Abugri J, Ofosu M, Mutocheluh M, Dongsogo J. Prevalence and predictors of gestational diabetes mellitus in Sub-Saharan Africa: a 10-year systematic review. Endocrinol Diabetes Metab. 2024;7(3):e00478. doi:10.1002/edm2.478
7. Ministry of Health and Social Protection of Morocco. National program for pregnancy and childbirth surveillance. Rabat, Morocco; 2021.
8. Lee J, Lee NK, Moon JH. Gestational diabetes mellitus: mechanisms underlying maternal and fetal complications. Endocrinol Metab (Seoul). 2025;40(1):10-25. doi:10.3803/EnM.2024.2264
9. Takele WW, Vesco KK, Josefson J, et al. Effective interventions in preventing gestational diabetes mellitus: a systematic review and meta-analysis. Commun Med (Lond). 2024;4(1):75. doi:10.1038/s43856-024-00491-1
10. American Diabetes Association Professional Practice Committee. 15. Management of diabetes in pregnancy: Standards of Care in Diabetes-2024. Diabetes Care. 2024;47(Suppl 1):S282-94. doi:10.2337/dc24-S015
11. National Institute for Health and Care Excellence (NICE). Evidence reviews for healthy lifestyle interventions for those with gestational diabetes: Maternal and child nutrition. 2025.
12. Sun G, Hou H, Yang S. The effect of probiotics on gestational diabetes mellitus: an umbrella meta-analysis. BMC endocrine disorders. 2024;24(1):253. doi:10.1186/s12902-024-01751-w
13. Zhang J, Ma S, Wu S, Guo C, Long S, Tan H. Effects of probiotic supplement in pregnant women with gestational diabetes mellitus: a systematic review and meta-analysis of randomized controlled trials. Journal of diabetes research. 2019;2019:5364730. doi:10.1155/2019/5364730
14. Li X, Zhang L, He Y, Zhang D, Zhang S. Probiotics for the prevention of gestational diabetes mellitus: a meta-analysis of randomized controlled trials. Biomol Biomed. 2024;24(5):1092-104. doi:10.17305/bb.2024.10377
15. Mu J, Guo X, Zhou Y, Cao G. The effects of probiotics/synbiotics on glucose and lipid metabolism in women with gestational diabetes mellitus: a meta-analysis of randomized controlled trials. Nutrients. 2023;15(6):1375. doi:10.3390/nu15061375
16. Yefet E, Bar L, Izhaki I, et al. Effects of probiotics on glycemic control and metabolic parameters in gestational diabetes mellitus: systematic review and meta-analysis. Nutrients. 2023;15(7):1633. doi:10.3390/nu15071633
17. Hasain Z, Mokhtar NM, Kamaruddin NA, et al. Gut microbiota and gestational diabetes mellitus: a review of host-gut microbiota interactions and their therapeutic potential. Front Cell Infect Microbiol. 2020;10:188. doi:10.3389/fcimb.2020.00188
18. Davidson SJ, Barrett HL, Price SA, Callaway LK, Dekker Nitert M. Probiotics for preventing gestational diabetes. Cochrane Database Syst Rev. 2021;4(4):CD009951. doi:10.1002/14651858.CD009951.pub3
19. Religioni U, Barrios-Rodríguez R, Requena P, Borowska M, Ostrowski J. Enhancing therapy adherence: impact on clinical outcomes, healthcare costs, and patient quality of life. Medicina (Kaunas). 2025;61(1):153. doi:10.3390/medicina61010153
20. Guo S, Liu D, Bi X, et al. Barriers and facilitators to self-management among women with gestational diabetes: a systematic review using the COM-B model. Midwifery. 2024;138:104141. doi:10.1016/j.midw.2024.104141
21. von Elm E, Altman DG, Egger M, et al. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet. 2007;370(9596):1453-7. doi:10.1016/S0140-6736(07)61602-X
22. Le DC, Vu TB, Tran TN, et al. The effectiveness of lifestyle changes in glycemic control among pregnant women with gestational diabetes mellitus. Medicina (Kaunas). 2023;59(9):1587. doi:10.3390/medicina59091587
23. Hindi Z, Belfakira C, Lafram A, et al. Exploring food consumption patterns in the province of Kenitra, Northwest of Morocco. BMC Public Health. 2024;24(1):1899. doi:10.1186/s12889-024-19335-7
24. Goldstein RF, Abell SK, Ranasinha S, et al. Association of gestational weight gain with maternal and infant outcomes: a systematic review and meta-analysis. JAMA. 2017;317(21):2207-25. doi:10.1001/jama.2017.3635
25. Santos S, Voerman E, Amiano P, et al. Impact of maternal body mass index and gestational weight gain on pregnancy complications: an individual participant data meta-analysis of European, North American and Australian cohorts. BJOG. 2019;126(8):984-95. doi:10.1111/1471-0528.15661
26. Xu H, Liu R. Comprehensive management of gestational diabetes mellitus: practical efficacy of exercise therapy and sustained intervention strategies. Front Endocrinol (Lausanne). 2024;15:1347754. doi:10.3389/fendo.2024.1347754
27. Huang X, Fan D, Li W, et al. Optimal gestational weight change associated with improved perinatal outcomes in women with gestational diabetes mellitus: a population-based study in the United States. Am J Clin Nutr. 2024;120(3):737-45. doi:10.1016/j.ajcnut.2024.07.008
28. de Castro R, Antunes R, Mendes D, Szumilewicz A, Santos-Rocha R. Can group exercise programs improve health outcomes in pregnant women? An updated systematic review. Int J Environ Res Public Health. 2022;19(8):4875. doi:10.3390/ijerph19084875
29. McAuliffe FM, Killeen SL, Jacob CM, et al. Management of prepregnancy, pregnancy, and postpartum obesity from the FIGO Pregnancy and Non-Communicable Diseases Committee: a FIGO (International Federation of Gynecology and Obstetrics) guideline. Int J Gynaecol Obstet. 2020;151(Suppl 1):16-36. doi:10.1002/ijgo.13334
30. Niebrzydowska-Tatus M, Pełech A, Rekowska AK, et al. Recent insights and recommendations for preventing excessive gestational weight gain. J Clin Med. 2024;13(5):1461. doi:10.3390/jcm13051461
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Copyright (c) 2026 Hanane Azargui , Fatine El Arabi , Btihaj Al Ibrahmi, Kaltoum Boutahar, Youssef Ikken, Soad Khal-Layoun, Abdellatif Bour
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