{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T04:30:59Z","timestamp":1786336259459,"version":"build-2736575974"},"reference-count":34,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T00:00:00Z","timestamp":1786320000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Nutr."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Gestational diabetes mellitus (GDM) is a common metabolic disorder of pregnancy associated with adverse maternal and neonatal outcomes. Emerging evidence suggests that dietary patterns supportive of gut microbial health and associated systemic inflammation may contribute to the pathophysiology of GDM. This study evaluated the association between a dietary index oriented toward gut microbiota (DI-GM)\u2014comprising foods previously linked to beneficial gut microbial composition\u2014and GDM odds, metabolic profiles, inflammatory markers, and pregnancy outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This case\u2013control study included 800 pregnant women (400 GDM cases and 400 controls) at 24\u201328\u202fweeks of gestation. Dietary intake was assessed using a validated food frequency questionnaire, and DI-GM scores were derived based on intake of microbiota-supportive and disruptive foods. Biochemical measurements included glucose parameters, lipid profile, hs-CRP, IL-6, TNF-\n                      <jats:italic>\u03b1<\/jats:italic>\n                      , and lipopolysaccharide. Multivariable logistic regression and structural equation modeling were used for association and mediation analyses.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Women with GDM had lower DI-GM scores than controls (7.09\u202f\u00b1\u202f1.64 vs. 9.52\u202f\u00b1\u202f1.83,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001). In the fully adjusted model (Model 2), women in the highest DI-GM tertile (T3) had 55.4% lower odds of GDM compared with those in the lowest tertile (T1) (OR\u202f=\u202f0.446). A significant inverse trend was observed across DI-GM tertiles (\n                      <jats:italic>P<\/jats:italic>\n                      trend\u202f=\u202f0.002), indicating a dose\u2013response relationship. Each 1-unit increase in DI-GM score was associated with an 11.0% lower adjusted odds of GDM (OR\u202f=\u202f0.890); however, the association appeared to be nonlinear, with the strongest protective effect observed in the highest tertile. These findings suggest a potential threshold effect, whereby clinically meaningful benefits become evident primarily at higher levels of dietary adherence. The highest DI-GM tertile demonstrated lower fasting glucose, HbA1c, HOMA-IR, triglycerides, hs-CRP, and LPS, alongside higher HDL-C (all\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.05). Among women with GDM, higher DI-GM scores were strongly associated with lower rates of cesarean delivery, preeclampsia, gestational hypertension, macrosomia, neonatal hypoglycemia, NICU admission, and respiratory distress syndrome (all\n                      <jats:italic>P<\/jats:italic>\n                      -trend &amp;lt; 0.001). However, in the control group, this protective trend was not observed for any outcome except for a paradoxical significant increase in cesarean delivery with higher DI-GM adherence (\n                      <jats:italic>P<\/jats:italic>\n                      -trend &amp;lt; 0.001), while all other outcomes showed no significant trends (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;gt;\u202f0.10). Exploratory mediation analyses suggested hs-CRP may partially explain the DI-GM-glycemic association, but concurrent measurement precludes causal mediation. The negative indirect effects indicate an inconsistent mediation pattern, suggesting hs-CRP may not function as a classical mediator but rather reflects shared metabolic pathways or residual confounding. These findings are exploratory and hypothesis-generating, not confirmatory.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Greater adherence to a microbiota-oriented dietary pattern was associated with lower GDM odds and improved maternal\u2013neonatal outcomes. However, without direct gut microbiota measurement, these findings represent associations\u2014not confirmation\u2014of diet\u2013microbiota\u2013inflammation pathways, and require further investigation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fnut.2026.1895387","type":"journal-article","created":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T04:22:22Z","timestamp":1786335742000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Dietary index for gut microbiota and odds of gestational diabetes mellitus: associations with inflammatory and metabolic biomarkers"],"prefix":"10.3389","volume":"13","author":[{"given":"Yi","family":"Su","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology, Shanxi Children\u2019s Hospital (Shanxi Maternal and Child Health Hospital)","place":["Taiyuan, Shanxi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiuping","family":"Du","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Shanxi Children\u2019s Hospital (Shanxi Maternal and Child Health Hospital)","place":["Taiyuan, Shanxi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhiying","family":"Song","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Shanxi Children\u2019s Hospital (Shanxi Maternal and Child Health Hospital)","place":["Taiyuan, Shanxi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xifeng","family":"He","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Shanxi Children\u2019s Hospital (Shanxi Maternal and Child Health Hospital)","place":["Taiyuan, Shanxi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,10]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"513","DOI":"10.1016\/j.ecl.2021.05.008","article-title":"Emerging and public health challenges existing in gestational diabetes mellitus and diabetes in pregnancy","volume":"50","author":"Yogev","year":"2021","journal-title":"Endocrinol Metab Clin N Am"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"597","DOI":"10.1186\/s12884-020-03310-y","article-title":"High physical activity and high sedentary behavior increased the risk of gestational diabetes mellitus among women with excessive gestational weight gain: a prospective study","volume":"20","author":"Yong","year":"2020","journal-title":"BMC Pregnancy Childbirth"},{"key":"ref3","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1007\/978-3-030-11815-0_6","volume-title":"The Diabetes Textbook: Clinical Principles, Patient Management and Public Health Issues","author":"Nandhini","year":"2019"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"816","DOI":"10.1111\/jhn.12932","article-title":"Early life programming of health and disease: the long-term consequences of obesity in pregnancy","volume":"35","author":"Langley-Evans","year":"2022","journal-title":"J Hum Nutr Diet"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"2320","DOI":"10.3390\/ijms26052320","article-title":"Unveiling gestational diabetes: an overview of pathophysiology and management","volume":"26","author":"Mittal","year":"2025","journal-title":"Int J Mol Sci"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"3467","DOI":"10.3390\/ijms19113467","article-title":"Maternal \u03b2-cell adaptations in pregnancy and placental signalling: implications for gestational diabetes","volume":"19","author":"Moyce","year":"2018","journal-title":"Int J Mol Sci"},{"key":"ref7","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1080\/09513590.2021.2015762","article-title":"Gestational diabetes mellitus is associated with blood inflammatory indicators in a Chinese pregnant women population","volume":"38","author":"Wang","year":"2022","journal-title":"Gynecol Endocrinol"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"221","DOI":"10.1007\/978-3-319-48382-5_10","article-title":"The pathogenesis of obesity-associated adipose tissue inflammation","volume":"960","author":"Engin","year":"2017","journal-title":"Adv Exp Med Biol."},{"key":"ref9","doi-asserted-by":"publisher","first-page":"188","DOI":"10.3389\/fcimb.2020.00188","article-title":"Gut microbiota and gestational diabetes mellitus: a review of host-gut microbiota interactions and their therapeutic potential","volume":"10","author":"Hasain","year":"2020","journal-title":"Front Cell Infect Microbiol"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"1725","DOI":"10.3390\/microorganisms11071725","article-title":"Gut microbiota and critical metabolites: potential target in preventing gestational diabetes mellitus?","volume":"11","author":"Hu","year":"2023","journal-title":"Microorganisms"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"424","DOI":"10.3390\/life12030424","article-title":"The maternal-fetal gut microbiota axis: physiological changes, dietary influence, and modulation possibilities","volume":"12","author":"Miko","year":"2022","journal-title":"Life"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"927","DOI":"10.1111\/1440-1681.13250","article-title":"Metabolic endotoxemia and cardiovascular disease: a systematic review about potential roles of prebiotics and probiotics","volume":"47","author":"Moludi","year":"2020","journal-title":"Clin Exp Pharmacol Physiol"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"9192","DOI":"10.1038\/s41598-022-13251-5","article-title":"Mycobiota composition and changes across pregnancy in patients with gestational diabetes mellitus (GDM)","volume":"12","author":"Ferrocino","year":"2022","journal-title":"Sci Rep"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1007\/s00394-017-1445-8","article-title":"Gut microbiota functions: metabolism of nutrients and other food components","volume":"57","author":"Rowland","year":"2018","journal-title":"Eur J Nutr"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"157","DOI":"10.3389\/fnut.2019.00157","article-title":"Plant-based fat, dietary patterns rich in vegetable fat and gut microbiota modulation","volume":"6","author":"Muralidharan","year":"2019","journal-title":"Front Nutr"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"1546","DOI":"10.3390\/nu15061546","article-title":"Low-grade inflammation and ultra-processed foods consumption: a review","volume":"15","author":"Tristan Asensi","year":"2023","journal-title":"Nutrients"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"1062304","DOI":"10.3389\/fpubh.2022.1062304","article-title":"The effect of diet quality on the risk of developing gestational diabetes mellitus: a systematic review and meta-analysis","volume":"10","author":"Gao","year":"2023","journal-title":"Front Public Health"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"216","DOI":"10.7762\/cnr.2015.4.4.216","article-title":"Dietary patterns and their associations with the diet quality index-international (DQI-I) in Korean women with gestational diabetes mellitus","volume":"4","author":"Shin","year":"2015","journal-title":"Clin Nutr Res"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"e250615","DOI":"10.1530\/EC-25-0615","article-title":"Pregnancy phytochemical dietary index is associated with the risk of gestational diabetes and perinatal outcomes","volume":"14","author":"Hou","year":"2025","journal-title":"Endocr Connect"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"4131","DOI":"10.3390\/nu16234131","article-title":"The interactions between diet and gut microbiota in preventing gestational diabetes mellitus: a narrative review","volume":"16","author":"Beldie","year":"2024","journal-title":"Nutrients"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"1045","DOI":"10.3390\/nu16071045","article-title":"The development and evaluation of a literature-based dietary index for gut microbiota","volume":"16","author":"Kase","year":"2024","journal-title":"Nutrients"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"1617287","DOI":"10.3389\/fnut.2025.1617287","article-title":"Association between the dietary index for gut microbiota and metabolic syndrome: the mediating role of the dietary inflammatory index","volume":"12","author":"Han","year":"2025","journal-title":"Front Nutr"},{"key":"ref23","doi-asserted-by":"publisher","DOI":"10.1007\/s13410-026-01669-0","article-title":"Gut microbiota dietary index (DI-GM) and the risk of type 2 diabetes mellitus, central obesity, and hypertension among older adults","author":"Dong","year":"2026","journal-title":"Int J Diabetes Dev Ctries"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"108144","DOI":"10.1016\/j.diabres.2020.108144","article-title":"The diagnosis of gestational diabetes mellitus (GDM) using a 75 g oral glucose tolerance test: a prospective observational study","volume":"163","author":"O'Malley","year":"2020","journal-title":"Diabetes Res Clin Pract"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"111193","DOI":"10.1016\/j.nut.2021.111193","article-title":"Association between dietary inflammatory index and gestational diabetes mellitus risk in a prospective birth cohort study","volume":"87","author":"Zhang","year":"2021","journal-title":"Nutrition"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"115","DOI":"10.1186\/1479-5868-8-115","article-title":"Validity of the international physical activity questionnaire short form (IPAQ-SF): a systematic review","volume":"8","author":"Lee","year":"2011","journal-title":"Int J Behav Nutr Phys Act"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"56","DOI":"10.1186\/s12937-015-0044-x","article-title":"Reproducibility and relative validity of a semi-quantitative food frequency questionnaire for Chinese pregnant women","volume":"14","author":"Zhang","year":"2015","journal-title":"Nutr J"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"399","DOI":"10.1016\/j.dsx.2018.03.007","article-title":"Dietary pattern in pregnancy and risk of gestational diabetes mellitus (GDM)","volume":"12","author":"Zareei","year":"2018","journal-title":"Diabetes Metab Syndr Clin Res Rev"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"406","DOI":"10.1038\/s41575-024-00893-5","article-title":"Ultra-processed foods and food additives in gut health and disease","volume":"21","author":"Whelan","year":"2024","journal-title":"Nat Rev Gastroenterol Hepatol"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"1732","DOI":"10.3390\/ijms22041732","article-title":"Maternal low-grade chronic inflammation and intrauterine programming of health and disease","volume":"22","author":"Parisi","year":"2021","journal-title":"Int J Mol Sci"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"1592683","DOI":"10.3389\/fendo.2025.1592683","article-title":"Adipose tissue dysfunction disrupts metabolic homeostasis: mechanisms linking fat dysregulation to disease","volume":"16","author":"Bou Matar","year":"2025","journal-title":"Front Endocrinol"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"71","DOI":"10.2478\/ahem-2022-0006","article-title":"Intestinal barrier disorders and metabolic endotoxemia in obesity: current knowledge","volume":"76","author":"Potrykus","year":"2022","journal-title":"Postepy Hig Med Dosw"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"11412","DOI":"10.3390\/ijms262311412","article-title":"The role of the gut microbiome in type 2 diabetes mellitus","volume":"26","author":"Mashal","year":"2025","journal-title":"Int J Mol Sci"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"415","DOI":"10.1007\/s00360-025-01612-3","article-title":"Nutritional and physiological effects of high-fat diets in finfish: effects on growth, immunity, lipid metabolism, and intestinal health: a review","volume":"195","author":"Desouky","year":"2025","journal-title":"J Comp Physiol B"}],"container-title":["Frontiers in Nutrition"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fnut.2026.1895387\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T04:22:23Z","timestamp":1786335743000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fnut.2026.1895387\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,10]]},"references-count":34,"alternative-id":["10.3389\/fnut.2026.1895387"],"URL":"https:\/\/doi.org\/10.3389\/fnut.2026.1895387","relation":{},"ISSN":["2296-861X"],"issn-type":[{"value":"2296-861X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,10]]},"article-number":"1895387"}}