Pre‒pregnancy body mass index and Gestational Diabetes as key determinants of long‒term metabolic risk: insights from a nutritional intervention during pregnancy.

AIMS: To evaluate the long‒term effect of a Mediterranean-based nutritional (MedDiet) intervention during pregnancy on the prevalence of metabolic syndrome (MetS) six years postpartum, and to determine the predictive value of postpartum lifestyle behaviours for MetS prevention.

METHODS

A prospective follow‒up study included 1,715 women randomised during pregnancy to an intervention or control group. Anthropometric, metabolic, and lifestyle parameters were assessed six years postpartum. Multivariate models were used to identify independent predictors of MetS.

RESULTS

The intervention group showed a significantly lower prevalence of MetS (7.3 vs. 10.4 %, p = 0.034) and improved metabolic parameters. Elevated pre-pregnancy BMI (OR = 7.912 [5.411‒11.57]) and Gestational Diabetes Mellitus (GDM), diagnosed by the International Association of Diabetes and Pregnancy Study Groups criteria [(OR = 2.958 [2.056‒4.256]), were the strongest MetS modifiable risk factors. ROC analysis identified that, six years postpartum, a healthy lifestyle‒MedDiet (≥7.5 points) and physical activity (≥307.5 MET·min/week)‒reduced MetS risk by up to 62 %, after adjusting for confounders.

CONCLUSIONS

GDM diagnosed using IADPSG criteria identifies women at increased long-term risk of MetS confirming its cardiovascular relevance. Early MedDiet intervention (8-12 GW) during pregnancy provides sustained metabolic benefits while pre-pregnancy BMI and GDM emerge as key modifiable determinants. Lifestyle cut-off points relevant to postpartum MetS prevention were identified.