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Name of Journal: World Journal of Diabetes Manuscript Type: LETTER TO THE EDITOR "Tailored Nutritional Interventions: A Precision Approach to Managing Gestational Diabetes Mellitus" Babita Pande, Henu Kumar Verma, L.V.K.S Bhaskar 1. Department of Physiology, All india institute of medical science Raipur, Chhattisgarh, India 2. Department of Immunopathology, Institute of lungs Health and Immunity, Comprehensive Pneumology Center, Helmholtz Zentrum, 85764 Neuherberg, Munich, Germany 3. Department of Zoology, Guru Ghasidas University Bilaspur, koni Chhattisgarh, India Author contributions: BP and HKV designed research; BP;HKV and LB performed research; BP,HKV, AND LB analyzed data and wrote the letter; and HKV, revised the letter. Corresponding author: Dr. Henu Kumar Verma Postdoctoral Scientist Department of Immunopathology, Institute of lungs Health and Immunity, Comprehensive Pneumology Center, Helmholtz Zentrum, 85764 Neuherberg, Munich, Germany Email: henu.verma@yahoo.com henu.verma@helmholtz-muenchen.de Mobile:+91 7879727474/ +39 3922185508 http://orcid.org/0000-0003-1130-8783   "Tailored Nutritional Interventions: A Precision Approach to Managing Gestational Diabetes Mellitus" Dear Editor, Gestational diabetes mellitus (GDM) is the most common metabolic disturbance during pregnancy that is associated with morbidity and poor maternal-fetal outcomes. GDM is characterized by abnormal glucose tolerance or hyperglycaemia having elevated blood glucose level above normal but below diagnostic level. GDM is the consequence of altered glucose regulation during pregnancy, and decrease maternal insulin sensitivity due to inability of pancreatic beta cells primarily in the third trimester [1]. GDM is now emerging as global burden with global prevalence of 14.0% [2]. Clinical diagnosis manifested interim and long standing consequences of GDM to both maternal and neonatal leading to development of type 2 diabetes in mother and offspring as well as in cardiometabolic disorders in offspring [1]. The pathophysiology of GDM women are abnormal glucolipid metabolism, raised fasting blood glucose or glycosylated hemoglobin (HbA1c), delayed lactation time, perinatal complications (like weight gain, cesarean section, premature rupture of membranes, postpartum hemorrhage, and pregnancy-induced hypertension), and neonatal adverse events (like stillbirth, premature infants, fetal macrosomia, fetal growth restriction, hypo-glycemia, and respiratory distress syndrome) as observed in the third trimester [3-5]. Nonetheless, the screening timing, diagnostic thresholds and treatment for GDM are varying and unclear. Routinely, GDM diagnosed during prenatal screening and the first-line of treatment strategies includes the lifestyle management in addition to pharmacological interventions. The lifestyle management through nutritional intervention is the preferred way to control GDM related adverse outcomes. In this context, the nutritional intervention study “Effect of individualized nutrition interventions on clinical outcomes of pregnant women with gestational diabetes mellitus” by Jian-Ying Luo [6], is of great interest. "In this single-center study, the researchers demonstrated the importance of individualized nutritional intervention as a crucial preventive and treatment strategy for Gestational Diabetes Mellitus (GDM). A total of 200 pregnant women diagnosed with GDM were provided with personalized nutritional plans tailored to their body weight, health condition, and energy demands. The personalized nutritional intervention included optimizing the quantity and timing of major meals, incorporating additional meals with appropriate nutrient quantities at specific time intervals, regular exercise, controlling body weight, and managing blood glucose levels. Additionally, the participants received guidance on basic and targeted lactation massage techniques and breastfeeding skills. In contrast, the control group, without individualized nutritional intervention, was advised to consume small and frequent meals along with vitamin supplementation, reduced fat intake, regular exercise, and maintaining control over body weight and blood glucose levels. The study's findings revealed a significant reduction in body weight and improved glucolipid metabolism, indicated by lowered total triglyceride, total cholesterol, fasting blood glucose, and glycosylated hemoglobin (HbA1c) levels among GDM women following the tailored regimen. Furthermore, the group receiving individualized nutritional intervention experienced earlier lactation initiation, reduced perinatal complications, and fewer neonatal adverse events. Individualized nutrition played a pivotal role in maintaining optimal body weight and glucose levels by modulating metabolic markers such as insulin resistance. These results emphasize the effectiveness of personalized nutritional interventions in managing GDM and promoting maternal and neonatal health [7]. Further, the gestational time for nutritional therapy and the type and amount of carbohydrates diet according to maternal health condition [8]. The findings of Luo et al.[6] and earlier reports [7,9] on nutritional therapy during pregnancy in women with GDM are of clinical relevance to improve maternal-foetal-offspring health and curtail risk of adverse pregnancy outcomes and suggested to implement such trials at multi center level to established the personalized nutritional treatment. "In this context, it is essential to highlight the concept of 'chrononutrition,' which is gaining attention as an effective means of nutritional intervention. Chrononutrition emphasizes the importance of 'optimum meal timing' synchronized with an individual's circadian rhythm to ensure health benefits [10]. Specifically, eating high-caloric foods at odd times, such as at night, can disrupt the circadian rhythm in glucose metabolism because insulin sensitivity remains low during the night [10]. A randomized controlled trial conducted by Messika et al. [11] demonstrated that chrononutritional interventions and improved sleep hygiene can enhance glycemic control in women with GDM by reducing carbohydrate intake during the evening hours. Therefore, we propose that, in addition to considering the quality and quantity of nutrition, meal timing and adequate sleep should be taken into account when providing personalized nutritional interventions to women with GDM. This holistic approach can contribute to alleviating maternal-fetal-offspring health outcomes and enhance the effectiveness of medications during pregnancy. Reference 1 Johns EC, Denison FC, Norman JE, Reynolds RM. Gestational diabetes mellitus: mechanisms, treatment, and complications. Trends Endocrinol Metab 2018; 29: 743-754 [PMID: 30297319 Doi: 10.1016/j.tem.2018.09.004] 2 Wang H, Li N, Chivese T, Werfalli M, Sun H, Yuen L, Hoegfeldt CA, Elise Powe C, Immanuel J, Karuranga S, Divakar H, Levitt N, Li C, Simmons D, Yang X; IDF Diabetes Atlas Committee Hyperglycaemia in Pregnancy Special Interest Group. IDF Diabetes Atlas: Estimation of Global and Regional Gestational Diabetes Mellitus Prevalence for 2021 by International Association of Diabetes in Pregnancy Study Group's Criteria. Diabetes Res Clin Pract 2022; 183: 109050. [PMID: 34883186 DOI: 10.1016/j.diabres.2021.109050] 3 Li X, Li TT, Tian RX, Fei JJ, Wang XX, Yu HH, Yin ZZ. Gestational diabetes mellitus: The optimal time of delivery. World J Diabetes 2023; 14: 179-187 [PMID: 37035228 DOI: 10.4239/wjd.v14.i3.179] 4 Lai M, Liu Y, Ronnett GV, Wu A, Cox BJ, Dai FF, Röst HL, Gunderson EP, Wheeler MB. Amino acid and lipid metabolism in post-gestational diabetes and progression to type 2 diabetes: A metabolic profiling study. PLoS Med 2020; 17: e1003112 [PMID: 32433647 DOI: 10.1371/journal.pmed.1003112] 5 Mullen AJ, O'Connor DL, Hanley AJ, Piedimonte G, Wallace M, Ley SH. Associations of metabolic and obstetric risk parameters with timing of lactogenesis II. Nutrients 2022; 14: 876 [PMID: 35215526 DOI: 10.3390/nu14040876] 6 Luo JY, Chen LG, Yan M, Mei YJ, Cui YQ, Jiang M. Effect of individualized nutrition interventions on clinical outcomes of pregnant women with gestational diabetes mellitus. World J Diabetes 2023; 14: 1524-1531 [DOI: 10.4239/wjd.v14.i10.1524] 7 Ferrara A, Hedderson MM, Brown SD, Ehrlich SF, Tsai AL, Feng J, Galarce M, Marcovina S, Catalano P, Quesenberry CP. A telehealth lifestyle intervention to reduce excess gestational weight gain in pregnant women with overweight or obesity (GLOW): a randomised, parallel-group, controlled trial. Lancet Diabetes Endocrinol 2020; 8: 490-500. Erratum in: Lancet Diabetes Endocrinol. 2023; 11: e6. [PMID: 32445736 DOI: 10.1016/S2213-8587(20)30107-8] 8 Rasmussen L, Poulsen CW, Kampmann U, Smedegaard SB, Ovesen PG, Fuglsang J. Diet and Healthy Lifestyle in the Management of Gestational Diabetes Mellitus. Nutrients 2020; 12: 3050. [PMID: 33036170 DOI: 10.3390/nu12103050] 9 Li CL, Wang YH, Wang JL, Zhang P, Sun Y. Effect of individualized medical nutrition guidance on pregnancy outcomes in older pregnant women. J Int Med Res 2021; 49:3000605211033193[PMID: 34344218 DOI: 10.1177/03000605211033193] 10 Loy SL, Loo RSX, Godfrey KM, Chong YS, Shek LP, Tan KH, Chong MF, Chan JKY, Yap F. Chrononutrition during Pregnancy: A Review on Maternal Night-Time Eating. Nutrients 2020; 12: 2783 [PMID: 32932985 DOI: 10.3390/nu12092783] 11 Messika A, Toledano Y, Hadar E, Shmuel E, Tauman R, Shamir R, Froy O. Relationship among chrononutrition, sleep, and glycemic control in women with gestational diabetes mellitus: a randomized controlled trial. Am J Obstet Gynecol MFM 2022; 4: 100660 [PMID: 35525420 DOI: 10.1016/j.ajogmf.2022.100660]

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