. 2021 Oct 1;10:e87. doi: 10.1017/jns.2021.77

Table 3.

Studies looking at the effect of pistachios on gestational diabetes and pregnancy outcomes

Study	Design, intervention and endpoints	Results
San Carlos Gestational Diabetes Mellitus Prevention Study. Madrid, Spain	Prospective, RCT- Parallel Intervention from 8th–12th GW until 24–28th GW. Mediterranean diet with ≥40 ml extra virgin olive oil and handful pistachios (25–30 g) daily (intervention); Control group followed a standard diet with limited fat intake.	See 1–3 below.
1. Assaf-Balut et al.⁽⁹²⁾	Primary endpoint: GDM incidence at 24–28th GW. Gestational weight gain, pregnancy-induced hypertension, caesarean section, preterm delivery, perineal trauma, small and large for gestational age and admissions to neonatal intensive care unit were also assessed.	Supplemented Mediterranean diet (intervention) had a lower incidence of GDM: 23⋅4 % (in the control group) compared to 17⋅1 %. Crude RR for GDM was 0⋅73 (95 % CI: 0⋅56–0⋅95) for intervention v. control. Intervention group had better maternal and neonatal outcomes (see Table 5).
2. Assaf-Balut et al.⁽⁹⁴⁾	Prospective sub-analysis. Primary endpoint: composite of maternofoetal outcomes pregnancy with normoglycemia during pregnancy.	Risk of urinary tract infections, emergency caesarean sections, perineal trauma, large-for-gestational age and small-for-gestational age new-borns were significantly reduced in the intervention group. Women in this group had lower fasting glucose and HbA_1c levels at 24–28^th and 36–38^th GW than the control group.
3. Melero et al.⁽⁹³⁾	Follow-up at 2-year post-partum. Primary endpoint: offspring health during first 2 years of life.	Shorter duration in hospital in intervention group (11⋅9 ± 25⋅2 days v. 6⋅8 ± 9⋅1 days). Significantly lower hospital admissions rate in intervention group due to bronchiolitis/asthma, antibiotic treatment and corticosteroid treatment in children born to women with pre-gestational BMI <25 kg/m².
Feng et al.. Shanghai, China⁽⁹⁾	Randomised Controlled Cross-over Trial. Two isoenergetic test meals: 42 g pistachios or 100 g whole wheat bread. Acute effect of pistachios on glucose, insulin and gut-derived incretins in women with GDM or GIGT	Pistachio intake induced significantly lower post-prandial glucose, insulin and GIP levels but higher GLP-1 levels compared to whole wheat bread.

RCT, randomised control trial; GW, gestational weeks; GDM, gestational diabetes mellitus; RR, relative risk; CI, confidence interval; HbA1c, glycated haemoglobin; BMI, body mass index; GIGT, gestational impaired glucose tolerance; GIP, gastric inhibitory polypeptide; GLP-1, glucagon-like peptide-1.