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Journal article
Body mass index, prebiotic supplementation during pregnancy and gestational diabetes mellitus risk: an effect modification analysis from a randomised controlled trial
Nutrition Journal, Vol.25(1)
2026
Abstract
Background
Prebiotic dietary supplementation has been shown to improve glucose homeostasis in type 2 diabetes patients. The aim of this analysis was to determine whether pre-pregnancy body mass index (BMI) modifies the effect of prebiotic supplementation from mid-pregnancy on reducing the risk of gestational diabetes mellitus (GDM).
Methods
In a double-blinded, randomised controlled trial, pregnant women < 21 gestational weeks were randomly assigned (1:1) to consume daily prebiotics (14.2 g galacto-oligosaccharides and fructo-oligosaccharides) or placebo (8.7 g maltodextrin) powder. An effect modification analysis was performed to assess the heterogeneity of the effect of prebiotic supplementation in relation to pre-pregnancy BMI on GDM diagnosis.
Results
Between June 2016 and November 2021, 329 women were assigned to the prebiotic group (50.4%), and 323 (49.5%) were assigned to the placebo group. Overall, 288 of 652 women (44.2%) were classified as overweight/obese prior to pregnancy (BMI ≥ 25 kg/m2). The distribution was balanced, with 146/329 (44.4%) randomised to the prebiotics group and 142/323 (44.0%) in the placebo group. Pre-pregnancy BMI modified the effect of prebiotic supplementation, with the intervention reducing GDM rates in women with a BMI ≥ 25 kg/m2 (prebiotic group 11.0% vs. control group 21.8%; adjusted relative risk 0.50; 95% confidence interval (CI) 0.28 to 0.89) but not in women with a pre-pregnancy BMI < 25 kg/m2 (7.7–7% vs. 4.4%; adjusted relative risk 1.72; 95% CI 0.70 to 4.19; interaction p = 0.02).
Conclusion
Pre-pregnancy BMI was found to modify the effect of prebiotic supplementation on GDM rates, with benefits observed in overweight and obese women. Our results highlight a target population for future randomised controlled trials to further investigate the effects of prebiotic supplementation during pregnancy on reducing the risk of GDM.
Trial registration
Primary and secondary infant allergic disease outcomes of this randomised controlled trial have been previously published. The trial was registered with the Australian New Zealand Clinical Trial Registry: ACTRN12615001075572, https://www.anzctr.org.au/on13/10/2015.
Details
- Title
- Body mass index, prebiotic supplementation during pregnancy and gestational diabetes mellitus risk: an effect modification analysis from a randomised controlled trial
- Authors/Creators
- Rachelle Pretorius (Author) - Murdoch University, School of Allied HealthThomas R. Sullivan - South Australian Health and Medical Research InstituteSummer V.M. Walker - Edith Cowan UniversityJohan Garssen - Utrecht UniversityJeffrey Keelan - The University of Western AustraliaDesiree Silva - Edith Cowan UniversitySusan L. Prescott - Murdoch UniversityDebra J. Palmer - The Kids Research Institute Australia
- Publication Details
- Nutrition Journal, Vol.25(1)
- Publisher
- Springer Nature
- Number of pages
- 7
- Identifiers
- 991005885953807891
- Copyright
- © The Author(s) 2026.
- Murdoch Affiliation
- School of Medical, Molecular and Forensic Sciences; School of Allied Health
- Resource Type
- Journal article
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