Prebiotic Supplementation Modulates Inflammatory markers and Gut Microbiotain Women with Gestational Diabetes Mellitus: A Randomized Controlled Trial

Abstract

Introduction: Gestational diabetes mellitus (GDM) has become a major metabolic disorder of pregnancy
associated with adverse maternal and neonatal outcomes. Emerging evidence suggests that prebiotics such as
fructo-oligosaccharides (FOS) may improve glycemic control, reduce inflammation, and beneficially modulate gut
microbiota. This study evaluated the effect of FOS supplementation on glycemic parameters, inflammatory markers,
and gut microbiota in women with GDM. Materials and Methods: A total of 923 pregnant women attending a
tertiary care hospital in rural Vadodara were screened using random blood sugar and oral glucose tolerance test,
identifying 76 (8%) with GDM. A comparative assessment between 76 GDM and 76 non-GDM women evaluated
socioeconomic, anthropometric, and dietary parameters. In a randomized controlled trial phase, 62 GDM women
were allocated into control (n = 30) and experimental (n = 32) groups. The experimental group received 10 g/day
FOS for 90 days. Glycemic indices (fasting blood sugar [FBS], glycated hemoglobin [HbA1c]), inflammatory
markers (high-sensitivity C-reactive protein, interleukin-6 [IL-6]), and gut microbiota (Bifidobacterium,
Lactobacillus, and Escherichia coli) were assessed pre- and post-intervention. Results: FOS supplementation
significantly reduced FBS (2.8%) and HbA1c (4.3%). IL-6 levels decreased by 3%, with improved colonization of
Bifidobacterium (15% increase) and reduced E. coli (22% decrease). Negative correlation was observed between
IL-6 and Bifidobacterium, while HbA1c positively correlated with E. coli. Discussion and Conclusion: FOS
supplementation improved glycemic control, reduced inflammation, and favorably modulated gut microbiota
without affecting neonatal outcomes. FOS may serve as a beneficial adjunct in GDM management. Further large-
scale studies are warranted