Waimanalo

Researchers are evaluating the impact of daily consumption of fermented poi on the maternal microbiome and the risk of gestational diabetes during pregnancy. This non-randomized pilot study focuses on pregnant participants between approximately 12 and 24 weeks of gestation. The study aims to assess changes in vaginal, oral, and rectal microbiome composition, diet quality, gestational diabetes diagnosis, and pregnancy outcomes, comparing results with matched controls from an existing cohort to inform future culturally grounded dietary interventions. Participants will undergo a brief dietary washout period avoiding poi and other fermented foods before receiving one pound of fermented poi daily for 28 consecutive days. Alongside this, they will receive culturally tailored nutrition education via secure text messaging throughout the intervention. The intervention is implemented during the second trimester, with participants encouraged to consume the fermented poi and engage with the nutrition guidance provided. Throughout the study, participants will complete assessments at enrollment, baseline, midpoint, end of intervention, and long-term follow-up in the third trimester. Maternal microbiome samples will be self-collected using vaginal swabs, with optional oral and rectal swabs, and returned to study staff. Anthropometrics and blood pressure will be measured at scheduled visits. Participants will also complete questionnaires on pregnancy, psychosocial and cultural factors, and intervention acceptability. Dietary intake will be tracked using a mobile food record and questionnaires. Information on gestational diabetes diagnosis and labor and delivery outcomes will be obtained with participant authorization. The primary outcome is maternal microbial composition at the end of the intervention.