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Effect of a Higher–Complex-Carbohydrate vs Conventional Diet in Patients With Gestational Diabetes on Newborn Adiposity
abstract
This abstract is available on the publisher's site.
Access this abstract nowOBJECTIVE
Nutrition therapy for gestational diabetes mellitus (GDM) has conventionally focused on carbohydrate restriction. In a randomized controlled trial (RCT), we tested the hypothesis that a diet (all meals provided) with liberalized complex carbohydrate (60%) and lower fat (25%) (CHOICE diet) could improve maternal insulin resistance and 24-h glycemia, resulting in reduced newborn adiposity (NB%fat; powered outcome) versus a conventional lower-carbohydrate (40%) and higher-fat (45%) (LC/CONV) diet.
RESEARCH DESIGN AND METHODS
After diagnosis (at ∼28-30 weeks' gestation), 59 women with diet-controlled GDM (mean ± SEM; BMI 32 ± 1 kg/m2) were randomized to a provided LC/CONV or CHOICE diet (BMI-matched calories) through delivery. At 30-31 and 36-37 weeks of gestation, a 2-h, 75-g oral glucose tolerance test (OGTT) was performed and a continuous glucose monitor (CGM) was worn for 72 h. Cord blood samples were collected at delivery. NB%fat was measured by air displacement plethysmography (13.4 ± 0.4 days).
RESULTS
There were 23 women per group (LC/CONV [214 g/day carbohydrate] and CHOICE [316 g/day carbohydrate]). For LC/CONV and CHOICE, respectively (mean ± SEM), NB%fat (10.1 ± 1 vs. 10.5 ± 1), birth weight (3,303 ± 98 vs. 3,293 ± 81 g), and cord C-peptide levels were not different. Weight gain, physical activity, and gestational age at delivery were similar. At 36-37 weeks of gestation, CGM fasting (86 ± 3 vs. 90 ± 3 mg/dL), 1-h postprandial (119 ± 3 vs. 117 ± 3 mg/dL), 2-h postprandial (106 ± 3 vs. 108 ± 3 mg/dL), percent time in range (%TIR; 92 ± 1 vs. 91 ± 1), and 24-h glucose area under the curve values were similar between diets. The %time >120 mg/dL was statistically higher (8%) in CHOICE, as was the nocturnal glucose AUC; however, nocturnal %TIR (63-100 mg/dL) was not different. There were no between-group differences in OGTT glucose and insulin levels at 36-37 weeks of gestation.
CONCLUSIONS
A ∼100 g/day difference in carbohydrate intake did not result in between-group differences in NB%fat, cord C-peptide level, maternal 24-h glycemia, %TIR, or insulin resistance indices in diet-controlled GDM.
Additional Info
Randomization to a Provided Higher-Complex-Carbohydrate Versus Conventional Diet in Gestational Diabetes Mellitus Results in Similar Newborn Adiposity
Diabetes Care 2023 Nov 01;46(11)1931-1940, TL Hernandez, SS Farabi, BK Fosdick, N Hirsch, EZ Dunn, K Rolloff, JP Corbett, E Haugen, T Marden, J Higgins, JE Friedman, LA BarbourFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
The CHOICE diet study in gestational diabetes is a randomized controlled trial of 59 pregnant individuals with diet-controlled gestational diabetes, comparing a conventional low-carbohydrate diet (40% carbohydrate, 45% fat) with a liberalized complex carbohydrate diet — the CHOICE diet (60% carbohydrate, 25% fat). The primary outcome of interest was newborn adiposity, measured within the first 2 weeks of life. The authors hypothesized that a diet low in fat and high in complex carbohydrates would result in reduced transfer and storage of free fatty acids and triglycerides into newborn fat.
The authors found no difference in their primary outcome, nor in any measured maternal or neonatal secondary outcomes. Interestingly, although both groups saw a reduction in fasting glucose values (approximately 5–7 mg/dL) after approximately 6 weeks on the study diet, only individuals randomized to the CHOICE diet saw improvement in HOMA-IR. Subtle between-group differences were observed on CGM metrics at 36 to 37 weeks: individuals on the CHOICE diet spent 8% more time above 120 mg/dL, and had higher nocturnal glycemia. However, the clinical relevance of these differences is not clear, as both dietary interventions were able to achieve excellent control by conventional measures and clinical outcomes of interest were no different between groups.
Overall, this study provides much-needed evidence that a gestational diabetes diet higher in complex carbohydrates is a reasonable and perhaps more culturally inclusive option. However, having all meals planned and provided (as in this study) is a benefit that few patients can enjoy. Real-world comparative effectiveness trials of dietary interventions during pregnancy are an important next step.