Low-carbohydrate diet for the treatment of gestational diabetes mellitus: a randomized controlled trial

Cristina Moreno-Castilla, Marta Hernandez, Merce Bergua, Maria C Alvarez, Maria A Arce, Karen Rodriguez, Montserrat Martinez-Alonso, Montserrat Iglesias, Magdalena Mateu, Maria D Santos, Linda R Pacheco, Yolanda Blasco, Eva Martin, Nuria Balsells, Nuria Aranda, Didac Mauricio, Cristina Moreno-Castilla, Marta Hernandez, Merce Bergua, Maria C Alvarez, Maria A Arce, Karen Rodriguez, Montserrat Martinez-Alonso, Montserrat Iglesias, Magdalena Mateu, Maria D Santos, Linda R Pacheco, Yolanda Blasco, Eva Martin, Nuria Balsells, Nuria Aranda, Didac Mauricio

Abstract

Objective: Medical nutrition therapy based on the control of the amount and distribution of carbohydrates (CHO) is the initial treatment for gestational diabetes mellitus (GDM), but there is a need for randomized controlled trials comparing different dietary strategies. The purpose of this study was to test the hypothesis that a low-CHO diet for the treatment of GDM would lead to a lower rate of insulin treatment with similar pregnancy outcomes compared with a control diet.

Research design and methods: A total of 152 women with GDM were included in this open, randomized controlled trial and assigned to follow either a diet with low-CHO content (40% of the total diet energy content as CHO) or a control diet (55% of the total diet energy content as CHO). CHO intake was assessed by 3-day food records. The main pregnancy outcomes were also assessed.

Results: The rate of women requiring insulin was not significantly different between the treatment groups (low CHO 54.7% vs. control 54.7%; P = 1). Daily food records confirmed a difference in the amount of CHO consumed between the groups (P = 0.0001). No differences were found in the obstetric and perinatal outcomes between the treatment groups.

Conclusions: Treatment of women with GDM using a low-CHO diet did not reduce the number of women needing insulin and produced similar pregnancy outcomes. In GDM, CHO amount (40 vs. 55% of calories) did not influence insulin need or pregnancy outcomes.

Trial registration: ClinicalTrials.gov NCT00911404.

Figures

Figure 1
Figure 1
Time to insulin treatment from study allocation in the two study groups.

References

    1. American Diabetes Association Diagnosis and classification of diabetes mellitus. Diabetes Care 2012;35(Suppl. 1):S64–S71
    1. Ricart W, Lopez J, Mozas J, et al. Spanish Group for the Study of the Impact of Carpenter and Coustan GDM thresholds Potential impact of American Diabetes Association (2000) for diagnosis of gestational diabetes mellitus in Spain. Diabetologia 2005;48:1135–1441
    1. Kjos SL, Buchanan TA. Gestational diabetes mellitus. N Engl J Med 1999;341:1749–1756
    1. National Academy of Sciences , Ed. Dietary Reference Intakes: Energy, Carbohydrate, Fiber, Fat, Fatty acids, Cholesterol, Protein, and Aminoacids (macronutrients). Washington, D.C., National Academy Press, 2005
    1. American Diabetes Association Nutrition recommendations and interventions for diabetes: a position statement of the American Diabetes Association. Diabetes Care 2008;31(Suppl. 1):S61–S78
    1. Metzger BE, Buchanan TA, Coustan DR, et al. Summary and recommendations of the fifth international workshop-conference on gestational diabetes mellitus. Diabetes Care 2007;30(Suppl. 2):S251–S260
    1. Moses RG, Barker M, Winter M, Petocz P, Brand-Miller JC. Can a low-glycemic index diet reduce the need for insulin in gestational diabetes mellitus? A randomized trial. Diabetes Care 2009;32:996–1000
    1. Louie JCY, Markovic TP, Perera N, et al. A randomized controlled trial investigating the effects of a low-glycemic index diet on pregnancy outcomes in gestational diabetes mellitus. Diabetes Care 2011;34:2341–2346
    1. Metzger BE. Summary and recommendations of the Third International Workshop-Conference on Gestational Diabetes Mellitus. Diabetes 1991;40(Suppl. 2):197–201
    1. Nelson M, Bingham S. Assessment of food consumption and nutrient intake. In Design Concepts in Nutritional Epidemiology. 2nd ed. Margetts B, Nelson M, Eds. New York, Oxford University Press, 1997, p. 123–169
    1. Porta A, Bergua M. Documentación Gráfica para la Valoración Nutricional: Alimentos y su Cocción. Barcelona, Laboratorios LifeScan, 2002
    1. Favier JC, Ireland-Ripert J, Toque C, Feinberg M. Répertoire General des Aliments. Table de Composition. Paris, TEC & DOC Lavoisier-INRA, 1997
    1. Mataix J. Tabla de Composición de Alimentos Española. 2nd ed. Granada, Servicio de Publicaciones Universidad de Granada, 1995
    1. Santamaria R, Verdu LI, Martin C, Garcia G. Tablas Españolas de Pesos Neonatales Según edad Gestacional. Barcelona, Master-Graf SL, 1998
    1. R Core Team R: A language and Environment for Statistical Computing. Vienna, Austria, R Foundation for Statistical Computing, 2012
    1. Tundidor D, García-Patterson A, María MA, et al. Perinatal, maternal and neonatal outcomes in women with gestational diabetes mellitus according to fetal sex. Gend Med 2012;9:411–417
    1. Ministerio de Sanidad Servicios Sociales e Igualdad. Evaluación nutricional de la dieta española. I. Energía y macronutrientes. Sobre datos de la Encuesta Nacional de Ingesta Dietética (ENIDE). Madrid, Agencia Española de Seguridad Alimentaria y Nutrición, 2011
    1. Major CA, Henry MJ, De Veciana M, Morgan MA. The effects of carbohydrate restriction in patients with diet-controlled gestational diabetes. Obstet Gynecol 1998;91:600–604
    1. Cypryk K, Kamińska P, Kosiński M, Pertyńska-Marczewska M, Lewiński A. A comparison of the effectiveness, tolerability and safety of high and low carbohydrate diets in women with gestational diabetes. Endokrynol Pol 2007;58:314–319
    1. Brand-Miller J, Holt SH, Petocz P. Reply to R. Mendosa (Letter). Am J Clin Nutr 2003;77:994–995
    1. Grant SM, Wolever TM, O’Connor DL, Nisenbaum R, Josse RG. Effect of a low glycaemic index diet on blood glucose in women with gestational hyperglycaemia. Diabetes Res Clin Pract 2011;91:15–22
    1. Walsh JM, McGowan CA, Mahony R, Foley ME, McAuliffe FM. Low glycaemic index diet in pregnancy to prevent macrosomia (ROLO study): randomised control trial. BMJ 2012;345:e5605.
    1. Streuling I, Beyerlein A, Rosenfeld E, Schukat B, von Kries R. Weight gain and dietary intake during pregnancy in industrialized countries—a systematic review of observational studies. J Perinat Med 2011;39:123–129
    1. Jali MV, Desai BR, Gowda S, Kambar S, Jali SM. A hospital based study of prevalence of gestational diabetes mellitus in an urban population of India. Eur Rev Med Pharmacol Sci 2011;15:1306–1310

Source: PubMed

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