Low-carbohydrate diet and maternal glucose metabolism in Chinese pregnant women

Abstract

Few studies have suggested that long-term adherence to low-carbohydrate diets (LCD) may affect maternal glucose metabolism in western countries. We aimed to investigate the association between LCD during pregnancy and glucose metabolism in Chinese population. A total of 1,018 women in mid-pregnancy were recruited in 2017-2018. Participants underwent a 75g oral glucose tolerance test (OGTT). Daily dietary intakes over the past month were accessed using a validated food frequency questionnaire. The overall, animal, and vegetable LCD scores which represent adherence to different low-carbohydrate dietary patterns were calculated. Mixed linear regression and generalized linear mixed regression were conducted to evaluate the associations between LCD scores and maternal glucose metabolism. Of the 1,018 subjects, 194 (19.1%) was diagnosed with gestational diabetes mellitus (GDM). The overall LCD score (β: 0.024, standard error (SE): 0.008, PFDR=0.02) and animal LCD score (β: 0.023, SE: 0.008, PFDR=0.02) was positively associated with OGTT 1-h glucose. No significant associations were found between the three different LCD scores with fasting plasma glucose (FPG), OGTT 2-h glucose, or insulin resistance, respectively. Compared with the lowest quartile, the crude odds ratios of GDM for the highest quartile were 1.84 (95% CI: 1.14, 2.95) for overall LCD score (P for trend = 0.02) and 1.56 (1.00, 2.45) for animal LCD score (P for trend = 0.02). However, these associations became nonsignificant after adjustment for covariates. In conclusion, a low-carbohydrate dietary pattern with high animal protein and fat is associated with higher postprandial 1-h glucose levels in Chinese pregnant women.

Carbohydrate Intake Prior to Oral Glucose Tolerance Testing

“…Moreover, similar to the case presented here, a very-low-carbohydrate meal (6.7% carbohydrate, <10 grams) immediately prior to OGTT has been shown to alter OGTT results during pregnancy [ 11 ]. Recent data also suggest that low-carbohydrate diets are associated with positive 1-hour OGTT and diagnosis of gestational diabetes in pregnancy diabetes screening programs [ 12 , 13 ]. As gestational diabetes diagnosis is increasing, some of the obstetrics community recognizes the flawed nature of OGTT and posits that alternative screening tools will eventually replace the OGTT for detection of gestational diabetes [ 14 ].…”

A low-carbohydrate dietary pattern characterised by high animal fat and protein during the first trimester is associated with an increased risk of gestational diabetes mellitus in Chinese women: a prospective cohort study

“…This was supported by other studies showing that a higher GDM risk was correlated with a higher consumption of animal fat (14) and animal protein (16) . In addition, a recent observational study from China indicated that the animal LCD score was positively associated with OGTT 1-h glucose (29) , suggesting that a low-carbohydrate dietary pattern with high animal fat Accepted manuscript and protein was associated with an increased risk of abnormal maternal glucose metabolism.…”

“…This was supported by other studies showing that a higher GDM risk was correlated with a higher consumption of animal fat (14) and animal protein (16) . In addition, a recent observational study from China indicated that the animal LCD score was positively associated with oral glucose tolerance test 1-h glucose (29) , suggesting that a low-carbohydrate dietary pattern with high animal fat and protein was associated with an increased risk of abnormal maternal glucose metabolism. However, the positive association between the animal LCD score and GDM risk was observed to be non-linear in our study because the RR was higher in the third quartile than in the highest quartile of animal LCD score.…”

“…Covariates were chosen based on previous studies (27)(28)(29) . The current review showed that maternal age, pre-pregnancy BMI, ethnicity, parity, family history of diabetes mellitus, cigarette smoking and physical activity were associated with GDM (27) .…”

“…The current review showed that maternal age, pre-pregnancy BMI, ethnicity, parity, family history of diabetes mellitus, cigarette smoking and physical activity were associated with GDM (27) . In addition to the above covariates, studies which exploring the relationship between dietary patterns and GDM have additionally selected education level, family income, alcohol consumption and gestational weight gain as covariates that might influence the association between dietary patterns and GDM for analysis (28,29) . Therefore, these covariates were assessed in our study.…”