Macronutrient Composition or Social Determinants? Impact on Infant Outcomes With Gestational Diabetes Mellitus

Abstract

The purpose of this study was to examine, through a randomized, controlled trial, the effects of a maternal carbohydrate-restricted diet on maternal and infant outcomes in gestational diabetes mellitus (GDM). Women diagnosed with GDM were randomly allocated into one of two groups: an intervention group that was placed on a lower-carbohydrate diet (35–40% of total calories) or a control group that was placed on the usual pregnancy diet (50–55% carbohydrate). A convenience sample of participants diagnosed with GDM (ages 18–45 years) was recruited from two different sites: one urban and low-income and the other suburban and more affluent. Individual face-to-face diet instruction occurred with certified diabetes educators at both sites. Participants tested their blood glucose four times daily. Specific socioeconomic status indicators included enrollment in the Supplemental Nutrition Program for Women, Infants and Children or Medicaid-funded health insurance, as well as cross-sectional census data. All analyses were based on an intention to treat. Although there were no differences found between the lower-carbohydrate and usual-care diets in terms of blood glucose or maternal-infant outcomes, there were significant differences noted between the two sites. There was a lower mean postprandial blood glucose (100.59 ± 7.3 mg/dL) at the suburban site compared to the urban site (116.3 ± 15 mg/dL) (P <0.01), even though there was no difference in carbohydrate intake. There were increased amounts of protein and fat consumed at the suburban site (P <0.01), as well as lower infant complications (P <0.01). Further research is needed to determine whether these disparities in outcomes were the result of macronutrient proportions or environmental conditions.

Lifestyle intervention during pregnancy in patients with gestational diabetes mellitus and the risk of neonatal hypoglycemia: A systematic review and meta-analysis

“…Sample sizes ranged from 45 ( 35 ) to 1,030 ( 19 ) newborns. 13 studies ( 20 , 21 , 24 , 25 , 35 – 42 , 44 ) had a sample size of fewer than 300 newborns. Five studies were conducted in China ( 21 , 22 , 24 , 36 , 43 ), four in Iran ( 25 , 35 , 38 , 44 ), two each in the United States ( 26 , 42 ) and Australia ( 19 , 41 ), and one each in the United Arab Emirates ( 20 ), Canada ( 37 ), Egypt ( 39 ), the United Kingdom ( 40 ), and Singapore ( 23 ).…”

“…In the control group, the mean maternal age ranged from 26.20 ± 3.10 ( 44 ) to 32.20 ± 4.40 ( 23 ) years. Studies were initiated in the first ( n = 3) ( 36 , 39 , 43 ), second ( n = 6) ( 21 , 23 , 25 , 35 , 38 , 40 ), and third ( n = 6) ( 19 , 22 , 24 , 26 , 41 , 42 ) trimesters, while three studies ( 20 , 37 , 44 ) were unspecified. Specific gestational age at trial entry was reported in 13 studies ( 19 , 21 – 24 , 26 , 35 , 36 , 38 , 40 – 43 ), with a mean age ranging from 10.00 ± 0.32 ( 36 ) to 30.46 ± 4.71 ( 24 ) weeks.…”

“…The specific fasting glucose level at trial entry was reported in 14 studies ( 19 , 21 – 26 , 36 , 37 , 39 – 43 ), with a mean level ranging from 4.65 ± 0.50 ( 23 ) to 10.05 ± 1.61 ( 37 ) mmol/L. Maternal BMI at trial entry and before pregnancy was reported in eight studies ( 19 , 24 , 25 , 38 , 39 , 41 , 42 , 44 ) and seven studies ( 22 , 23 , 26 , 35 , 36 , 40 , 43 ), respectively. As for treatments of the intervention groups, the comprehensive intervention was utilized in seven studies ( 19 – 21 , 23 , 24 , 26 , 43 ), a calorie/carbohydrate-restricted diet was utilized in three studies ( 37 , 41 , 42 ), vitamin D supplements were utilized in two studies ( 25 , 35 ), probiotics were utilized in two studies ( 25 , 44 ), and phytosterol-enriched food ( 36 ), omega-3 fatty acids plus vitamin E supplements ( 38 ), vitamin C supplements ( 39 ), docosahexaenoic acid (DHA) supplements ( 40 ), and epigallocatechin 3-gallate (EGCG) supplements ( 22 ) were used in every single study.…”

“…As shown in Figures 2 , 3 , three studies ( 21 , 24 , 42 ) were considered to be of unclear risk of bias for randomization, the other 15 ( 19 , 20 , 22 , 23 , 25 , 26 , 35 – 41 , 43 , 44 ) studies were at low risk of bias. Three studies ( 21 , 24 , 37 ) were considered to be of high risk of bias for allocation concealment, one study ( 42 ) was judged to be of unclear risk of bias. Four studies ( 20 , 21 , 23 , 26 ) had a high risk of performance bias, one study ( 42 ) was judged to be of unclear risk of bias.…”

Carbohydrate Content in the GDM Diet: Two Views: View 2: Low-Carbohydrate Diets Should Remain the Initial Therapy for Gestational Diabetes

“…Trout et al ( 17 ), in an article published in this issue of Diabetes Spectrum (p. 71), compared a low-carbohydrate diet (40% carbohydrate, 40% fat, and 15% protein) to a high-carbohydrate diet. However, the primary outcome of lower 2-hour postprandial blood glucose was not achieved.…”