Metabolic Effects of Hypocaloric Diets in Management of Gestational Diabetes

Abstract

Although hypocaloric diets have been advocated for the management of the obese gravida and the obese mother with gestational diabetes, there is no general agreement on how severely calories should be restricted or on how this therapeutic approach compares with insulin therapy. The lack of consensus is in part because of the lack of studies comparing insulin management with the effects of different degrees of hypocaloric feeding and its effects on metabolism and glycemic status. We review the effects of 50 and 33% calorie restriction on glycemic status and intermediary fuel status in obese gestational diabetic subjects and compare the results with the administration of 20 U NPH and 10 U regular insulin every morning, a therapy of proven value in reducing macrosomia in gestational diabetes. When the two calorie-restriction regimens were compared after a 9-h overnight fast, glycemic status improved 10-20% on both. Ketonuria increased about twofold with 50% calorie restriction, but on average no increase in ketonuria was seen on the 33% calorie-restriction regimen. Both calorie-restriction programs led to a reduction in levels of plasma triglyceride, a correlate of infant birth weight. In contrast, the insulin regimen diminished ketonuria, but glycemic status improved little, and plasma triglyceride concentrations did not decline. Although more studies are needed to confirm these trends, the beneficial effect of 33% calorie restriction, which occurred without marked ketonuria, is consistent with previous studies in gestational diabetes. In addition, the simultaneous improvements observed in plasma glucose and triglyceride concentrations suggest that moderate calorie restriction may be valuable in preventing macrosomia in the offspring of the obese subject with gestational diabetes.(ABSTRACT TRUNCATED AT 250 WORDS)

Prevention of gestational diabetes mellitus: a review of studies on weight management

“…Caloric restriction has been a controversial issue for many years because of its less desirable effect in increasing plasma ketone bodies [47,48]. The majority of studies and literature reviews concluded that a moderate caloric restriction of 30-33% of total energy has a beneficial effect on glucose metabolism without causing ketonaemia in obese women with GDM [47][48][49][50]. None of the studies using energy restriction to control glycaemia and gestational weight gain demonstrated a significant increase in ketone bodies or adverse pregnancy outcomes in the current review.…”

Gestational diabetes and nutritional recommendations

“…Severe calorie restriction (reduction of kcal by 50%) has resulted in maternal weight loss, ketonuria, and ketonemia [33,36] and is, therefore, not advisable. Weight loss and energy restriction, efficacious treatment strategies for overweight persons with type 2 diabetes, have been viewed with caution as a treatment for the pregnant woman with GDM.…”

“…Severe calorie restriction by 50% or intakes in the range of 1200 to 1500 kcal/d result in weight loss, ketonuria, and improved blood glucose control [32,33,35,36]. Overall, moderate calorie restriction at levels of 1700 to 1800 kcal/d has resulted in lower maternal weight gain without ketonuria among obese women with GDM [14,[32][33][34].…”

Gestational Weight Gain and Pregnancy Outcomes in 481 Obese Glucose-Tolerant Women

“…The figures are too small to draw firm conclusions, but the frequencies are comparable with those of the background population. The effect of caloric restriction on ketone levels has previously been studied in women with GDM (23,24). It was concluded that a 50% caloric restriction was associated with a significant increase in ketonuria, whereas a 33% restriction was not.…”