Abstract
BackgroundGestational Diabetes Mellitus (GDM) is prevalent with lasting health implications for the mother and offspring. Medical nutrition therapy is the foundation of GDM management yet achieving optimal glycaemic control often requires treatment with medications, like insulin. New dietary strategies to improve GDM management and outcomes are required.Gut dysbiosis is a feature of GDM pregnancies, therefore, dietary manipulation of the gut microbiota may offer a new avenue for management. Resistant starch is a fermentable dietary fibre known to alter the gut microbiota and enhance production of short-chain fatty acids. Evidence suggests that short-chain fatty acids improve glycaemia via multiple mechanisms, however, this has not been evaluated in GDM.MethodsAn open-label, parallel-group design study will investigate whether a high dietary resistant starch intake or resistant starch supplement improves glycaemic control and changes the gut microbiome compared with standard dietary advice in women with newly diagnosed GDM. Ninety women will be randomised to one of three groups - standard dietary treatment for GDM (Control), a high resistant starch diet or a high resistant starch diet plus a 16 g resistant starch supplement. Measurements taken at Baseline (24 to 30-weeks’ gestation), Day 10 and Day 56 (approximately 36 weeks’ gestation) will include fasting plasma glucose levels, microbial composition and short-chain fatty acid concentrations in stool, 3-day dietary intake records and bowel symptoms questionnaires. One-week post-natal data collection will include microbial composition and short-chain fatty acid concentrations of maternal and neonatal stools, microbial composition of breastmilk, birthweight, maternal and neonatal outcomes. Mixed model analysis of variance will assess change in glycaemia and permutation-based multivariate analysis of variance will assess changes in microbial composition within and between intervention groups. Distance-based linear modelling will identify correlation between change in stool microbiota, short-chain fatty acids and measures of glycaemia.DiscussionTo improve outcomes for GDM dyads, evaluation of a high dietary intake of resistant starch to improve glycaemia through the gut microbiome needs to be established. This will expand the dietary interventions available to manage GDM without medication.Trial registrationAustralian New Zealand Clinical Trial Registry, ACTRN12620000968976p. Registered 28 September 2020
Highlights
Gestational Diabetes Mellitus (GDM) is prevalent with lasting health implications for the mother and offspring
Women post-GDM and their offspring remain at greater risk of metabolic health problems over their lifetimes [2]
Gut dysbiosis has been reported as a feature of GDM pregnancies [21,22,23] and it is established that dietary intake of fermentable fibres, such as resistant starch (RS), changes the gut microbiota and metabolome [39, 75]
Summary
Gestational Diabetes Mellitus (GDM) is prevalent with lasting health implications for the mother and offspring. Gestational Diabetes (GDM) is a state of glucose intolerance first discovered in pregnancy via routine screening undertaken between 24 and 28 weeks of gestation [1] It is largely a disease of insulin resistance (IR) with the prevalence increasing in parallel with increasing rates of obesity [2]. Current evidence-based dietary strategies are often insufficient to optimise glycaemia [13] in some populations, more than half of GDM women require pharmacotherapy to control their blood glucose [14,15,16,17] This increases the burden to the woman and health system through additional monitoring and clinic appointments to ameliorate the risk [18]. New dietary strategies are required to improve outcomes for women and their offspring [5] and to reduce health expenditure [18]
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