Effect of Carbohydrate-Restricted Dietary Pattern on Insulin Treatment Rate, Lipid Metabolism and Nutritional Status in Pregnant Women with Gestational Diabetes in Beijing, China.

Mingxuan Cui,Lulu Lu,Qianying Guo,Chen Yang,Shilong Zhao,Peng Liu,Xuening Li,Linlin Wang

doi:10.3390/nu14020359

Abstract

Carbohydrates play an important role in blood glucose control in pregnant women with GDM. Carbohydrate-restricted dietary (CRD) pattern for gestational diabetes mellitus (GDM) has been widely used in clinics, but the change in insulin utilization rate beyond CRD intervention in GDM remains unclear. The aim of the present study was to explore the application of insulin in pregnancy with GDM, as well as the influence of CRD pattern on lipid metabolism and nutritional state. A retrospective study of 265 women with GDM who delivered in Peking University People’s Hospital from July 2018 to January 2020 was conducted using a questionnaire survey. Women were divided into a CRD group or a control group according to whether they had received CRD intervention during pregnancy. There was no statistically significant difference in the rate of insulin therapy between the two groups (p > 0.05), the initial gestational week of the CRD group combined with insulin treatment was significantly higher than that of the control group (p < 0.05), and the risk of insulin therapy was positively correlated with fasting plasma glucose (FPG) in early pregnancy (p < 0.05). The incidence of abnormal low-density lipoprotein cholesterol levels in the CRD group was significantly lower than that in the control group (p < 0.05). There were no significant differences in nutritional indexes between the two groups. The results indicate that CRD intervention may be effective in delaying the use of insulin and improving the blood lipids metabolism during GDM pregnancy, while nutritional status may not be significantly affected under CRD intervention, and a high FPG in early pregnancy with GDM may be a risk factor for combined insulin therapy with CRD intervention.

Highlights

This study explored the changes in lipid metabolism and nutritional status, which were associated with glucose metabolism under
The Carbohydrate-restricted dietary (CRD) pattern can effectively delay the use of insulin during pregnancy with gestational diabetes mellitus (GDM), which confirms the effectiveness of CRD pattern in blood glucose management from this perspective
High fasting plasma glucose (FPG) in early pregnancy may be the most important risk factor for GDM in pregnancy treated with a CRD pattern combined with insulin

Summary

Introduction

Gestational diabetes mellitus (GDM) is one of the most common complications of pregnancy, and the number of women diagnosed with GDM is increasing worldwide [1]. GDM is a pregnancy-specific disease that harms both maternal and fetal health. Improper management of blood glucose during pregnancy can lead to premature delivery, dystocia, polyhydramnios, macrosomia, fetal growth restriction, fetal distress, fetal death in utero, neonatal respiratory distress syndrome and neonatal hypoglycemia, as well as other adverse pregnancy outcomes. In terms of long-term effects, women with a history of GDM have a significantly increased risk of long-term obesity, diabetes and cardiovascular diseases, and the offspring of GDM patients have a significantly increased risk of developing type 2 diabetes, obesity and metabolic syndrome, posing a serious threat to the health of mothers and children [2,3]

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