Abstract
Nutrition therapy provides the foundation for treatment of gestational diabetes (GDM), and has historically been based on restricting carbohydrate (CHO) intake. In this paper, randomized controlled trials (RCTs) are reviewed to assess the effects of both low- and higher CHO nutrition approaches in GDM. The prevailing pattern across the evidence underscores that although CHO restriction improves glycemia at least in the short-term, similar outcomes could be achievable using less restrictive approaches that may not exacerbate IR. The quality of existing studies is limited, in part due to dietary non-adherence and confounding effects of treatment with insulin or oral medication. Recent evidence suggests that modified nutritional manipulation in GDM from usual intake, including but not limited to CHO restriction, improves maternal glucose and lowers infant birthweight. This creates a platform for future studies to further clarify the impact of multiple nutritional patterns in GDM on both maternal and infant outcomes.
Highlights
Gestational diabetes is one of the most intensely debated topics in obstetric history
Postpartum follow-up of these mothers tends to be poor [33]. It was recently identified in the Hyperglycemia and Adverse Pregnancy Outcomes (HAPO) cohort that 11 years after GDM, the higher incidence of childhood overweight/obesity, increased adiposity, and larger waist circumference was explained by pre-pregnancy BMI [34]
In the GI study from Australia, a high rate of insulin treatment in both GI groups further confounds the increased Gestational Weight Gain (GWG) for two reasons: first, weight gain is independently correlated with insulin therapy; and second, with insulin treatment comes a higher risk for hypoglycemia that could necessitate higher CHO intake for avoidance [9]
Summary
Gestational diabetes is one of the most intensely debated topics in obstetric history. RCTs demonstrated improved perinatal outcomes from diagnosis and treatment [2,3] Evidence from these trials supported the inclusion of GDM screening in standard-of-care protocols for pregnancy world-wide, ending decades of controversy. Since the HAPO study, the field of diabetes in pregnancy again finds GDM as the focus of debate; international consensus on diagnostic criteria has not been reached nearly a decade later [6], and first-line medical [pharmaceutical] therapy has recently been called into question [7,8]. There are a number of formative studies using both restrictive and less-restrictive approaches to CHO consumption that have informed our contemporary understanding of nutrition therapy in GDM.
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