Therapy For Gestational Diabetes Mellitus Research Articles

Multiple positive points during the 75 g oral glucose tolerance test are good predictors for early insulin therapy in gestational diabetes mellitus diagnosed before 24 gestational weeks

ABSTRACTAims/IntroductionThis study evaluated the risk factors for insulin therapy before 24 gestational weeks (early insulin therapy) in pregnant women with gestational diabetes diagnosed before 24 gestational weeks (E‐GDM).Materials and MethodsThis study included 530 singleton mothers with E‐GDM who underwent a 75 g oral glucose tolerance test (OGTT) in the first trimester at Keio University Hospital between January 2013 and December 2021. E‐GDM can be classified according to its management into only diet therapy until delivery (Diet E‐GDM), insulin therapy started before 24 gestational weeks (EarlyIns E‐GDM), and insulin therapy started after 24 gestational weeks (LateIns E‐GDM). We analyzed the risk factors for EarlyIns E‐GDM.ResultsPatients with EarlyIns E‐GDM had a significantly higher maternal age at delivery, pre‐pregnancy BMI, first trimester hemoglobin A1c, 1 h plasma glucose levels (1 h‐PG), and 2 h‐PG, as well as a more pronounced initial increase and subsequent decrease, compared with those in the Diet E‐GDM group. However, the Apgar scores at both 1 and 5 min were significantly lower in patients with EarlyIns E‐GDM than in those with Diet E‐GDM. The number of abnormal values in the OGTT showed the largest area under the receiver operating characteristic curve (AUC) for predicting EarlyIns E‐GDM (0.83, 95% confidence interval [CI]: 0.79–0.86), followed by the 1 h‐PG value (AUC: 0.81, 95% CI: 0.77–0.85). The initial increase showed the third largest AUC (0.78, 95% CI: 0.74–0.82).ConclusionsAlthough further research is needed, our data suggest the importance of early insulin therapy in cases of E‐GDM with multiple abnormal OGTT values, especially with high 1 h‐PG levels and initial increase.

Perinatal Outcomes of Diet Therapy in Gestational Diabetes Mellitus Diagnosed before 24 Gestational Weeks.

To evaluate perinatal outcomes and risk factors for large for gestational age (LGA; birth weight over 90 percentile) in gestational diabetes diagnosed before 24 gestational weeks and treated with diet therapy alone until delivery (Diet Early gestational diabetes mellitus (Diet Early GDM)), we assessed the maternal characteristics and perinatal outcomes of patients with early GDM (n = 309) and normal glucose tolerance (NGT; n = 309) at Keio University Hospital. The gestational weight gain (GWG) expected at 40 weeks was significantly lower in the Diet Early GDM group than in the NGT group. The Diet Early GDM group exhibited a significantly lower incidence of low birth weight (<2500 g) and higher Apgar score at 5 min than the NGT group. Multiple logistic regression analysis revealed that the pre-pregnancy body mass index and GWG expected at 40 weeks were significantly associated with LGA for Diet Early GDM. No differences were observed in random plasma glucose levels in the first trimester, 75 g oral glucose tolerance test values, and initial increase or subsequent decrease between the two groups. Dietary early GDM did not exhibit a worse prognosis than NGT. To prevent LGA, it might be important to control maternal body weight not only during pregnancy but also before conception.

1305-P: The Effect of Limited Pregnancy Weight Gain on Fetal Growth during Dietary Therapy in Gestational Diabetes Mellitus–Affected Women

Aims: We aimed to evaluate how diet-related maternal weight gain (GWG) affected foetal growth in gestational diabetes (GDM)-complicated pregnancies. Methods: This study involved 182 women who were sequentially diagnosed with GDM before 34 weeks of pregnancy and gave birth to live singletons at our hospital. To gauge compliance with an energy-limited “diabetic diet,” the women were divided into three groups based on their restricted (53%), appropriate (16%), and excessive (31%) weekly GWG. If necessary, insulin therapy was started in accordance with regional clinical recommendations. Results: At the time of the diagnosis of GDM at 276 ± 51 weeks, the three groups' glucose tolerance, HbA1c, weekly GWG before dietary treatment, and SD score for foetal abdominal circumference were comparable. The women were monitored for 100 ± 51 weeks, during which time 54% of them got further insulin medication, and the average GWG during dietary therapy varied amongst the three groups, weighing 0 kg, 3 kg, and 5 kg. Increased HbA1c between the time of GDM diagnosis and late pregnancy was associated with excessive weekly GWG during dietary treatment, reflecting poor dietary adherence, and newborns had a birthweight-SD score of 0.59 ± 1.6. Conclusions: In women with GDM, restricted GWG during nutritional therapy was linked to improved foetal growth. Clinical determinants of infant birthweight-SD score that are possibly modifiable include GWG during nutritional therapy and late-pregnancy HbA1c. Disclosure N.Kumar: None. S.C.Jha: None.

Initiation of Oral Agents Versus Insulin as First-Line Therapy for Gestational Diabetes Mellitus [ID: 1360154

INTRODUCTION: Although the American College of Obstetricians and Gynecologists recommends insulin as first-line pharmacologic treatment for gestational diabetes mellitus (GDM) since 2017, use of oral agents as first-line remains common. This study aims to identify patient-level factors associated with choice of initial pharmacologic treatment of GDM with oral agents compared to insulin. METHODS: Case–control study of 617 patients with White's class A2 GDM treated at a single academic center in a comprehensive GDM treatment program, 2011–2018. Pregestational diabetes and GDM not requiring medication (A1 GDM) were excluded. Case group was GDM pregnancies treated with any oral agent first-line and control group was treated with insulin as first-line treatment. Logistic regression was performed to identify patient factors associated with oral agents as first-line pharmacologic treatment. Receiver-operator characteristic (ROC) curve estimated the ability of these factors to predict initial medication choice. RESULTS: Among those with GDMA2, 80% were started on an oral agent and 20% were started on insulin. Those started initially on oral agents were more likely to be Hispanic or non-Hispanic White, be non-English speakers, have private insurance, and have normal body mass index (BMI). Factors strongly associated with starting on an oral agent rather than insulin were Hispanic ethnicity, treatment initiated later in pregnancy (&gt;28 weeks), normal BMI, and 1-hour glucose challenge test (GCT) greater than 200. The ROC derived from the adjusted logistic regression model found a predictive value of these variables for initiating oral agents of 79% (area under the curve 0.79). CONCLUSION: Patient-level factors are predictive of pharmacological agent chosen for first-line treatment of GDM. Factors that are typically associated with more difficult to control GDM, such as obesity, high values on the GCT screening test and earlier gestational age at diagnosis are more common in patients treated initially with insulin. However, some demographic factors such as Hispanic ethnicity and non-English primary language are more common among patients initiated on oral agents for treatment of GDM.

Medical Nutrition Therapy in Gestational Diabetes Mellitus

Aim: The aim of this study was to elicit information on the perception of dietitians about gestational diabetes mellitus (GDM) and their dietetic practices. Materials and Methods: A survey was conducted among dietitians working in hospitals, maternity centers, and other clinics using the purposive sampling criterion. A validated questionnaire was used to obtain details about the perception of GDM, guidelines used, dietetic screening, assessment, interventions and follow-up. Descriptive statistics were reported as frequency of total number of responses for each question. Fisher's exact test on perception of GDM, operating guidelines and topics discussed in diet consultations with respect to the years of clinical experience, age group and educational qualification of the participants were performed. Results: Perception of dietitians on family history of type2 DM as an associated risk factor of GDM had significant association with their clinical experience. Majorly discussed topic in diet consultation was carbohydrate distribution followed by protein requirement, fiber and small frequent meal pattern. On the basis of clinical experience of dietitians, difference was observed in discussed topics such as hypoglycemia, food groups, post-natal diet, and breast feeding. A major inconsistency observed was the nonavailability or lack in the use of pregnancy specific screening tool. Conclusion: Specific screening tools for pregnancy should be brought into practice. There is also the need for sustainable protocols in hospitals for uniformity in management of GDM.

Nutritional therapy for gestational diabetes mellitus: what does the evidence say?

Gestational diabetes mellitus (DM) is a disease that is characterized by glucose intolerance first recognized during pregnancy but does not meet the criteria of overt diabetes. Gestational DM is a major medico-social issue because it is associated with adverse pregnancy outcomes. The primary method of gestational DM treatment is nutrition therapy, which can be supplemented with antihyperglycemic agents. Lifestyle modification has shown to be effective in preventing the complications of gestational diabetes mellitus. Despite this fact, there is no consensus on which dietary recommendations should be recommended in case of glucose intolerance during pregnancy. Most of the current guideline recommendations suggest controlling carbohydrate or calorie intake, diet with a low glycemic index, and Mediterranean or Dietary Approaches to Stop Hypertension diet. Another essential aspect of nutrition therapy in gestational DM is the safety of diet outcomes for both mothers and their offspring. This review aimed to evaluate the current recommendations for gestational diabetes mellitus nutrition management and their supporting evidence.&#x0D; Along with this the goal was to the review common and uncommon proposed gestational diabetes mellitus diets and ultimately and provide an analysis of their safety and efficacy and the possibility of application in clinical practice for the treatment of patients with gestational diabetes mellitus.

Medical nutrition therapy for gestational diabetes mellitus in Australia: What has changed in 10 years and how does current practice compare with best practice?

The present study aimed to report Australian dietetic practice regarding management of gestational diabetes mellitus (GDM) and to make comparisons with the findings from a 2009 survey of dietitians and with the Academy of Nutrition and Dietetics Evidence-Based Nutrition Practice Guidelines (NPG). Cross-sectional surveys were conducted in 2019 and 2009 of dietitians providing medical nutrition therapy (MNT) to women with GDM in Australia. The present study compares responses on demographics, dietetic assessment and interventions, and guideline use in 2019 vs. 2009. In total, 149 dietitians (2019) and 220 (2009) met survey inclusion criteria. In both surveys >60% of respondents reported dietary interventions aiming for >45% energy from carbohydrate, 15%-25% energy from protein and 15%-30% energy from fat. Many variations in MNT found in 2009 continued to be evident in 2019, including the percentage of energy from carbohydrate aimed for (30%-65% in 2019 vs. 20%-75% in 2009) and the wide range in the recommended minimum daily carbohydrate intake (40-220 and 60-300 g). Few dietitians reported aiming for the NPG minimum of 175 g of carbohydrate daily in both surveys (32% in 2019 vs. 26% in 2009). There were, however, some significant increases in MNT consistent with NPG recommendations in 2019 vs. 2009, including the minimum frequency of visits provided (49%, n = 61 vs. 33%, n = 69; p < 0.001) and provision of gestational weight gain advice (59%, n = 95 vs. 40%, n = 195; p < 0.05). Although many dietitians continue to provide MNT consistent with existing NPG, there is a need to support greater uptake, especially for recommendations regarding carbohydrate intake.

An Update of Medical Nutrition Therapy in Gestational Diabetes Mellitus.

Gestational diabetes mellitus (GDM) is a serious and frequent pregnancy complication that can lead to short and long-term risks for both mother and fetus. Different health organizations proposed different algorithms for the screening, diagnosis, and management of GDM. Medical Nutrition Therapy (MNT), together with physical exercise and frequent self-monitoring, represents the milestone for GDM treatment in order to reduce maternal and fetal complications. The pregnant woman should benefit from her family support and make changes in their lifestyles, changes that, in the end, will be beneficial for the whole family. The aim of this manuscript is to review the literature about the Medical Nutrition Therapy in GDM and its crucial role in GDM management.

The Role of High-Content Complex Dietary Fiber in Medical Nutrition Therapy for Gestational Diabetes Mellitus.

Objectives: A controlled open clinical study was conducted to evaluate the role of Ricnoat, a high-content complex dietary fiber powder produced by Zhuhai Aimed Biotechnology Co. Ltd., in medical nutrition therapy (MNT) to treat gestational diabetes mellitus (GDM). The study aimed to investigate glycemic control, lipid control, weight control, and pregnancy outcomes (neonatal weight) in patients with GDM, as well as evaluate the clinical safety of Ricnoat.Methods: A total of 120 patients with GDM who were admitted to three hospitals in Shanghai between January 2019 and January 2020 were enrolled. Ricnoat was used for intervention for patients in the experimental group. Using a χ2 test and t-test, respectively, comparisons were conducted between the measurement data and countable data of the demographics and baseline disease characteristics of the experimental group and control group.Results: Fasting blood glucose, 2-h postprandial blood glucose, glycated hemoglobin, total cholesterol, triglycerides, low-density lipoprotein, maternal gestational weight gain, neonatal weight, serum creatinine, glutamate transaminase, and aspartate aminotransferase were lower in the experimental group than in the control group, whereas high-density lipoprotein was higher in the experimental group than in the control group. Ricnoat intervention resulted in satiety higher than the expected 80% and more common occurrence of type 4 (smooth and soft, like salami or a snake) and type 5 (a soft mass with clear edges) stools.Conclusion: Ricnoat intervention had a significant effect on glycemic control, lipid control, weight control, and pregnancy outcomes (neonatal weight) in patients with GDM by enhancing maternal satiety and improving the stool features of pregnant women. It was also found to be safe for application during pregnancy.

A comparison of meal tolerance test and oral glucose tolerance test for predicting insulin therapy in patients with gestational diabetes.

AimsTo identify factors predicting a need for insulin therapy in gestational diabetes mellitus (GDM) by comparing plasma glucose (PG) levels in a 75-g oral glucose tolerance test (75-g OGTT) with those in a 500-kcal meal tolerance test (MTT) containing 75 g of carbohydrate.Subjects and methodsThe MTT was performed in 61 patients who diagnosed with GDM by a 75-g OGTT (age, 33.2 ± 4.5 years; prepregnancy body mass index, 22.6 ± 4.7 kg/m2; number of gestational weeks, 25.1 ± 6.4 weeks). PG and serum insulin levels were measured before the meal and up to 180 min after the meal. The insulin secretion capacity and resistance index were calculated.ResultsPG levels increased from 86.8 ± 8.8 mg/dL at fasting to 132.7 ± 20.1 mg/dL at 30 min, and 137.8 ± 27.7 mg/dL at 60 min after MTT in the 35 patients with needed insulin therapy; these levels were significantly higher than those in the 26 patients, who only needed diet therapy. The patients with needed insulin therapy had significantly higher fasting PG levels in the 75-g OGTT, PG levels at fasting and 30 min after the MTT, and homeostasis model assessment of insulin resistance (HOMA-IR), and a significantly lower disposition index (DI) and insulin index than patients treated by diet alone. Receiver operating characteristic curve analysis was performed for factors involved in insulin therapy, with the following cutoff values: fasting PG in the 75-g OGTT, 92 mg/dL; PG 30 min after MTT, 129 mg/dL; HOMA-IR, 1.51; DI, 3.9; HbA1c, 5.4%. Multivariate analysis revealed that the 30-min PG level after MTT and HOMA-IR predicted insulin therapy.ConclusionPG levels at 30 min after MTT may be useful for identifying patients with GDM, who need insulin therapy.

Provider-based initiation and management of pharmacologic therapy for gestational diabetes mellitus

Objective After failure of diet and exercise prescribed for gestational diabetes mellitus (GDM), pharmacotherapy initiation is recommended. The objective of this study was to examine the association between provider type and timing of pharmacotherapy initiation. Methods This was a retrospective cohort study of women with a singleton pregnancy and diagnosis of A2GDM (GDM requiring pharmacotherapy) delivering in a tertiary care center between 2009 and 2019. Variables including maternal demographics, GDM characteristics, and provider type (general obstetrician/gynecologists (OBGYN), maternal–fetal medicine (MFM), or endocrinology) were assessed. The percent of abnormal glucose values at pharmacotherapy initiation was compared among provider types via univariable and multivariable analyses. Results A total of 428 women were included in the analysis. Eighteen percent were managed by MFM, 54% by general OBGYN, and 28% by endocrinology. Insulin was prescribed in 45.8% of women. In univariable analysis, the percent of abnormal glucose values was higher in women managed by MFMs, compared with general OBGYN and endocrinology (58.0%±25.1, 50.0%±23.1, and 50.3%±26.8, respectively, p = .041). Women started on insulin as first-line pharmacotherapy were more likely to be managed by endocrinology (p < .001). After adjusting for confounding variables, provider type was not significantly associated with percent of abnormal glucose values at pharmacotherapy initiation, but endocrinology was more likely to initiate insulin (aOR = 9.33, 95% CI 4.27–20.39). Conclusions Provider type was not associated with percent of elevated glucose values at the time of pharmacotherapy initiation for A2GDM, but it was associated with insulin usage as first-line pharmacotherapy.

Insulin Therapy in Pregnancy Hypertensive Diseases and its Effect on the Offspring and Mother Later in Life.

Pregnancy hypertensive disorders such as Preeclampsia (PE) are strongly correlated with insulin resistance, a condition in which the metabolic handling of D-glucose is deficient. In addition, the impact of preeclampsia is enhanced by other insulin-resistant disorders, including polycystic ovary syndrome and obesity. For this reason, there is a clear association between maternal insulin resistance, polycystic ovary syndrome, obesity and the development of PE. However, whether PE is a consequence or the cause of these disorders is still unclear. Insulin therapy is usually recommended to pregnant women with diabetes mellitus when dietary and lifestyle measures have failed. The advantage of insulin therapy for Gestational Diabetes Mellitus (GDM) patients with hypertension is still controversial; surprisingly, there are no studies in which insulin therapy has been used in patients with hypertension in pregnancy without or with an established GDM. This review is focused on the use of insulin therapy in hypertensive disorders in the pregnancy and its effect on offspring and mother later in life. PubMed and relevant medical databases have been screened for literature covering research in the field especially in the last 5-10 years.

Guidelines for Medical Nutrition Therapy in Gestational Diabetes Mellitus: Systematic Review and Critical Appraisal

BackgroundMedical nutrition therapy is the cornerstone of gestational diabetes mellitus treatment. However, guidelines often present contradictory guidance to health care practitioners. ObjectiveTo systematically review and critically appraise medical nutrition therapy guidelines for treating patients with gestational diabetes mellitus. DesignWe searched Medline, the Cochrane Library, Guidelines International Network, and Google Scholar to retrieve clinical practice guidelines (CPGs) for medical nutrition therapy in gestational diabetes mellitus from professional or governmental organizations, published in English, between January 1, 2007, and November 24, 2018. CPGs were reviewed and appraised using the Appraisal of Guidelines, Research, and Evaluation II instrument. ResultsOf 1,286 retrieved articles, 21 CPGs fulfilled the inclusion criteria. CPGs of the Academy of Nutrition and Dietetics, Diabetes Canada, and Malaysia Health Technology Assessment Section received the greatest overall scores and the highest scores concerning rigor of recommendations development. Many CPGs failed to involve multidisciplinary teams in their development, including patients, and often, dietitians. Applicability of the recommendations was low, lacking facilitators and tools to enhance implementation. Many CPGs demonstrated low editorial independence by failing to disclose funding and competing interests. More medical nutrition therapy recommendations were incorporated in the Academy of Nutrition and Dietetics and Malaysia Health Technology Assessment Section CPGs. The Malaysia Health Technology Assessment Section, Diabetes Canada, Academy of Nutrition and Dietetics, and Endocrine Society guidelines were recommended by the review panel herein without modifications. Overall, the CPGs suggested the consumption of adequate protein and the selection of foods with low glycemic index, divided into three main meals and two to four snacks. Weight gain recommendations were mostly based on the Institute of Medicine body mass index thresholds. ConclusionsWith few exceptions, the main developmental limitations of the appraised CPGs involved low rigor of recommendations development, lack of multidisciplinary stakeholder involvement, low applicability, and inadequate editorial independence. This indicates a need for developing more clear, unbiased, practical, and evidence-based CPGs.

The MTNR1B rs10830963 Variant in Interaction with Pre-Pregnancy BMI is a Pharmacogenetic Marker for the Initiation of Antenatal Insulin Therapy in Gestational Diabetes Mellitus.

The rs10830963 variant of the Melatonin Receptor 1B (MTNR1B) gene is associated with the development of gestational diabetes mellitus (GDM). We hypothesized that carrying the rs10830963/G risk allele had effect on antenatal insulin therapy (AIT) initiation in GDM in a body mass index (BMI)-dependent manner. Design: In this post hoc analysis the MTNR1B rs10830963 genotype and the clinical data of 211 Caucasian GDM patients were assessed. As a first step, a pre-pregnancy BMI threshold was determined where the effect of MTNR1B rs10830963/G allele carrying on AIT initiation was the most significant using logistic regression. Maternal age adjusted real-life odds ratios (OR) values were calculated. The chi-square test was also used to calculate the p value and 10.000 bootstrap simulations were performed in each case to re-assess the statistical power and the OR. Carrying the MTNR1B rs10830963/G allele increased the odds of AIT initiation (OR = 5.2, p = 0.02 [χ2 test], statistical power = 0.53) in GDM patients with pre-pregnancy BMI ≥ 29 kg/m2. The statistical power reached 0.77, when the pre-pregnancy BMI cutoff of 27 kg/m2 was used and the genetic effect on AIT initiation was still significant, but only using the logistic regression model. Carrying the MTNR1B rs10830963/G risk allele—in interaction with pre-pregnancy BMI—is likely be considered as a candidate pharmacogenetic marker of antenatal insulin therapy initiation and should be further assessed in precision medicine trials in GDM.

Medical nutrition therapy for gestational diabetes mellitus based on Mediterranean Diet principles: a subanalysis of the St Carlos GDM Prevention Study

ObjectivesTo assess whether Mediterranean Diet (MedDiet)-based medical nutrition therapy facilitates near-normoglycemia in women with gestational diabetes mellitus (GDMw) and observe the effects on adverse pregnancy outcomes.Research design and methodsThis is...

Medical Nutrition Therapy for Gestational Diabetes Mellitus (GDM) Based on Mediterranean Diet Principles

Background: Medical nutrition therapy (MNT) is the first-line therapy to achieve glycemic control in women with gestational diabetes mellitus (GDMw). It has been associated with better pregnancy outcomes. Whether MNT can make pregnancy outcomes like women without GDM remains unknown. Objective: To assess if a Mediterranean-diet-based medical nutrition therapy (MNT) facilitates near-normoglycemia (determined by HbA1c levels) at 36-38 gestational weeks in GDMw, and observe its effects on adverse pregnancy outcomes. Study Design: A sub-analysis of the St Carlos GDM Prevention Study. It was conducted between January-December 2015 in the Hospital Clínico San Carlos (Madrid, Spain). One thousand consecutive normoglycemic women were included before 12th gestational weeks, and 874 included in the final analysis: 177 were diagnosed with GDM (IADPSG criteria) and 697 had normal glucose tolerance. GDMw received Mediterranean diet-based MNT, with a daily intake of ≥40 ml extra-virgin olive oil and a handful of nuts (mainly pistachios). Results: GDMw had higher HbA1c levels, fastinG insulin and HOMA-IR at 24-28 gestational weeks as compared with NGT. At 36-38 gestational weeks these values became similar. Insulin therapy was necessary in 26.6% of GDMw. Rates of macrosomia, large-for-gestational-age, pregnancy-induced hypertensive disorders, prematurity and c-sections were similar between groups. Crude RR analysis showed that GDMw had a higher risk of insufficient weight gain [2.37(1.64-3.30), P=.001], urinary tract infection [1.69(1.20-2.38), P=.005], small-for-gestational age newborns [2.05(1.29-3.24), P=.009] and neonate ICU admission [3.42(1.45-8.04), P=.006]. Conclusions: Using a Mediterranean-diet-based MNT in GDMw helps to achieve a near-normoglycemia, making most pregnancy outcomes similar to women with NGT. The higher rates of small-for-gestational-age and insufficient weight gain require further analysis. Disclosure A. Duran: None. C. Assaf-Balut: None. N. Garcia de la Torre: None. M. Fuentes: None. E. Bordiu: None. L. Del Valle: None. A.M. Barabash: None. M. Cuesta: None. M.A. Rubio: None. A.L. Calle: None.

Патогенез и основы терапии гестационного сахарного диабета

Патогенез и основы терапии гестационного сахарного диабета

The importance of determining C-peptide level for forecasting the therapy of gestational diabetes mellitus

The importance of determining C-peptide level for forecasting the therapy of gestational diabetes mellitus

Women With Gestational Diabetes Mellitus Randomized to a Higher-Complex Carbohydrate/Low-Fat Diet Manifest Lower Adipose Tissue Insulin Resistance, Inflammation, Glucose, and Free Fatty Acids: A Pilot Study.

Diet therapy in gestational diabetes mellitus (GDM) has focused on carbohydrate restriction but is poorly substantiated. In this pilot randomized clinical trial, we challenged the conventional low-carbohydrate/higher-fat (LC/CONV) diet, hypothesizing that a higher-complex carbohydrate/lower-fat (CHOICE) diet would improve maternal insulin resistance (IR), adipose tissue (AT) lipolysis, and infant adiposity. At 31 weeks, 12 diet-controlled overweight/obese women with GDM were randomized to an isocaloric LC/CONV (40% carbohydrate/45% fat/15% protein; n = 6) or CHOICE (60%/25%/15%; n = 6) diet. All meals were provided. AT was biopsied at 37 weeks. After ∼7 weeks, fasting glucose (P = 0.03) and free fatty acids (P = 0.06) decreased on CHOICE, whereas fasting glucose increased on LC/CONV (P = 0.03). Insulin suppression of AT lipolysis was improved on CHOICE versus LC/CONV (56 vs. 31%, P = 0.005), consistent with improved IR. AT expression of multiple proinflammatory genes was lower on CHOICE (P < 0.01). Infant adiposity trended lower with CHOICE (10.1 ± 1.4 vs. 12.6 ± 2%, respectively). A CHOICE diet may improve maternal IR and infant adiposity, challenging recommendations for a LC/CONV diet.

Translation of a gestational diabetes nutrition model of care into practice: results from an implementation project

Background Reduced need for insulin therapy in Gestational Diabetes Mellitus (GDM) has been documented in a study validating American Nutrition Practice Guidelines, which recommend at least 3 dietitian visits. No Australian GDM Nutrition Practice Guidelines exist and systematic delivery of dietetic care to women with GDM does not occur in Australia. This paper evaluates a theory-informed implementation plan to translate a dietetic model of care based on the American guidelines in an Australian maternity hospital.