American Diabetes Association
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Randomization to a Provided Higher-Complex Carbohydrate vs. Conventional Diet in Gestational Diabetes Results in Similar Maternal 24-hour Glycemia and Newborn Adiposity

posted on 2023-08-29, 18:26 authored by Teri L. Hernandez, Sarah S. Farabi, Bailey K. Fosdick, Nicole Hirsch, Emily Z. Dunn, Kristy Rolloff, John P. Corbett, Elizabeth Haugen, Tyson Marden, Janine Higgins, Jacob E. Friedman, Linda A. Barbour

Objective: Nutrition therapy for gestational diabetes (GDM) has conventionally focused on carbohydrate restriction. In a randomized controlled trial (RCT), we tested the hypothesis that a diet (all meals provided) with liberalized complex carbohydrate (60%) and lower fat (25%)(CHOICE™) could improve maternal insulin resistance and 24-hr glycemia, resulting in reduced newborn adiposity (NB�t; powered outcome) vs. a conventional lower-carbohydrate (40%)/higher fat (45%) diet (LC/CONV).

Research Design and Methods: After diagnosis (~28-30wks), 59 diet-controlled GDM women (mean±SEM; BMI 32±1 kg/m2) were randomized to a provided LC/CONV or CHOICE™ diet (BMI-matched calories) through delivery. At 30-31 and 36-37wks, a 2-hr 75-g OGTT was performed and a continuous glucose monitor (CGM) was worn (72hrs). Cord blood was collected at delivery. NB�t was measured by air displacement plethysmography (13.4±0.4d).

Results: In n=23/group (mean±SEM; LC/CONV [214g/d carbohydrate] vs. CHOICE™ [316g/d]), NB�t (10.1±1 vs. 10.5±1%), birthweight (3303±98 vs 3293±81g), and cord C-peptide were not different. Weight gain, physical activity, and gestational age at delivery were similar. At 36-37wks, CGM fasting (86±3 vs. 90±3), 1-hr (119±3 vs.117±3), 2-hr postprandial (106±3 vs.108±3mg/dL), %time-in-range (TIR 92±1 vs. 91±1%), and 24-hr glucose area-under-the curve (AUC) were similar between diets. The %time >120mg/dL was statistically higher (8%) in CHOICE™ as was the nocturnal glucose AUC; however, nocturnal %TIR (63-100mg/dL) was not different. There were no between-group differences in OGTT glucose and insulin at 36-37wks.

Conclusion: A ~100g/d difference in carbohydrate intake did not result in between-group differences in NB�t, cord C-peptide, maternal 24-hr glycemia, %TIR, or insulin resistance indices in diet-controlled GDM.


Funding and Assistance: This study was supported by the National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Disease (R01DK101659), and by a cooperative grant from Janssen Research and Development. S.S.F. was supported by T32DK007446 for part of the study period. Continuous glucose monitors were provided at a reduced cost by Dexcom, Inc. Additional support was provided by NIH/NCATS Colorado CTSA Grant Number UL1 TR002535. Contents are the authors’ sole responsibility and do not necessarily represent official NIH views.