Introduction and Objective: The optimal dietary carbohydrate intake for pregnant women is disputed internationally. Some authorities recommend consuming >175g/d of carbohydrate aiming to support safe placental function; others use carbohydrate restriction to ≤120g/d to reduce hyperglycemia in gestational diabetes. We assessed if consumption of a low (<175g/d) or very low (<120g/d) habitual carbohydrate intake was associated with altered nutrient intake, glycemia and pregnancy outcomes in women with gestational diabetes.Methods: Women recruited into the dietary intervention in gestational diabetes trial (DiGest) completed masked continuous glucose monitoring (CGM) and a 24-hour dietary recall (Intake-24) at baseline before randomisation to a standard energy diet (2000kcal/day) or reduced energy diet (1200 kcal/day) from ~29-36 weeks’ gestation. Associations with glycemia and outcomes were adjusted for demographics, trial arm and center.Results: At baseline, 215 women completed a dietary assessment: 66 (30.7%), 74 (34.4%) and 75 (34.9%) reported standard (>175g/d), low (120-175g/d) or very low (<120g/d) carbohydrate intakes, respectively. Women consuming low or very low carbohydrate consumed less energy, fiber, vitamins (B, E) and minerals, but proportionally more protein and fat. Consuming <120g/d carbohydrates was associated with a 6.8% reduction in CGM time-above-range (TAR; Adjusted Coeff -6.8% (95% CI -13.4 to -0.2; p=0.044) and a reduction in birthweight (-9.6 centiles (95% CI -18.7 to -0.6; p=0.037), but no difference in large- or small-for-gestational-age. Low carbohydrate intakes as a proportion of total energy intake (<35%) without energy restricted intervention was associated with reduced CGM TAR, but no difference in birthweight.Conclusion: A very low carbohydrate intake appeared safe and improved glycemia, but requires vigilance to maintain adequate intake of micronutrients and fiber. Reduced birthweight was only evident with concomitant energy restriction.
E. Ahmad: Speaker’s Bureau; Current; Lilly. Other – Travel grant to attend conference; Ended; Novo Nordisk. Advisory Panel; Current; Medexpress. S. Dib: None. L. Oude Griep: None. L. Kusinski: None. C. Meek: Research Support; Current; Dexcom, Inc.
Diabetes UK
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