Robust evidence for specific nutrition therapy for gestational diabetes (GDM) is lacking. Preliminary data suggested our CHOICE diet, higher in complex carbohydrate (60%) and lower in fat (25%) reduced fasting glucose (FBG), free fatty acids (FFA), and newborn adiposity (NB%fat). We tested the hypothesis that 7-8 wks of CHOICE would improve insulin resistance, reduce FFA and NB%fat (2-wk PeaPod; 1° powered outcome) vs. a conventional low-carbohydrate (40%), higher fat (45%) diet (LC/CONV). After diagnosis (∼28-30 wks), 59 BMI-matched diet-controlled GDM women (mean±SD; BMI 32±5) were randomized to a eucaloric CHOICE or LC/CONV diet (7.2±1 wks; ALL MEALS PROVIDED). At baseline, a 2-hr 75g OGTT (with insulins) was performed and diet initiated. On day-4, a breakfast meal was given (30% of total calories) with fasting and hourly blood drawn x5 (gluc, insulin, FFA, triglycerides[TG]) for area-under-the curve (AUC). Measures were repeated at 36-37 wks. Of 59, 13 met exclusions (4 diet failures, 2/group). By ANCOVA (n=23/group), total and weight gain during diet were similar (CHOICE 1.9 vs. LC/CONV 1.8 kg) as was delivery wk (39.2 vs. 39.3 wks). At 37 wks, the meal gluc (p=0.001) and insulin AUCs (p=0.013) were lower for LC/CONV, though fasting gluc/insulin were similar. TG increased similarly. The FFA AUC decreased from 30-37 wks on CHOICE but rose on LC/CONV (p=0.016), and was lower for CHOICE at 37 wks (p=0.009). By the 37-wk OGTT, FBG decreased within both groups (CHOICE -7.2, LC/CONV -3.5 mg/dL, both p<0.01) but CHOICE led to improved (p=0.001) and lower gluc AUC (p<0.05)(similar insulin AUCs). Birthweight (3293 vs. 3303 g), anthropometrics, NB%fat (10.8±4 vs. 10.3±4%), and cord blood gluc, C-peptide, FFA and TG were similar. This RCT shows that complex carbohydrate can be liberalized by 20% above conventional recommendations and may improve gluc tolerance and similarly normalize fetal growth, expanding nutrition options in GDM.
T.L. Hernandez: None. S.S. Farabi: None. J. Arbet: None. N. Hirsch: None. E.Z. Dunn: None. K.P. Heiss: None. J. Martin Carli: None. N.F. Krebs: None. T.L. Powell: None. R. Reynolds: None. R.E. Van Pelt: None. J.E. Friedman: None. L.A. Barbour: None.
National Institutes of Health (R01DK101659, UL1TR002535); Janssen Research & Development, LLC