Direct RCT evidence to support a range of nutrition options for treatment of GDM is lacking. We randomized women with diet-controlled GDM to either our CHOICE (60% complex carbohydrate (CHO) /25% fat) or a conventional diet (CONV; 40% CHO/45% fat) and previously reported equivalent newborn adiposity. We further tested the hypothesis that 6 wks on either diet would result in a similar 24-hr glucose (gluc) area-under-the-curve (AUC) by CGM. BMI-matched women were randomized to CHOICE or CONV by wk 31 (n=59; mean±SEM; BMI 32±1kg/m2) . All meals were provided, eucaloric, and simple sugars were controlled in both. A CGM was worn for 72 hrs in wk 31 and 36. Total gestational weight gain (GWG) (CHOICE vs. CONV; 9.8±0.9 vs. 10.8±1.2 kg) , GWG from 31 wks to delivery (2.0±0.4 vs. 1.8±0.3 kg) , physical activity, and days on diet were similar (48±2 vs. 54±2 days; p>0.all) . At wk 31 (n=23 vs. 25/group) , fasting (89±3 vs. 87±2 mg/dL) , 1-hr (127±4 vs. 127±4) and 2-hr postprandial (PP) (112±3 vs. 110±3) gluc, and time in range (TIR; 70-140mg/dL) (89±1 vs. 86±1%) , were not different on CHOICE vs. CONV as were the mean 24-hr gluc, 24-hr AUC, nocturnal and daytime AUC (p>0.5 all) . By wk 36, (n=22 vs. 21/group) , fasting (90±3 vs. 86±3) , 1-hr (117±4 vs. 119±3) , 2-hr PP (108±3 vs. 106±3) , 2-hr PP AUC, TIR (88±2 vs. 88±1%) , 24-hr AUC, nocturnal AUC and daytime AUC remained highly similar between diets (p>0.all) . In paired analyses (n=19-21/group) , women on CHOICE showed an actual reduction in 1-hr PP gluc between 31-36 wks (124±5 vs. 115±4; p=0.02) . Surprisingly, the fasting, 2-hr PP gluc, 24-hr AUC, daytime and nocturnal AUC did not increase (nor did TIR decrease) , over time in either group with the expected rise in the insulin resistance of pregnancy. These data directly support for the first time in an RCT with all provided meals that excellent glycemic control by CGM was achieved with either a higher complex CHO versus low CHO diet in GDM, with similar glycemic parameters that did not increase over time.


T.L.Hernandez: None. E.Z.Dunn: None. N.Hirsch: None. K.P.Rolloff: None. J.P.Corbett: Employee; Tandem Diabetes Care, Inc., Other Relationship; Dexcom, Inc. S.S.Farabi: n/a. J.E.Friedman: None. L.A.Barbour: None.


National Institutes of Health (R01DK101659) CTSA UL1 TR002535 Janssen Research and Development

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