The Carbohydrate Threshold in Pregnancy and Gestational Diabetes: How Low Can We Go?
Birth Weight
Blood Glucose
Databases, Factual
Diabetes, Gestational
/ diet therapy
Diet, Carbohydrate-Restricted
Dietary Carbohydrates
/ administration & dosage
Eating
Energy Intake
Female
Fetal Macrosomia
Glycemic Index
Humans
Ketones
Lipids
Micronutrients
Pregnancy
Pregnancy Outcome
Pregnant Women
birth weight
ketones
lipids
low carbohydrate
micronutrients
pregnancy
Journal
Nutrients
ISSN: 2072-6643
Titre abrégé: Nutrients
Pays: Switzerland
ID NLM: 101521595
Informations de publication
Date de publication:
28 Jul 2021
28 Jul 2021
Historique:
received:
06
06
2021
revised:
19
07
2021
accepted:
22
07
2021
entrez:
27
8
2021
pubmed:
28
8
2021
medline:
29
9
2021
Statut:
epublish
Résumé
The original nutrition approach for the treatment of gestational diabetes mellitus (GDM) was to reduce total carbohydrate intake to 33-40% of total energy (EI) to decrease fetal overgrowth. Conversely, accumulating evidence suggests that higher carbohydrate intakes (60-70% EI, higher quality carbohydrates with low glycemic index/low added sugars) can control maternal glycemia. The Institute of Medicine (IOM) recommends ≥175 g/d of carbohydrate intake during pregnancy; however, many women are consuming lower carbohydrate (LC) diets (<175 g/d of carbohydrate or <40% of EI) within pregnancy and the periconceptual period aiming to improve glycemic control and pregnancy outcomes. This report systematically evaluates recent data (2018-2020) to identify the LC threshold in pregnancy in relation to safety considerations. Evidence from 11 reports suggests an optimal carbohydrate range of 47-70% EI supports normal fetal growth; higher than the conventionally recognized LC threshold. However, inadequate total maternal EI, which independently slows fetal growth was a frequent confounder across studies. Effects of a carbohydrate intake <175 g/d on maternal ketonemia and plasma triglyceride/free fatty acid concentrations remain unclear. A recent randomized controlled trial (RCT) suggests a higher risk for micronutrient deficiency with carbohydrate intake ≤165 g/d in GDM. Well-controlled prospective RCTs comparing LC (<165 g/d) and higher carbohydrate energy-balanced diets in pregnant women are clearly overdue.
Identifiants
pubmed: 34444759
pii: nu13082599
doi: 10.3390/nu13082599
pmc: PMC8398846
pii:
doi:
Substances chimiques
Blood Glucose
0
Dietary Carbohydrates
0
Ketones
0
Lipids
0
Micronutrients
0
Types de publication
Journal Article
Review
Langues
eng
Sous-ensembles de citation
IM
Subventions
Organisme : NIDDK NIH HHS
ID : R01 DK101659
Pays : United States
Organisme : NIH HHS
ID : R01DK101659
Pays : United States
Organisme : National Health and Medical Research Council
ID : GNT1148952
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