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Evidenced-Based Nutrition for Gestational Diabetes Mellitus

  • Diabetes and Pregnancy (M-F Hivert and CE Powe, Section Editors)
  • Published:
Current Diabetes Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

To review the latest evidence for dietary interventions for treatment of gestational diabetes (GDM).

Recent Findings

High-quality systematic reviews demonstrate no major advantages between the low-carbohydrate or calorie-restricted diets. However, the low glycemic index (GI) diet, characterized by intake of high-quality, complex carbohydrates, demonstrated lower insulin use and reduced risk of macrosomia in multiple reviews. Recent evidence suggests the Mediterranean diet is safe in pregnancy, though trials are needed to determine its efficacy over conventional dietary advice. Currently, there are insufficient data to support the safety of the ketogenic diet for the treatment of GDM.

Summary

The low GI diet may improve maternal and neonatal outcomes in GDM. The liberalized carbohydrate intake is less restrictive, culturally adaptable, and may improve long-term maternal adherence. Further research is needed to establish the optimal, most sustainable, and most acceptable medical nutrition therapy for management of women with GDM.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Metzger BE, Gabbe SG, Persson B, Buchanan TA, Catalano PA, Damm P, et al. International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care. 2010;33(3):676–82.

    PubMed  Google Scholar 

  2. Guariguata L, Linnenkamp U, Beagley J, Whiting DR, Cho NH. Global estimates of the prevalence of hyperglycaemia in pregnancy. Diabetes Res Clin Pract. 2014;103(2):176–85.

    CAS  PubMed  Google Scholar 

  3. Catalano PM, McIntyre HD, Cruickshank JK, McCance DR, Dyer AR, Metzger BE, et al. The hyperglycemia and adverse pregnancy outcome study: associations of GDM and obesity with pregnancy outcomes. Diabetes Care. 2012;35(4):780–6.

    CAS  PubMed  PubMed Central  Google Scholar 

  4. American Diabetes A. 13. Management of diabetes in pregnancy: standards of medical care in diabetes-2018. Diabetes Care. 2018;41(Suppl 1):S137–S43.

    Google Scholar 

  5. Simmons D. Diabetes and obesity in pregnancy. Best Pract Res Clin Obstet Gynaecol. 2011;25(1):25–36.

    PubMed  Google Scholar 

  6. Kim SY, England L, Wilson HG, Bish C, Satten GA, Dietz P. Percentage of gestational diabetes mellitus attributable to overweight and obesity. Am J Public Health. 2010;100(6):1047–52.

    PubMed  PubMed Central  Google Scholar 

  7. Chen C, Xu X, Yan Y. Estimated global overweight and obesity burden in pregnant women based on panel data model. PLoS One. 2018;13(8):e0202183.

    PubMed  PubMed Central  Google Scholar 

  8. Diagnostic criteria and classification of hyperglycaemia first detected in pregnancy: a World Health Organization Guideline. Diabetes Res Clin Pract. 2014;103(3):341–63.

  9. Group HSCR, Metzger BE, Lowe LP, Dyer AR, Trimble ER, Chaovarindr U, et al. Hyperglycemia and adverse pregnancy outcomes. N Engl J Med. 2008;358(19):1991–2002.

    Google Scholar 

  10. Sermer M, Naylor CD, Gare DJ, Kenshole AB, Ritchie JW, Farine D, et al. Impact of increasing carbohydrate intolerance on maternal-fetal outcomes in 3637 women without gestational diabetes. The Toronto tri-hospital gestational diabetes project. Am J Obstet Gynecol. 1995;173(1):146–56.

    CAS  PubMed  Google Scholar 

  11. Egan AM, Simmons D. Lessons learned from lifestyle prevention trials in gestational diabetes mellitus. Diabet Med. 2019;36(2):142–50.

    CAS  PubMed  Google Scholar 

  12. Jiwani A, Marseille E, Lohse N, Damm P, Hod M, Kahn JG. Gestational diabetes mellitus: results from a survey of country prevalence and practices. J Matern Fetal Neonatal Med. 2012;25(6):600–10.

    PubMed  Google Scholar 

  13. Blumer I, Hadar E, Hadden DR, Jovanovic L, Mestman JH, Murad MH, et al. Diabetes and pregnancy: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2013;98(11):4227–49.

    CAS  PubMed  Google Scholar 

  14. Hartling L, Dryden DM, Guthrie A, Muise M, Vandermeer B, Donovan L. Benefits and harms of treating gestational diabetes mellitus: a systematic review and meta-analysis for the U.S. preventive services task force and the National Institutes of Health Office of medical applications of research. Ann Intern Med. 2013;159(2):123–9.

    PubMed  Google Scholar 

  15. Landon MB, Spong CY, Thom E, Carpenter MW, Ramin SM, Casey B, et al. A multicenter, randomized trial of treatment for mild gestational diabetes. N Engl J Med. 2009;361(14):1339–48.

    CAS  PubMed  PubMed Central  Google Scholar 

  16. Knopp RH, Magee MS, Raisys V, Benedetti T, Bonet B. Hypocaloric diets and ketogenesis in the management of obese gestational diabetic women. J Am Coll Nutr. 1991;10(6):649–67.

    CAS  PubMed  Google Scholar 

  17. • Yamamoto JM, Kellett JE, Balsells M, Garcia-Patterson A, Hadar E, Sola I, et al. Gestational diabetes mellitus and diet: a systematic review and meta-analysis of randomized controlled trials examining the impact of modified dietary interventions on maternal glucose control and neonatal birth weight. Diabetes Care. 2018;41(7):1346–61. Results of this systematic review and meta-analysis revealed modified dietary interventions, beyond the typical dietary advice for GDM, resulted in improved maternal glycemic control and infant birthweight outcomes.

    CAS  PubMed  Google Scholar 

  18. Garcia-Patterson A, Balsells M, Yamamoto JM, Kellett JE, Sola I, Gich I, et al. Usual dietary treatment of gestational diabetes mellitus assessed after control diet in randomized controlled trials: subanalysis of a systematic review and meta-analysis. Acta Diabetol. 2019;56(2):237–40.

    CAS  PubMed  Google Scholar 

  19. Diabetes Canada Clinical Practice Guidelines Expert C, Feig DS, Berger H, Donovan L, Godbout A, Kader T, et al. Diabetes and pregnancy. Can J Diabetes. 2018;42(Suppl 1):S255–S82.

    Google Scholar 

  20. National Collaborating Centre for Ws, Children’s H. National Institute for Health and Care Excellence: clinical guidelines. Diabetes in pregnancy: management of diabetes and its complications from preconception to the postnatal period. London: National Institute for Health and Care Excellence (UK) Copyright (c) 2015 National Collaborating Centre for Women's and Children's Health.; 2015.

  21. IDF Clinical Guidelines Task Force. Global Guideline on Pregnancy and Diabetes. Brussels: International Diabetes Federation. 2009.

  22. Hernandez TL, Mande A, Barbour LA. Nutrition therapy within and beyond gestational diabetes. Diabetes Res Clin Pract. 2018;145:39–50.

    PubMed  PubMed Central  Google Scholar 

  23. Han S, Middleton P, Shepherd E, Van Ryswyk E, Crowther CA. Different types of dietary advice for women with gestational diabetes mellitus. Cochrane Database Syst Rev. 2017;2:Cd009275.

    PubMed  Google Scholar 

  24. Viana LV, Gross JL, Azevedo MJ. Dietary intervention in patients with gestational diabetes mellitus: a systematic review and meta-analysis of randomized clinical trials on maternal and newborn outcomes. Diabetes Care. 2014;37(12):3345–55.

    PubMed  Google Scholar 

  25. Hernandez TL. Carbohydrate content in the GDM diet: two views: view 1: nutrition therapy in gestational diabetes: the case for complex carbohydrates. Diabetes Spectr. 2016;29(2):82–8.

    PubMed  PubMed Central  Google Scholar 

  26. Elidottir AS, Halldorsson TI, Gunnarsdottir I, Ramel A. Dietary intake and cardiovascular risk factors in Icelanders following voluntarily a low carbohydrate diet. PLoS One. 2016;11(8):e0156655.

    PubMed  PubMed Central  Google Scholar 

  27. Derbyshire E, Davies J, Costarelli V, Dettmar P. Diet, physical inactivity and the prevalence of constipation throughout and after pregnancy. Matern Child Nutr. 2006;2(3):127–34.

    PubMed  Google Scholar 

  28. Hui AL, Sevenhuysen G, Harvey D, Salamon E. Stress and anxiety in women with gestational diabetes during dietary management. Diabetes Educ. 2014;40(5):668–77.

    PubMed  Google Scholar 

  29. Hui AL, Sevenhuysen G, Harvey D, Salamon E. Food choice decision-making by women with gestational diabetes. Can J Diabetes. 2014;38(1):26–31.

    PubMed  Google Scholar 

  30. van Wyk HJ, Davis RE, Davies JS. A critical review of low-carbohydrate diets in people with type 2 diabetes. Diabet Med. 2016;33(2):148–57.

    PubMed  Google Scholar 

  31. Feinman RD, Pogozelski WK, Astrup A, Bernstein RK, Fine EJ, Westman EC, et al. Dietary carbohydrate restriction as the first approach in diabetes management: critical review and evidence base. Nutrition. 2015;31(1):1–13.

    CAS  PubMed  Google Scholar 

  32. Jovanovic-Peterson L, Peterson CM. Dietary manipulation as a primary treatment strategy for pregnancies complicated by diabetes. J Am Coll Nutr. 1990;9(4):320–5.

    CAS  PubMed  Google Scholar 

  33. Peterson CM, Jovanovic-Peterson L. Percentage of carbohydrate and glycemic response to breakfast, lunch, and dinner in women with gestational diabetes. Diabetes. 1991;40(Suppl 2):172–4.

    PubMed  Google Scholar 

  34. Major CA, Henry MJ, De Veciana M, Morgan MA. The effects of carbohydrate restriction in patients with diet-controlled gestational diabetes. Obstet Gynecol. 1998;91(4):600–4.

    CAS  PubMed  Google Scholar 

  35. Cypryk K, Kaminska P, Kosinski M, Pertynska-Marczewska M, Lewinski A. A comparison of the effectiveness, tolerability and safety of high and low carbohydrate diets in women with gestational diabetes. Endokrynol Pol. 2007;58(4):314–9.

    PubMed  Google Scholar 

  36. Moreno-Castilla C, Hernandez M, Bergua M, Alvarez MC, Arce MA, Rodriguez K, et al. Low-carbohydrate diet for the treatment of gestational diabetes mellitus: a randomized controlled trial. Diabetes Care. 2013;36(8):2233–8.

    CAS  PubMed  PubMed Central  Google Scholar 

  37. • Hernandez TL, Van Pelt RE, Anderson MA, Reece MS, Reynolds RM, de la Houssaye BA, et al. Women with gestational diabetes mellitus randomized to a higher-complex carbohydrate/low-fat diet manifest lower adipose tissue insulin resistance, inflammation, glucose, and free fatty acids: a pilot study. Diabetes Care. 2016;39(1):39–42. Results of this highly controlled pilot study resulted in improved maternal glycemic control and metabolic parameters with a high-complex carbohydrate/low fat diet when compared to low-carbohydrate diet.

    CAS  PubMed  Google Scholar 

  38. Butte NF. Carbohydrate and lipid metabolism in pregnancy: normal compared with gestational diabetes mellitus. Am J Clin Nutr. 2000;71(5 Suppl):1256S–61S.

    CAS  PubMed  Google Scholar 

  39. Hernandez TL, Sutherland JP, Wolfe P, Allian-Sauer M, Capell WH, Talley ND, et al. Lack of suppression of circulating free fatty acids and hypercholesterolemia during weight loss on a high-fat, low-carbohydrate diet. Am J Clin Nutr. 2010;91(3):578–85.

    CAS  PubMed  PubMed Central  Google Scholar 

  40. Schaefer-Graf UM, Graf K, Kulbacka I, Kjos SL, Dudenhausen J, Vetter K, et al. Maternal lipids as strong determinants of fetal environment and growth in pregnancies with gestational diabetes mellitus. Diabetes Care. 2008;31(9):1858–63.

    PubMed  PubMed Central  Google Scholar 

  41. Barry D, Ellul S, Watters L, Lee D, Haluska R Jr, White R. The ketogenic diet in disease and development. Int J Dev Neurosci. 2018;68:53–8.

    PubMed  Google Scholar 

  42. Dalfra MG, Burlina S, Sartore G, Lapolla A. Ketoacidosis in diabetic pregnancy. J Matern Fetal Neonatal Med. 2016;29(17):2889–95.

    CAS  PubMed  Google Scholar 

  43. Sussman D, Ellegood J, Henkelman M. A gestational ketogenic diet alters maternal metabolic status as well as offspring physiological growth and brain structure in the neonatal mouse. BMC Pregnancy Childbirth. 2013;13:198.

    PubMed  PubMed Central  Google Scholar 

  44. Glaser N, Ngo C, Anderson S, Yuen N, Trifu A, O'Donnell M. Effects of hyperglycemia and effects of ketosis on cerebral perfusion, cerebral water distribution, and cerebral metabolism. Diabetes. 2012;61(7):1831–7.

    CAS  PubMed  PubMed Central  Google Scholar 

  45. al-Mudallal AS, Levin BE, Lust WD, Harik SI. Effects of unbalanced diets on cerebral glucose metabolism in the adult rat. Neurology. 1995;45(12):2261–5.

    CAS  PubMed  Google Scholar 

  46. Sussman D, van Eede M, Wong MD, Adamson SL, Henkelman M. Effects of a ketogenic diet during pregnancy on embryonic growth in the mouse. BMC Pregnancy Childbirth. 2013;13:109.

    CAS  PubMed  PubMed Central  Google Scholar 

  47. Rizzo T, Metzger BE, Burns WJ, Burns K. Correlations between antepartum maternal metabolism and intelligence of offspring. N Engl J Med. 1991;325(13):911–6.

    CAS  PubMed  Google Scholar 

  48. Augustin LS, Kendall CW, Jenkins DJ, Willett WC, Astrup A, Barclay AW, et al. Glycemic index, glycemic load and glycemic response: an international scientific consensus summit from the international carbohydrate quality consortium (ICQC). Nutr Metab Cardiovasc Dis. 2015;25(9):795–815.

    CAS  PubMed  Google Scholar 

  49. Lock DR, Bar-Eyal A, Voet H, Madar Z. Glycemic indices of various foods given to pregnant diabetic subjects. Obstet Gynecol. 1988;71(2):180–3.

    CAS  PubMed  Google Scholar 

  50. Brand-Miller JC, Petocz P, Colagiuri S. Meta-analysis of low-glycemic index diets in the management of diabetes: response to Franz. Diabetes Care. 2003;26(12):3363–4 author reply 4-5.

    PubMed  Google Scholar 

  51. Moses RG, Luebcke M, Davis WS, Coleman KJ, Tapsell LC, Petocz P, et al. Effect of a low-glycemic-index diet during pregnancy on obstetric outcomes. Am J Clin Nutr. 2006;84(4):807–12.

    CAS  PubMed  Google Scholar 

  52. Barr S, Reeves S, Sharp K, Jeanes YM. An isocaloric low glycemic index diet improves insulin sensitivity in women with polycystic ovary syndrome. J Acad Nutr Diet. 2013;113(11):1523–31.

    PubMed  Google Scholar 

  53. Zhang C, Liu S, Solomon CG, Hu FB. Dietary fiber intake, dietary glycemic load, and the risk for gestational diabetes mellitus. Diabetes Care. 2006;29(10):2223–30.

    CAS  PubMed  Google Scholar 

  54. Moses RG, Barker M, Winter M, Petocz P, Brand-Miller JC. Can a low-glycemic index diet reduce the need for insulin in gestational diabetes mellitus? A randomized trial. Diabetes Care. 2009;32(6):996–1000.

    CAS  PubMed  PubMed Central  Google Scholar 

  55. Louie JC, Markovic TP, Perera N, Foote D, Petocz P, Ross GP, et al. A randomized controlled trial investigating the effects of a low-glycemic index diet on pregnancy outcomes in gestational diabetes mellitus. Diabetes Care. 2011;34(11):2341–6.

    CAS  PubMed  PubMed Central  Google Scholar 

  56. • Wei Y, Jin Z, Shen G, Zhao X, Yang W, Zhong Y, et al. Effects of intensive antihypertensive treatment on Chinese hypertensive patients older than 70 years. J Clin Hypertens (Greenwich). 2013;15(6):420–7. Results of this systematic review and meta-analysis provide evidence that women with GDM following a low GI diet have lower rates of insulin use and decreased risk of neonatal macrosomia compared to control diets.

    CAS  Google Scholar 

  57. Drewnowski A, Darmon N. Food choices and diet costs: an economic analysis. J Nutr. 2005;135(4):900–4.

    CAS  PubMed  Google Scholar 

  58. Seligman HK, Jacobs EA, Lopez A, Tschann J, Fernandez A. Food insecurity and glycemic control among low-income patients with type 2 diabetes. Diabetes Care. 2012;35(2):233–8.

    PubMed  PubMed Central  Google Scholar 

  59. Moreno-Castilla C, Mauricio D, Hernandez M. Role of medical nutrition therapy in the management of gestational diabetes mellitus. Curr Diab Rep. 2016;16(4):22.

    PubMed  Google Scholar 

  60. Catalano PM, Mele L, Landon MB, Ramin SM, Reddy UM, Casey B, et al. Inadequate weight gain in overweight and obese pregnant women: what is the effect on fetal growth? Am J Obstet Gynecol. 2014;211(2):137.e1–7.

    Google Scholar 

  61. Rae A, Bond D, Evans S, North F, Roberman B, Walters B. A randomised controlled trial of dietary energy restriction in the management of obese women with gestational diabetes. Aust N Z J Obstet Gynaecol. 2000;40(4):416–22.

    CAS  PubMed  Google Scholar 

  62. Estruch R, Ros E, Salas-Salvado J, Covas MI, Corella D, Aros F, et al. Primary prevention of cardiovascular disease with a Mediterranean diet supplemented with extra-virgin olive oil or nuts. N Engl J Med. 2018;378(25):e34.

    CAS  PubMed  Google Scholar 

  63. Assaf-Balut C, Garcia de la Torre N, Duran A, Fuentes M, Bordiu E, Del Valle L, et al. Medical nutrition therapy for gestational diabetes mellitus based on Mediterranean diet principles: a subanalysis of the St Carlos GDM Prevention Study. BMJ Open Diabetes Res Care. 2018;6(1):e000550.

    PubMed  PubMed Central  Google Scholar 

  64. Estruch R, Martinez-Gonzalez MA, Corella D, Salas-Salvado J, Fito M, Chiva-Blanch G, et al. Effect of a high-fat Mediterranean diet on bodyweight and waist circumference: a prespecified secondary outcomes analysis of the PREDIMED randomised controlled trial. Lancet Diabetes Endocrinol. 2016;4(8):666–76.

    CAS  PubMed  Google Scholar 

  65. Salas-Salvado J, Bullo M, Babio N, Martinez-Gonzalez MA, Ibarrola-Jurado N, Basora J, et al. Reduction in the incidence of type 2 diabetes with the Mediterranean diet: results of the PREDIMED-Reus nutrition intervention randomized trial. Diabetes Care. 2011;34(1):14–9.

    PubMed  Google Scholar 

  66. Assaf-Balut C, Garcia de la Torre N, Duran A, Fuentes M, Bordiu E, Del Valle L, et al. A Mediterranean diet with additional extra virgin olive oil and pistachios reduces the incidence of gestational diabetes mellitus (GDM): a randomized controlled trial: the St. Carlos GDM prevention study. PLoS One. 2017;12(10):e0185873.

    PubMed  PubMed Central  Google Scholar 

  67. Teixeira PJ, Carraca EV, Marques MM, Rutter H, Oppert JM, De Bourdeaudhuij I, et al. Successful behavior change in obesity interventions in adults: a systematic review of self-regulation mediators. BMC Med. 2015;13:84.

    PubMed  PubMed Central  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Medicine – Division of Endocrinology and Metabolism, Cumming School of Medicine, University of Calgary, Calgary, Canada

    Amita Mahajan

  2. Department of Medicine – Division of Endocrinology and Metabolism, Department of Obstetrics and Gynecology, and Alberta Children’s Hospital Research Institute Calgary, Cumming School of Medicine - University of Calgary, Calgary, Canada

    Lois E. Donovan & Jennifer M. Yamamoto

  3. Diabetes in Pregnancy Clinic, Alberta Health Services, Calgary, Canada

    Rachelle Vallee

  4. Cumming School of Medicine, Richmond Road Diagnostic and Treatment Centre, University of Calgary, 1820 Richmond Road SW, Calgary, AB, T2T 5C7, Canada

    Jennifer M. Yamamoto

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AM and JY contributed the design and drafting of the paper. AM prepared the manuscript, which all authors critically reviewed. All the authors were fully responsible for all the content, and editorial decisions were involved at all stages of the manuscript development and have approved the final version.

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Correspondence to Jennifer M. Yamamoto.

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Mahajan, A., Donovan, L.E., Vallee, R. et al. Evidenced-Based Nutrition for Gestational Diabetes Mellitus. Curr Diab Rep 19, 94 (2019). https://doi.org/10.1007/s11892-019-1208-4

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