Changing Meal Sequence Affects Glucose Excursions in Gestational Diabetes Mellitus

Abstract

Studies on nutrient sequences during meals suggest that consuming carbohydrates last lowers postprandial glucose excursions more than consuming carbohydrates first. However, this phenomenon has not been studied in gestational diabetes mellitus (GDM). Ten women with GDM consumed the same caloric foods in different sequences over five successive days: (A) dish first, followed by carbohydrate and soup last; (B) carbohydrate first, followed by dish and soup last; (C) soup first, followed by dish and carbohydrate last; (D) three meals a day ad libitum; and (E) six meals a day as ad libitum. Continuous glucose monitoring (CGM) was used to assess diurnal glycemia. Decreases in mean glucose levels and the largest glucose levels in A were similar to group C. The peak glucose of breakfast and lunch in group B was more significant than in groups A and C. The B meal pattern showed more marked glycemic excursions than groups A and C. Increasing the number of meals reduced the peak glucose level and the glycemic excursions with the same total calories. Changing meal sequences or increasing the number of meals may reduce glycemic excursions in GDM. Our trial was registered retrospectively and the trial registration number is ChiCTR2200057044.

Chrononutrition during Pregnancy and Its Association with Maternal and Offspring Outcomes: A Systematic Review and Meta-Analysis of Ramadan and Non-Ramadan Studies

“…Another randomized crossover trial with isocaloric meals provided to 10 women with GDM showed that increasing meal frequency to six meals a day for one day, as compared with three meals a day, could significantly affect glycemic excursions measured by continuous glucose monitoring. Specifically, higher meal frequency reduced the peak glucose level, standard deviation, coefficient variation, mean amplitude, and the largest amplitude of glycemic excursions (all p < 0.05), but no differences were observed for the mean and lowest glucose levels [ 40 ].…”

“…In summary, studies on the associations of meal frequency during pregnancy with maternal and child outcomes provided mixed findings. Higher meal frequency may be associated with lower risk of low birth weight, preterm birth [ 36 ], anemia [ 41 , 42 , 43 , 44 , 45 ], and less glycemic variability [ 40 ], but it may have the potential to increase postprandial gestational glycemia [ 39 ]. More studies are needed to determine the optimal meal frequency for pregnant women.…”

“…Regression coefficient: beta estimates (β); gestational diabetes mellitus (GDM); low birth weight (LBW); postpartum weight retention (PPWR); odds ratio (OR); relative risk (RR). Due to different approaches used, the studies by Englund-Ögge et al and Ainscough et al were not included in the figure; please refer to main text for the results [ 31 , 36 , 39 , 40 , 41 , 42 , 43 , 44 , 45 ].…”

“…Thus, whether meal frequency is linked to blood glucose level and diabetes in the healthy population is still inconclusive. However, among patients with GDM, six meals a day led to better glycemic control than three meals a day in an isocaloric trial [ 40 ]. These data are similar to another study among type 1 diabetes patients, which observed that the number of meals was inversely associated with HbA1c and mean blood glucose measurements [ 91 ].…”