The Role of Dietary Carbohydrates in Gestational Diabetes

Abstract

Gestational diabetes (GDM) is hyperglycemia that is recognized for the first time during pregnancy. GDM is associated with a wide range of short- and long-term adverse health consequences for both mother and offspring. It is a complex disease with a multifactorial etiology, with disturbances in glucose, lipid, inflammation and gut microbiota. Consequently, its management is complex, requiring patients to self-manage their diet, lifestyle and self-care behaviors in combination with use of insulin. In addition to nutritional recommendations for all pregnant women, special attention to dietary carbohydrate (CHO) amount and type on glucose levels is especially important in GDM. Dietary CHO are diverse, ranging from simple sugars to longer-chain oligo- and poly- saccharides which have diverse effects on blood glucose, microbial fermentation and bowel function. Studies have established that dietary CHO amount and type can impact maternal glucose and nutritional recommendations advise women with GDM to limit total intake or choose complex and low glycemic CHO. However, robust maternal and infant benefits are not consistently shown. Novel approaches which help women with GDM adhere to dietary recommendations such as diabetes-specific meal replacements (which provide a defined and complete nutritional composition with slowly-digested CHO) and continuous glucose monitors (which provide unlimited monitoring of maternal glycemic fluctuations) have shown benefits on both maternal and neonatal outcomes. Continued research is needed to understand and develop tools to facilitate patient adherence to treatment goals, individualize interventions and improve outcomes.

A comparison of meal tolerance test and oral glucose tolerance test for predicting insulin therapy in patients with gestational diabetes

“…Further research is needed to determine whether the GDM control target for blood glucose 2 h after a meal is adequate. Furthermore, postprandial hyperglycemia is related to the amount of carbohydrates in a meal, and both a low-glycemic and a divided diet may be useful in controlling it ( 35 ).…”

Searching for Utopia, the Challenge of Standardized Medical Nutrition Therapy Prescription in Gestational Diabetes Mellitus Management: A Critical Review

“…68 Lower CHO diets are highly likely to limit fiber and nutritional quality and therefore their use is difficult to justify. 17 Higher CHO diets do not worsen glycemic control compared with lower CHO diets. In two separate randomized, crossover trials where all meals were provided, women with GDM were able to maintain BGLs within target ranges with lower postprandial free fatty acids (FFAs) with a higher CHO (60% of total daily energy intake)/lower fat diet when compared with a lower CHO (40% of total daily energy intake)/higher fat diet.…”

“…Numerous reviews 9,[12][13][14][15][16][17][18] have attempted to uncover the optimal dietary prescription for GDM but often generate more questions than answers. The impact of CHO amount, 17,19,20 timing and quality, 17,[21][22][23][24][25][26][27][28] factors such as individual glycemic response, 29,30 the little-known role of microbiome interactions, [31][32][33][34][35][36] and ethnic, cultural, and genetic considerations make it difficult to be prescriptive in GDM diets. Thus, an ideal dietary prescription or pattern is not recommended and is unlikely to be elucidated with further randomized controlled trials (RCTs).…”

Gut Microbiota Metabolism and Interaction with Food Components

“…HCF consumption is associated with significant changes in the Firmicutes/Bacteroidetes ratio, with a lowering of butyrate-producing bacteria compared to healthy individuals. HCF is usually very deficient of indigestible carbohydrates such as fibers, which provide important physiological benefits such as stimulating incretin production, serving as an energy source for colonic microbes that promote normal bowel movements [71] and the aforementioned production of SCFAs.…”