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The Carbohydrate Threshold in Pregnancy and Gestational Diabetes: How Low Can We Go?
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 carbohy...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8398846/ https://www.ncbi.nlm.nih.gov/pubmed/34444759 http://dx.doi.org/10.3390/nu13082599 |
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author | Sweeting, Arianne Mijatovic, Jovana Brinkworth, Grant D. Markovic, Tania P. Ross, Glynis P. Brand-Miller, Jennie Hernandez, Teri L. |
author_facet | Sweeting, Arianne Mijatovic, Jovana Brinkworth, Grant D. Markovic, Tania P. Ross, Glynis P. Brand-Miller, Jennie Hernandez, Teri L. |
author_sort | Sweeting, Arianne |
collection | PubMed |
description | 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. |
format | Online Article Text |
id | pubmed-8398846 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
spelling | pubmed-83988462021-08-29 The Carbohydrate Threshold in Pregnancy and Gestational Diabetes: How Low Can We Go? Sweeting, Arianne Mijatovic, Jovana Brinkworth, Grant D. Markovic, Tania P. Ross, Glynis P. Brand-Miller, Jennie Hernandez, Teri L. Nutrients Review 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. MDPI 2021-07-28 /pmc/articles/PMC8398846/ /pubmed/34444759 http://dx.doi.org/10.3390/nu13082599 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Review Sweeting, Arianne Mijatovic, Jovana Brinkworth, Grant D. Markovic, Tania P. Ross, Glynis P. Brand-Miller, Jennie Hernandez, Teri L. The Carbohydrate Threshold in Pregnancy and Gestational Diabetes: How Low Can We Go? |
title | The Carbohydrate Threshold in Pregnancy and Gestational Diabetes: How Low Can We Go? |
title_full | The Carbohydrate Threshold in Pregnancy and Gestational Diabetes: How Low Can We Go? |
title_fullStr | The Carbohydrate Threshold in Pregnancy and Gestational Diabetes: How Low Can We Go? |
title_full_unstemmed | The Carbohydrate Threshold in Pregnancy and Gestational Diabetes: How Low Can We Go? |
title_short | The Carbohydrate Threshold in Pregnancy and Gestational Diabetes: How Low Can We Go? |
title_sort | carbohydrate threshold in pregnancy and gestational diabetes: how low can we go? |
topic | Review |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8398846/ https://www.ncbi.nlm.nih.gov/pubmed/34444759 http://dx.doi.org/10.3390/nu13082599 |
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