Cargando…

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...

Descripción completa

Detalles Bibliográficos
Autores principales: Sweeting, Arianne, Mijatovic, Jovana, Brinkworth, Grant D., Markovic, Tania P., Ross, Glynis P., Brand-Miller, Jennie, Hernandez, Teri L.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
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
_version_ 1783744935709638656
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
work_keys_str_mv AT sweetingarianne thecarbohydratethresholdinpregnancyandgestationaldiabeteshowlowcanwego
AT mijatovicjovana thecarbohydratethresholdinpregnancyandgestationaldiabeteshowlowcanwego
AT brinkworthgrantd thecarbohydratethresholdinpregnancyandgestationaldiabeteshowlowcanwego
AT markovictaniap thecarbohydratethresholdinpregnancyandgestationaldiabeteshowlowcanwego
AT rossglynisp thecarbohydratethresholdinpregnancyandgestationaldiabeteshowlowcanwego
AT brandmillerjennie thecarbohydratethresholdinpregnancyandgestationaldiabeteshowlowcanwego
AT hernandezteril thecarbohydratethresholdinpregnancyandgestationaldiabeteshowlowcanwego
AT sweetingarianne carbohydratethresholdinpregnancyandgestationaldiabeteshowlowcanwego
AT mijatovicjovana carbohydratethresholdinpregnancyandgestationaldiabeteshowlowcanwego
AT brinkworthgrantd carbohydratethresholdinpregnancyandgestationaldiabeteshowlowcanwego
AT markovictaniap carbohydratethresholdinpregnancyandgestationaldiabeteshowlowcanwego
AT rossglynisp carbohydratethresholdinpregnancyandgestationaldiabeteshowlowcanwego
AT brandmillerjennie carbohydratethresholdinpregnancyandgestationaldiabeteshowlowcanwego
AT hernandezteril carbohydratethresholdinpregnancyandgestationaldiabeteshowlowcanwego