Gestational Diabetes

GDM: Carbohydrate (2016)

• Intervention
  In women with GDM, what impact does the amount of carbohydrate consumed (independent of dietary patterns based on the DASH diet and glycemic index) have on fetal/neonatal and maternal outcomes?

  • Conclusion
    Limited evidence was found to demonstrate the impact of the amount of carbohydrate (CHO) consumption on fetal or neonatal and maternal outcomes in women with GDM. In one study, women prescribed a minimum of 1,800kcal per day found reductions in post-prandial blood glucose (PPBG) levels at all three meals with 202g per day CHO, while those prescribed more than 270g CHO showed reductions in PPBG at two meals only. Another study of women with an average intake of 1,852±343kcal per day found zero incidence of large for gestational age (LGA) when CHO intake was more than 211g per day, but a 23% incidence in women consuming less CHO. No other differences in fetal and maternal outcomes were found in these studies.
    
    Results were confounded by use of prescribed vs. reported intakes, variable sample sizes and different outcomes reported, making comparison and synthesis of the research challenging. 
  • Grade: III
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: In women with GDM, what impact does the amount of carbohydrate consumed (independent of dietary patterns based on the DASH diet and glycemic index) have on fetal/neonatal and maternal outcomes?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • 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. Polish Journal of Endocrinology, 2007; 58: 314-319.
      • Moreno-Castilla C, Hernandez M, Bergua M, Alvarez MC, Arce MA, Rodriguez K, Martinez-Alonso M, Iglesias M, Mateu M, Santos MD, Pacheco LR, Blasco Y, Martin E, Balsells N, Aranda N, Mauricio D. Low-carbohydrate diet for the treatment of gestational diabetes mellitus: a randomized controlled trial. Diabetes Care, 2013. Aug; 36 (8): 2,233-2,238. PMID: 23564917.
  • Search Plan and Results: GDM: Carbohydrate 2014
     
  In women with GDM, what impact does the amount or type of carbohydrate consumed have on post-prandial breakfast glycemia?

  • Conclusion
    Limited evidence was found to demonstrate the impact of the type or amount of carbohydrate (CHO) consumption on post-prandial breakfast glycemia in women with gestational diabetes mellitus (GDM). Three studies that evaluated glycemic index (GI) reported that lower GI diets containing 42% to 60% total CHO (GI for breakfast meal less than 55; CHO range 15g to 60g or more) improved glycemic control after breakfast. One study that did not consider the GI showed that lower CHO (45% vs. 60% of kcal) improved post-prandial blood glucose after breakfast. No studies evaluated the effect of only restricting individual foods (e.g., fruit or milk) at breakfast, although one study showed improved blood glucose when fruit, bread and milk were eaten in a low GI breakfast vs. a high GI breakfast with CHOs from other sources.
    
    Interpretation of results was challenging due to inability to compare diets across studies (varying amounts of CHO and GI), prescribed vs. reported intakes or lack of description of the breakfast meal. 
  • Grade: III
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: In women with GDM, what impact does the amount or type of carbohydrate consumed have on postprandial breakfast glycemia?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • 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. Polish Journal of Endocrinology, 2007; 58: 314-319.
      • Grant SM, Wolever TMS, O'Connor DL, Nisenbaum R, Josse RG. Effect of a low glycaemic index diet on blood glucose in wowen with gestational hyperglycaemia. Diabetes Res Clin Pract. 2011, 91: 15-22.
      • Hernandez TL, Van Pelt RE, Anderson MA, Daniels LJ, West NA, Donahoo WT, Friedman JE, Barbour LA. A higher-complex carbohydrate diet in gestational diabetes achieves glucose targets and lowers postprandial lipids: a randomized crossover study. Diabetes Care, 2014 DOI: 10.2337/dc13-2411.
      • Louie JCY, Markovic TP, Ross GP, Foote D, Brand-Miller JC. Timing of Peak Blood Glucose after Breakfast Meals of Different Glycemic Index in Women with Gestational Diabetes. Nutrients, 2013, 5, 1-9.
      • Perichart-Perera O, Balas-Nakash M, Rodriguez-Cano A. Legorreta-Legorreta J, Parra-Covarrubias A, Vadillo-Ortega F. Low glycemic index carbohydrates versus all types of carbohydrates for treating diabetes in pregnancy: A randomized clinical trial to evaluate the effect of glycemic control. International Journal of Endocrinology. 2012; 2012: 296017.
  • Search Plan and Results: GDM: Carbohydrate 2014