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...
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| Format: | Article |
| Language: | English |
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MDPI AG
2021-07-01
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| Series: | Nutrients |
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| Online Access: | https://www.mdpi.com/2072-6643/13/8/2599 |
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| author | Arianne Sweeting Jovana Mijatovic Grant D. Brinkworth Tania P. Markovic Glynis P. Ross Jennie Brand-Miller Teri L. Hernandez |
| author_facet | Arianne Sweeting Jovana Mijatovic Grant D. Brinkworth Tania P. Markovic Glynis P. Ross Jennie Brand-Miller Teri L. Hernandez |
| author_sort | Arianne Sweeting |
| collection | DOAJ |
| 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. |
| first_indexed | 2024-03-10T08:30:59Z |
| format | Article |
| id | doaj.art-29f23aa3f6144b4ea34873e08dc2a2bb |
| institution | Directory Open Access Journal |
| issn | 2072-6643 |
| language | English |
| last_indexed | 2024-03-10T08:30:59Z |
| publishDate | 2021-07-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Nutrients |
| spelling | doaj.art-29f23aa3f6144b4ea34873e08dc2a2bb2023-11-22T09:03:11ZengMDPI AGNutrients2072-66432021-07-01138259910.3390/nu13082599The Carbohydrate Threshold in Pregnancy and Gestational Diabetes: How Low Can We Go?Arianne Sweeting0Jovana Mijatovic1Grant D. Brinkworth2Tania P. Markovic3Glynis P. Ross4Jennie Brand-Miller5Teri L. Hernandez6Sydney Medical School, The University of Sydney, Sydney, NSW 2006, AustraliaCharles Perkins Centre, Boden Initiative, University of Sydney, NSW 2006, AustraliaCommonwealth Scientific and Industrial Research Organisation—Health and Biosecurity, Sydney, NSW 2113, AustraliaSydney Medical School, The University of Sydney, Sydney, NSW 2006, AustraliaSydney Medical School, The University of Sydney, Sydney, NSW 2006, AustraliaSchool of Life and Environmental Sciences and Charles Perkins Centre, The University of Sydney, Sydney, NSW 2006, AustraliaCollege of Nursing, Anschutz Medical Campus, University of Colorado, Aurora, CO 80045, USAThe 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.https://www.mdpi.com/2072-6643/13/8/2599pregnancylow carbohydratebirth weightmicronutrientsketoneslipids |
| spellingShingle | Arianne Sweeting Jovana Mijatovic Grant D. Brinkworth Tania P. Markovic Glynis P. Ross Jennie Brand-Miller Teri L. Hernandez The Carbohydrate Threshold in Pregnancy and Gestational Diabetes: How Low Can We Go? Nutrients pregnancy low carbohydrate birth weight micronutrients ketones lipids |
| 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 | pregnancy low carbohydrate birth weight micronutrients ketones lipids |
| url | https://www.mdpi.com/2072-6643/13/8/2599 |
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