The effects of low carbohydrate diet on the outcomes of gestational diabetes: A systematic review

Document Type : Review Article

Authors

1 B.Sc. Student of Nutrition Sciences, Student Research Committee, School of Nutrition and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

2 Assistant Professor, Department of Cellular and Molecular Nutrition, School of Nutrition Sciences and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Abstract

Introduction: Gestational diabetes is one of the most common pregnancy complications, which has negative consequences for both mother and fetus. A crucial treatment strategy is modifying the mother's diet. The present study was performed with aim to determine the effects of low carbohydrate (LC) diets on the outcomes of gestational diabetes.
Methods: In this systematic review, search was done with the keywords including low carbohydrate diet, carbohydrate restriction, ketogenic diet, gestational diabetes, hyperglycemia, glucose intolerance, insulin resistance, and clinical trials in Persian and English languages in databases of Medline, PubMed, Embase, Science Direct, Magiran, ISD, ISC, and Cochrane until March 2023.
Results: This systematic review examined seven studies. Some studies showed that carbohydrate restriction can have beneficial effects on metabolic outcomes, glycemic control, less insulin therapy needs, delivery method, and fetal weight. The LC diet did not lead to ketonemia in pregnant women. However, in other studies, adherence to the LC regimen did not reduce the number of women requiring insulin. There were no significant differences between the groups in terms of insulin dose or time of insulin treatment initiation, and both groups had similar pregnancy outcomes.
Conclusion: Adherence to the low carbohydrate diet (about 40%) in pregnant mothers with gestational diabetes could have beneficial effects on some metabolic outcomes, delivery method, weight and health of the fetus. It did not lead to ketonemia in pregnant mothers. However, there are contradictions in the findings of the studies due to the amount and type of carbohydrates. It is recommended to conduct more clinical trials with different percentages of carbohydrates and a higher sample size.

Keywords


  1. Mulla WR. Carbohydrate content in the GDM diet: two views: view 2: low-carbohydrate diets should remain the initial therapy for gestational diabetes. Diabetes Spectrum: a Publication of the American Diabetes Association 2016; 29(2):89-91.
  2. Mustad VA, Huynh DTT, López-Pedrosa JM, Campoy C, Rueda R. The Role of Dietary Carbohydrates in Gestational Diabetes. Nutrients 2020; 12(2):385.
  3. Louie JC, Markovic TP, Perera N, Foote D, Petocz P, Ross GP, et al. A randomized controlled trial investigating the effects of a low–glycemic index diet on pregnancy outcomes in gestational diabetes mellitus. Diabetes care 2011; 34(11):2341-6.
  4. Mir H, Roustazadeh A, Jafarirad S, Mogharab F, Hosseini SA, Abdoli A, et al. Interaction relationship of major dietary patterns and adiponectin gene polymorphisms on biochemical parameters in healthy pregnant women and those with gestational diabetes. Iran J Obstet Gynecol Infertil 2022; 24(13):17-28.
  5. Bao W, Li S, Chavarro JE, Tobias DK, Zhu Y, Hu FB, et al. Low carbohydrate–diet scores and long-term risk of type 2 diabetes among women with a history of gestational diabetes mellitus: a prospective cohort study. Diabetes care 2016; 39(1):43-9.
  6. Moreno-Castilla C, Hernandez M, Bergua M, Alvarez MC, Arce MA, Rodriguez K, et al. Low-carbohydrate diet for the treatment of gestational diabetes mellitus: a randomized controlled trial. Diabetes Care 2013; 36(8):2233-8.
  7. Lindsay RS, Mackin ST, Nelson SM. Gestational diabetes mellitus—right person, right treatment, right time?. BMC medicine 2017; 15:1-7.
  8. Mirgaloybayat S, Sarhadi S, Farzaneh F, Sheikhi Z. Frequency of shoulder dystocia and its relationship with maternal factors and fetal parameters in ali ebn-e abitaleb hospital of zahedan from 2015 to 2019: Cross-sectional study. Iran J Obstet Gynecol Infertil 2021; 24(8):10-4.
  9. Viana LV, Gross JL, Azevedo MJ. Dietary intervention in patients with gestational diabetes mellitus: a systematic review and meta-analysis of randomized clinical trials on maternal and newborn outcomes. Diabetes care 2014; 37(12):3345-55.
  10. Rahimi M, Karami Moghadam F. The prevalence of gestational diabetes mellitus and its related risk factors using one-step method in Kermanshah, 2016. Iran J Obstet Gynecol Infertil 2017; 20(4):1-4.
  11. Poomalar GK. Changing trends in management of gestational diabetes mellitus. World journal of diabetes 2015; 6(2):284-95.
  12. Farabi SS, Hernandez TL. Low-carbohydrate diets for gestational diabetes. Nutrients 2019; 11(8):1737.
  13. Hernandez TL, Van Pelt RE, Anderson MA, Reece MS, Reynolds RM, de la Houssaye BA, et al. Women with gestational diabetes mellitus randomized to a higher–complex carbohydrate/low-fat diet manifest lower adipose tissue insulin resistance, inflammation, glucose, and free fatty acids: a pilot study. Diabetes care 2016; 39(1):39-42.
  14. Sweeting A, Mijatovic J, Brinkworth GD, Markovic TP, Ross GP, Brand-Miller J, et al. The carbohydrate threshold in pregnancy and gestational diabetes: how low can we go?. Nutrients 2021; 13(8):2599.
  15. Mahajan A, Donovan LE, Vallee R, Yamamoto JM. Evidenced-based nutrition for gestational diabetes mellitus. Current Diabetes Reports 2019; 19:94.
  16. Major CA, Henry MJ, de Veciana M, Morgan MA. The effects of carbohydrate restriction in patients with diet-controlled gestational diabetes. Obstetrics & Gynecology 1998; 91(4):600-4.
  17. Mijatovic J, Louie JC, Buso ME, Atkinson FS, Ross GP, Markovic TP, et al. Effects of a modestly lower carbohydrate diet in gestational diabetes: a randomized controlled trial. The American journal of clinical nutrition 2020; 112(2):284-92.
  18. Fagherazzi S, Farias DR, Belfort GP, Dos Santos K, de Lima TS, Dos Santos MS, et al. Impact of the Dietary Approaches to Stop Hypertension (DASH) diet on glycaemic control and consumption of processed and ultraprocessed foods in pregnant women with pre-gestational diabetes mellitus: a randomised clinical trial. British Journal of Nutrition 2021; 126(6):865-76.
  19. Jaworsky K, DeVillez P, Basu A. The Role of Phytochemicals and Plant-Based Diets in Gestational Diabetes: Evidence from Clinical Trials. International Journal of Environmental Research and Public Health 2023; 20(5):4188.
  20. Hernandez TL, Van Pelt RE, Anderson MA, Daniels LJ, West NA, Donahoo WT, et al. A higher-complex carbohydrate diet in gestational diabetes mellitus achieves glucose targets and lowers postprandial lipids: a randomized crossover study. Diabetes care 2014; 37(5):1254-62.
  21. Han S, Middleton P, Shepherd E, Van Ryswyk E, Crowther CA. Different types of dietary advice for women with gestational diabetes mellitus. Cochrane Database of Systematic Reviews 2017(2).
  22. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Syst Rev 2021; 10(1):89.
  23. Sc CJ. Improved glucose tolerance in gestational diabetic women on a low fat, high unrefined carbohydrate diet. Australian and New Zealand Journal of Obstetrics and Gynaecology 1984; 24(3):174-7.
  24. Rizzo T, Metzger BE, Burns WJ, Burns K. Correlations between antepartum maternal metabolism and intelligence of offspring. New England Journal of Medicine 1991; 325(13):911-6.
  25. Bazzano LA, Green T, Harrison TN, Reynolds K. Dietary approaches to prevent hypertension. Current hypertension reports 2013; 15:694-702.
  26. D’Arcy E, Rayner J, Hodge A, Ross LJ, Schoenaker DA. The role of diet in the prevention of diabetes among women with prior gestational diabetes: a systematic review of intervention and observational studies. Journal of the Academy of Nutrition and Dietetics 2020; 120(1):69-85.
  27. Trumbo P, Schlicker S, Yates AA, Poos M. Dietary reference intakes for energy, carbohydrate, fiber, fat, fatty acids, cholesterol, protein and amino acids.(Commentary). Journal of the american dietetic association 2002; 102(11):1621-31.