A randomised control trial of low glycemic index carbohydrate diet versus no dietary intervention in the prevention of recurrence of macrosomia

Department of Obstetrics and Gynaecology, University College Dublin National Maternity Hospital, Dublin, Ireland.
BMC Pregnancy and Childbirth (Impact Factor: 2.19). 04/2010; 10(1):16. DOI: 10.1186/1471-2393-10-16
Source: PubMed


Maternal weight and maternal weight gain during pregnancy exert a significant influence on infant birth weight and the incidence of macrosomia. Fetal macrosomia is associated with an increase in both adverse obstetric and neonatal outcome, and also confers a future risk of childhood obesity. Studies have shown that a low glycaemic diet is associated with lower birth weights, however these studies have been small and not randomised 12. Fetal macrosomia recurs in a second pregnancy in one third of women, and maternal weight influences this recurrence risk 3.
We propose a randomised control trial of low glycaemic index carbohydrate diet vs. no dietary intervention in the prevention of recurrence of fetal macrosomia. Secundigravid women whose first baby was macrosomic, defined as a birth weight greater than 4000 g will be recruited at their first antenatal visit.Patients will be randomised into two arms, a control arm which will receive no dietary intervention and a diet arm which will be commenced on a low glycaemic index diet.The primary outcome measure will be the mean birth weight centiles and ponderal indices in each group.
Altering the source of maternal dietary carbohydrate may prove to be valuable in the management of pregnancies where there has been a history of fetal macrosomia. Fetal macrosomia recurs in a second pregnancy in one third of women. This randomised control trial will investigate whether or not a low glycaemic index diet can affect this recurrence risk.

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    • "The ROLO study was a randomised control trial of 800 secundigravida women with a previous macrosomic baby (>4 kg) randomised to receive low glycaemic index (GI) dietary advice versus usual care (no dietary advice) to reduce recurrence of macrosomia. Detailed methodology and results of the ROLO study, which was carried out in the National Maternity Hospital, Ireland, have previously been published [25,26] but in brief; the primary outcome was birthweight and the secondary outcomes were gestational weight gain and glucose intolerance. Low GI dietary advice was given at week 14 of pregnancy while demographic, well-being and lifestyle questionnaires were returned by 28 weeks gestation. "
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    ABSTRACT: The in utero environment is known to affect fetal development however many of the mechanisms by which this occurs remain unknown. The aim of this study was to examine the association between maternal dietary macronutrient intake and lifestyle throughout pregnancy and neonatal weight and adiposity. This was an analysis of 542 mother and infant pairs from the ROLO study (Randomised cOntrol trial of LOw glycaemic index diet versus no dietary intervention to prevent recurrence of fetal macrosomia). Food diaries as well as food frequency and lifestyle and physical activity questionnaires were completed during pregnancy. Maternal anthropometry was measured throughout pregnancy and neonatal anthropometry was measured at birth. Multiple linear regression analysis revealed the main maternal factor associated with increased birth weight was greater gestational weight gain R2 adj23.3% (F = 11.547, p < 0.001). The main maternal factor associated with increased birth length was non-smoking status R2 adj27.8% (F = 6.193, p < 0.001). Neonatal central adiposity (determined using waist:length ratio) was negatively associated with maternal age, and positively associated with the following parameters: smoking status, maternal pre-pregnancy arm circumference, percentage energy from saturated fat in late pregnancy, postprandial glucose at 28 weeks gestation and membership of the control group with a positive trend towards association with trimester 2 glycaemic load R2 adj 38.1% (F = 8.000, p < 0.001). Several maternal diet and lifestyle factors were associated with neonatal anthropometry . Low glycaemic index dietary intervention in pregnancy was found to have a beneficial effect on neonatal central adiposity. Additionally, central adiposity was positively associated with maternal dietary fat intake and postprandial glucose highlighting the important role of healthy diet in pregnancy in promoting normal neonatal adiposity. Trial registration Current Controlled Trials ISRCTN54392969.
    Nutrition Journal 08/2014; 13(1):78. DOI:10.1186/1475-2891-13-78 · 2.60 Impact Factor
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    • "Ethical approval for the study was obtained from the National Maternity Hospital Ethics Committee in November 2006. Detailed methods and principal results of the ROLO study have been previously published [11,12]. In brief, the ROLO study used a presenting sample of secundigravid women who previously delivered a macrosomic infant weighing equal to or greater than 4000 g. "
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    ABSTRACT: Maternal diet is known to impact pregnancy outcome. Following a low glycemic index (GI) diet during pregnancy has been shown to improve maternal glycemia and reduce infant birthweight and may be associated with a higher fibre intake. We assessed the impact of a low GI dietary intervention on maternal GI, nutritional intake and gestational weight gain (GWG) during pregnancy. Compliance and acceptability of the low GI diet was also examined. Eight hundred women were randomised in early pregnancy to receive low GI and healthy eating dietary advice or to receive standard maternity care. The intervention group received dietary advice at a group education session before 22 weeks gestation. All women completed a 3 day food diary during each trimester of pregnancy. Two hundred and thirty five women from the intervention arm and 285 women from the control arm returned complete 3x3d FDs and were included in the present analysis. Maternal GI was significantly reduced in the intervention group at trimester 2 and 3. The numbers of women within the lowest quartile of GI increased from 37% in trimester 1 to 52% in trimester 3 (P < 0.001) among the intervention group. The intervention group had significantly lower energy intake (P < 0.05), higher protein (%TE) (P < 0.01) and higher dietary fibre intake (P < 0.01) post intervention. Consumption of food groups with known high GI values were significantly reduced among the intervention group. Women in the intervention low GI group were less likely to exceed the Institute of Medicine's GWG goals. A dietary intervention in early pregnancy had a positive influence on maternal GI, food and nutrient intakes and GWG. Following a low GI diet may be particularly beneficial for women at risk of exceeding the GWG goals for pregnancy.Trial registration: Current Controlled Trials Registration Number: ISRCTN54392969.
    Nutrition Journal 10/2013; 12(1):140. DOI:10.1186/1475-2891-12-140 · 2.60 Impact Factor
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    • "Since carbohydrates are the main determinant of postprandial blood glucose level [124], intervention trials were assessed or are presently being held to establish the effect of low glycemic index diet during pregnancy on neonatal outcomes [125, 126]. Accordingly, one interventional study conducted in healthy pregnant women proposed that low glycemic index diet reduces the incidence of macrosomia [117]. "
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    ABSTRACT: Prepregnancy overweight or obesity and excessive gestational weight gain have been associated with increased risk of maternal and neonatal complications. Moreover, offspring from obese women are more likely to develop obesity, diabetes mellitus, and cardiovascular diseases in their lifetime. Gestational diabetes mellitus (GDM) is one of the most common complications associated with obesity and appears to have a direct impact on the future metabolic health of the child. Fetal programming of metabolic function induced by obesity and GDM may have intergenerational effect and thus perpetuate the epidemic of cardiometabolic conditions. The present paper thus aims at discussing the impact of maternal obesity and GDM on the developmental programming of obesity and metabolic disorders in the offspring. The main interventions designed to reduce maternal obesity and GDM and their ability to break the vicious circle that perpetuates the transmission of obesity and metabolic conditions to the next generations are also addressed.
    Experimental Diabetes Research 10/2011; 2011(7579):596060. DOI:10.1155/2011/596060 · 4.33 Impact Factor
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