Effects of a low-glycemic load diet in overweight and obese pregnant women: A pilot randomized controlled trial

Division of Endocrinology, Children's Hospital Boston, Boston, MA, USA.
American Journal of Clinical Nutrition (Impact Factor: 6.77). 10/2010; 92(6):1306-15. DOI: 10.3945/ajcn.2010.30130
Source: PubMed


The optimal diet for pregnancy that is complicated by excessive weight is unknown.
We aimed to examine the effects of a low-glycemic load (low-GL) diet in overweight and obese pregnant women.
We randomly assigned 46 overweight or obese pregnant women to receive a low-GL or a low-fat diet. Participants received carbohydrate-rich foods, fats, and snack foods through home delivery or study visits. The primary outcome was birth weight z score. Other endpoints included infant anthropometric measurements, gestational duration, maternal weight gain, and maternal metabolic parameters.
There were no significant differences in birth weight z score or other measures of infant adiposity between groups. However, in the low-GL compared with the low-fat group, gestational duration was longer (mean ± SD: 39.3 ± 1.1 compared with 37.9 ± 3.1 wk; P = 0.05) and fewer deliveries occurred at ≤ 38.0 wk (13% compared with 48%, P = 0.02; with exclusion of planned cesarean deliveries: 5% compared with 53%; P = 0.002). Adjusted head circumference was greater in the low-GL group (35.0 ± 0.8 compared with 34.2 ± 1.3 cm, P = 0.01). Women in the low-GL group had smaller increases in triglycerides [median (interquartile range): 49 (19, 70) compared with 93 (34, 129) mg/dL; P = 0.03] and total cholesterol [13 (0, 36) compared with 33 (22, 56) mg/dL, P = 0.04] and a greater decrease in C-reactive protein [-2.5 (-5.5, -0.7) compared with -0.4 (-1.4, 1.5) mg/dL, P = 0.007].
A low-GL diet resulted in longer pregnancy duration, greater infant head circumference, and improved maternal cardiovascular risk factors. Large-scale studies are warranted to evaluate whether dietary intervention during pregnancy aimed at lowering GL may be useful in the prevention of prematurity and other adverse maternal and infant outcomes. This trial is registered at clinicaltrials.gov as NCT00364403.

Download full-text


Available from: Henry A. Feldman, Mar 26, 2014
  • Source
    • "Clapp (1997) and Moses et al. (2006) documented that those women in the low GI groups had a lower prevalence of large-for-gestational-age infants than did those on a high GI diet. Although Rhodes et al. (2010) and more recently, Walsh et al. (2010) found little or no effect on an infant's birth weight in obese women or in a group of women at risk of foetal macrosomia, respectively, an improvement in maternal outcomes was an encouraging finding after a low GI dietary intervention. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Abstract This review aims to evaluate the effectiveness of low glycemic index (GI) dietary intervention for the treatment of gestational diabetes mellitus (GDM), specifically from the Asian perspective. A systematic review of the literature using multiple databases without time restriction was conducted. Three studies were retrieved based upon a priori inclusion criteria. While there was a trend towards improvement, no significant differences were observed in overall glycemic control and pregnancy outcomes in GDM women. However, a tendency for lower birth weight and birth centile if the intervention began earlier was noted. Low GI diets were well accepted and had identical macro-micronutrient compositions as the control diets. However, due to genetic, environment and especially food pattern discrepancies between Western countries and Asians, these results may not be contributed to Asian context. Clearly, there are limited studies focusing on the effect of low GI dietary intervention in women with GDM, particularly in Asia.
    International Journal of Food Sciences and Nutrition 03/2014; 65(2):144-50. DOI:10.3109/09637486.2013.845652 · 1.21 Impact Factor
  • Source
    • "A possible limitation of the current study was that the low GI advice was only delivered once during pregnancy. All previous clinical trials of low GI diet and pregnancy delivered advice on a number of occasions [6,32]. Despite this, having a successful once-off dietary intervention would be more feasible to carry out on a larger scale. "
    [Show abstract] [Hide abstract]
    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
  • Source
    • "Associations of maternal dietary intake during pregnancy with neonatal head circumference are not necessarily consistent with those for birth weight. In a small randomized trial, the offspring of mothers receiving a low glycemic index diet had similar birth weight but increased head circumference relative to those receiving a low-fat diet (Rhodes et al., 2010). Whilst the evidence remains preliminary, these studies collectively offer support for the hypothesis that the emergence of agricultural diets, with higher glycemic load and lower protein content than typical forager diet, could have impacted each of maternal size and neonatal mass and brain size, and may therefore have exacerbated the obstetric dilemma. "
    [Show abstract] [Hide abstract]
    ABSTRACT: The difficult birth process of humans, often described as the "obstetric dilemma," is commonly assumed to reflect antagonistic selective pressures favoring neonatal encephalization and maternal bipedal locomotion. However, cephalo-pelvic disproportion is not exclusive to humans, and is present in some primate species of smaller body size. The fossil record indicates mosaic evolution of the obstetric dilemma, involving a number of different evolutionary processes, and it appears to have shifted in magnitude between Australopithecus, Pleistocene Homo, and recent human populations. Most attention to date has focused on its generic nature, rather than on its variability between populations. We re-evaluate the nature of the human obstetric dilemma using updated hominin and primate literature, and then consider the contribution of phenotypic plasticity to variability in its magnitude. Both maternal pelvic dimensions and fetal growth patterns are sensitive to ecological factors such as diet and the thermal environment. Neonatal head girth has low plasticity, whereas neonatal mass and maternal stature have higher plasticity. Secular trends in body size may therefore exacerbate or decrease the obstetric dilemma. The emergence of agriculture may have exacerbated the dilemma, by decreasing maternal stature and increasing neonatal growth and adiposity due to dietary shifts. Paleodemographic comparisons between foragers and agriculturalists suggest that foragers have considerably lower rates of perinatal mortality. In contemporary populations, maternal stature remains strongly associated with perinatal mortality in many populations. Long-term improvements in nutrition across future generations may relieve the dilemma, but in the meantime, variability in its magnitude is likely to persist. Am J Phys Anthropol, 2012. © 2012 Wiley Periodicals, Inc.
    American Journal of Physical Anthropology 11/2012; 149(S55). DOI:10.1002/ajpa.22160 · 2.38 Impact Factor
Show more