title: Probiotics and dietary counselling contribute to glucose regulation during and after pregnancy: a randomised controlled trial. Low glycaemic index diet in pregnancy to prevent macrosomia (ROLO study): randomised control trial Intensive low-glycaemic-load dietary intervention for the management of glycaemia and serum lipids among women with gestational diabetes: a randomized control trial. Randomized Controlled Trial Investigating the Effects of a Low–Glycemic Index Diet on Pregnancy Outcomes in Women at High Risk of Gestational Diabetes Mellitus: The GI Baby 3 Study 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 Early Second Trimester Maternal Plasma Choline and Betaine Are Related to Measures of Early Cognitive Development in Term Infants A randomized controlled clinical trial investigating the effect of DASH diet on insulin resistance, inflammation, and oxidative stress in gestational diabetes. Can a Low–Glycemic Index Diet Reduce the Need for Insulin in Gestational Diabetes Mellitus? 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 Favourable effects of the Dietary Approaches to Stop Hypertension diet on glucose tolerance and lipid profiles in gestational diabetes: a randomised clinical trial. Effect of a low glycaemic index diet on blood glucose in women with gestational hyperglycaemia. A randomised controlled trial of dietary energy restriction in the management of obese women with gestational diabetes Impacts of dietary fat changes on pregnant women with gestational diabetes mellitus: a randomized controlled study. A comparison of glyburide and insulin in women with gestational diabetes mellitus. A comparison of the effectiveness, tolerability and safety of high and low carbohydrate diets in women with gestational diabetes. Decreased Insulin Requirement and Improved Control of Diabetes in Pregnant Women Given a High-Carbohydrate, High-Fiber, Low-Fat Diet Effect of low glycemic load diet with and without wheat bran on glucose control in gestational diabetes mellitus: A randomized trial
abstract: Balanced glucose metabolism ensures optimal fetal growth with long-term health implication s conferred on both mother and child . We examined whether supplementation of probiotics with dietary counselling affects glucose metabolism in normoglycaemic pregnant women . At the first trimester of pregnancy 256 women were r and omised to receive nutrition counselling to modify dietary intake according to current recommendations or as controls ; the dietary intervention group was further r and omised to receive probiotics ( Lactobacillus rhamnosus GG and Bifidobacterium lactis Bb12 ; diet/probiotics ) or placebo ( diet/placebo ) in a double-blind manner , whilst the control group received placebo ( control/placebo ) . Blood glucose concentrations were lowest in the diet/probiotics group during pregnancy ( baseline-adjusted means 4.45 , 4.60 and 4.56 mmol/l in diet/probiotics , diet/placebo and control/placebo , respectively ; P = 0.025 ) and over the 12 months ' postpartum period ( baseline-adjusted means 4.87 , 5.01 and 5.02 mmol/l ; P = 0.025 ) . Better glucose tolerance in the diet/probiotics group was confirmed by a reduced risk of elevated glucose concentration compared with the control/placebo group ( OR 0.31 ( 95 % CI 0.12 , 0.78 ) ; P = 0.013 ) as well as by the lowest insulin concentration ( adjusted means 7.55 , 9.32 and 9.27 mU/l ; P = 0.032 ) and homeostasis model assessment ( adjusted means 1.49 , 1.90 and 1.88 ; P = 0.028 ) and the highest quantitative insulin sensitivity check index ( adjusted means 0.37 , 0.35 and 0.35 ; P = 0.028 ) during the last trimester of pregnancy . The effects observed extended over the 12-month postpartum period . The present study demonstrated that improved blood glucose control can be achieved by dietary counselling with probiotics even in a normoglycaemic population and thus may provide potential novel means for the prophylactic and therapeutic management of glucose disorders Objective To determine if a low glycaemic index diet in pregnancy could reduce the incidence of macrosomia in an at risk group . Design R and omised controlled trial . Setting Maternity hospital in Dublin , Irel and . Participants 800 women without diabetes , all in their second pregnancy between January 2007 to January 2011 , having previously delivered an infant weighing greater than 4 kg . Intervention Women were r and omised to receive no dietary intervention or start on a low glycaemic index diet from early pregnancy . Main outcomes The primary outcome measure was difference in birth weight . The secondary outcome measure was difference in gestational weight gain . Results No significant difference was seen between the two groups in absolute birth weight , birthweight centile , or ponderal index . Significantly less gestational weight gain occurred in women in the intervention arm ( 12.2 v 13.7 kg ; mean difference −1.3 , 95 % confidence interval −2.4 to −0.2 ; P=0.01 ) . The rate of glucose intolerance was also lower in the intervention arm : 21 % ( 67/320 ) compared with 28 % ( 100/352 ) of controls had a fasting glucose of 5.1 mmol/L or greater or a 1 hour glucose challenge test result of greater than 7.8 mmol/L ( P=0.02 ) . Conclusion A low glycaemic index diet in pregnancy did not reduce the incidence of large for gestational age  infants in a group at risk of fetal macrosomia . It did , however , have a significant positive effect on gestational weight gain and maternal glucose intolerance . Trial registration Current Controlled Trials IS RCT N54392969 OBJECTIVE The present study aim ed to compare the effects of a general dietary intervention and an intervention with low glycaemic load ( GL ) on glycaemic control , blood lipid metabolism and pregnancy outcomes in women with gestational diabetes mellitus . DESIGN Participants were r and omly assigned to two groups , receiving either an individualized general dietary intervention ( Control group ) or an intensive low-GL intervention ( Low-GL group ) every two weeks , from 24 - 26 weeks of gestation to delivery . SETTING The Center of Maternal Primary Care in Guangdong General Hospital , China . SUBJECTS Ninety-five women with gestational diabetes mellitus were enrolled from June 2008 to July 2009 . RESULTS After the intervention , both groups significantly decreased their dietary intakes of energy , fat and carbohydrate . The Low-GL group had significantly lower values for GL ( 122 v. 136 ) and glycaemic index ( 50 v. 54 ) but greater dietary fibre intake ( 33 v. 29 g/d ) than did the Control group ( all P<0·01 ) . Significantly greater decreases in fasting plasma glucose ( -0·33 v. -0·02 mmol/l , P<0·01 ) and 2 h postpr and ial glucose ( -2·98 v. -2·51 mmol/l , P<0·01 ) , significantly lower increases in total cholesterol ( 0·12 v. 0·23 mmol/l ) and TAG ( 0·41 v. 0·56 mmol/l ) and a significantly lower decrease in HDL cholesterol ( -0·01 v. -0·11 mmol/l ) were also observed in the Low-GL group compared with the Control group ( all P<0·05 ) . There were no significant differences in body weight gain , birth weight or other maternal-fetal perinatal outcomes between the two groups . CONCLUSIONS The low-GL targeted dietary intervention outperformed the general dietary intervention in glycaemic control and the improvement of blood lipid levels in women with gestational diabetes mellitus OBJECTIVE Dietary interventions can improve pregnancy outcomes in women with gestational diabetes mellitus ( GDM ) . We compared the effect of a low – glycemic index ( GI ) versus a conventional high-fiber ( HF ) diet on pregnancy outcomes , birth weight z score , and maternal metabolic profile in women at high risk of GDM . RESEARCH DESIGN AND METHODS One hundred thirty-nine women [ mean ( SD ) age 34.7 ( 0.4 ) years and prepregnancy BMI 25.2 ( 0.5 ) kg/m2 ] were r and omly assigned to a low-GI ( LGI ) diet ( n = 72 ; target GI ∼50 ) or a high-fiber , moderate-GI ( HF ) diet ( n = 67 ; target GI ∼60 ) at 14–20 weeks ’ gestation .  Diet was assessed by 3-day food records and infant body composition by air-displacement plethysmography , and pregnancy outcomes were assessed from medical records . RESULTS The LGI group achieved a lower GI than the HF group [ mean ( SD ) 50 ( 5 ) vs. 58 ( 5 ) ; P < 0.001 ] . There were no differences in glycosylated hemoglobin , fructosamine , or lipids at 36 weeks or differences in birth weight [ LGI 3.4 ( 0.4 ) kg vs. HF 3.4 ( 0.5 ) kg ; P = 0.514 ] , birth weight z score [ LGI 0.31 ( 0.90 ) vs. HF 0.24 ( 1.07 ) ; P = 0.697 ] , ponderal index [ LGI 2.71 ( 0.22 ) vs. HF 2.69 ( 0.23 ) kg/m3 ; P = 0.672 ] , birth weight centile [ LGI 46.2 ( 25.4 ) vs. HF 41.8 ( 25.6 ) ; P = 0.330 ] , % fat mass [ LGI 10 ( 4 ) vs. HF 10 ( 4 ) ; P = 0.789 ] , or incidence of GDM . CONCLUSIONS In intensively monitored women at risk for GDM , a low-GI diet and a healthy diet produce similar pregnancy outcomes OBJECTIVE Diet therapy in gestational diabetes mellitus ( GDM ) has focused on carbohydrate restriction but is poorly substantiated . In this pilot r and omized clinical trial , we challenged the conventional low-carbohydrate/higher-fat ( LC/CONV ) diet , hypothesizing that a higher – complex carbohydrate/lower-fat ( CHOICE ) diet would improve  maternal insulin resistance ( IR ) , adipose tissue ( AT ) lipolysis , and infant adiposity . RESEARCH DESIGN AND METHODS At 31 weeks , 12 diet-controlled overweight/obese women with GDM were r and omized to an isocaloric LC/CONV ( 40 % carbohydrate/45 % fat/15 % protein ; n = 6 ) or CHOICE ( 60%/25%/15 % ; n = 6 ) diet . All meals were provided . AT was biopsied at 37 weeks . RESULTS After ∼7 weeks , fasting glucose ( P = 0.03 ) and free fatty acids ( P = 0.06 ) decreased on CHOICE , whereas fasting glucose increased on LC/CONV ( P = 0.03 ) . Insulin suppression of AT lipolysis was improved on CHOICE versus LC/CONV ( 56 vs. 31 % , P = 0.005 ) , consistent with improved IR . AT expression of multiple proinflammatory genes was lower on CHOICE ( P < 0.01 ) . Infant adiposity trended lower with CHOICE ( 10.1 ± 1.4 vs. 12.6 ± 2 % , respectively ) . CONCLUSIONS A CHOICE diet may  improve maternal IR and infant adiposity  , challenging recommendations for a LC/CONV diet Background The importance of maternal dietary choline for fetal neural development and later cognitive function has been well-documented in experimental studies . Although choline is an essential dietary nutrient for humans , evidence that low maternal choline in pregnancy impacts neurodevelopment in human infants is lacking . We determined potential associations between maternal plasma free choline and its metabolites betaine and dimethylglycine in pregnancy and infant neurodevelopment at 18 months of age . Methodology This was a prospect i ve study of healthy pregnant women and their full-term , single birth infants . Maternal blood was collected at 16 and 36 weeks of gestation and infant neurodevelopment was assessed at 18 months of age for 154 mother-infant pairs .  Maternal plasma choline , betaine , dimethylglycine , methionine , homocysteine , cysteine , total B12 , holotranscobalamin and folate were quantified . Infant neurodevelopment was evaluated using the Bayley Scales of Infant Development – III . Multivariate regression , adjusting for covariates that impact development , was used to determine the associations between maternal plasma choline , betaine and dimethylglycine and infant neurodevelopment . Results The maternal plasma free choline at 16 and 36 weeks gestation was median ( interquartile range ) 6.70 ( 5.78–8.03 ) and 9.40 ( 8.10–11.3 ) µmol/L , respectively . Estimated choline intakes were ( mean ±SD ) 383±98.6 mg/day , and lower than the recommended 450 mg/day . Betaine intakes were 142±70.2 mg/day . Significant positive associations were found between infant cognitive test scores and maternal plasma free choline ( B = 6.054 , SE = 2.283 , p = 0.009 ) and betaine ( B = 7.350 , SE = 1.933 , p = 0.0002 ) at 16 weeks of gestation . Maternal folate , total B12 , or holotranscobalamin were not related to infant development . Conclusion We show that choline status in the first half of pregnancy is associated with cognitive development among healthy term gestation infants . More work is needed on the potential limitation of choline or betaine in the diets of pregnant women OBJECTIVE To our knowledge , no reports are available indicating the effects of the dietary approaches to stop hypertension ( DASH ) eating plan on insulin resistance , inflammation , and oxidative stress among pregnant women with gestational diabetes mellitus ( GDM ) . This study was design ed to investigate the effects of the DASH diet on insulin resistance , serum high-sensitivity C-reactive protein ( hs-CRP ) and biomarkers of oxidative stress among pregnant women with GDM . METHODS This r and omized controlled clinical trial was performed with 32 pregnant women diagnosed with GDM at 24 to 28 wk gestation . Participants were r and omly assigned to consume either the control ( n = 16 ) or DASH diet ( n = 16 ) for 4 wk . The DASH diet was rich in fruits , vegetables , whole grains , and low-fat dairy products and was low in saturated fats , total fats , cholesterol , refined grains , and sweets , with a total of 2400 mg/d of sodium . The control diet contained 40 % to 55 % of its energy as carbohydrates , 10 % to 20 % as proteins , and 25 % to 30 % as total fats . Fasting blood sample s were taken at baseline and after 4 wk of intervention to measure fasting plasma glucose ( FPG ) , serum insulin , and hs-CRP , homeostasis model of assessment -insulin resistance ( HOMA-IR ) , plasma total antioxidant capacity ( TAC ) , and total glutathione levels ( GSH ) . RESULTS Consumption of the DASH diet compared with the control diet result ed in decreased FPG ( -7.62 versus 3.68 mg/dL ; P = 0.02 ) , serum insulin levels ( -2.62 versus 4.32 μIU/mL , P = 0.03 ) , and HOMA-IR score ( -0.8 versus 1.1 ; P = 0.03 ) . Increased concentrations of plasma TAC ( 45.2 versus -159.2 mmol/L ; P < 0.0001 ) and GSH ( 108.1 versus -150.9 μmol/L ; P < 0.0001 ) also were seen in the DASH group compared with control group . We failed to find a significant difference in mean changes of serum hs-CRP levels between the two diets . Within-group comparisons revealed significant reductions in plasma TAC and GSH levels in the control diet , while a significant increase in these biomarkers in the DASH diet . CONCLUSION Consumption of the DASH diet in pregnant women with GDM had beneficial effects on FPG , serum insulin levels , HOMA-IR score , plasma TAC , and total GSH levels . The effects of this dietary pattern on pregnancy outcomes need to be investigated in future studies OBJECTIVE A low – glycemic index diet is effective as a treatment for individuals with diabetes and has been shown to improve pregnancy outcomes when used from the first trimester . A low – glycemic index diet is commonly advised as treatment for women with gestational diabetes mellitus ( GDM ) . However , the efficacy of this advice and associated pregnancy outcomes have not been systematic ally examined . The purpose of this study was to determine whether prescribing a low – glycemic index diet for women with GDM could reduce the number of women requiring insulin without compromise of pregnancy outcomes . RESEARCH DESIGN AND METHODS All women with GDM seen over a 12-month period were considered for inclusion in the study . Women ( n = 63 ) were r and omly assigned to receive either a low – glycemic index diet or a conventional high-fiber ( and higher glycemic index ) diet . RESULTS Of the 31 women r and omly assigned to a low – glycemic index diet , 9 ( 29 % ) required insulin . Of the women r and omly assigned to a higher – glycemic index diet , a significantly higher proportion , 19 of 32 ( 59 % ) , met the criteria to commence insulin treatment ( P = 0.023 ) . However , 9 of these 19 women were able to avoid insulin use by changing to a low – glycemic index diet . Key obstetric and fetal outcomes were not significantly different . CONCLUSIONS Using a low – glycemic index diet for women with GDM effectively halved the number needing to use insulin , with no compromise of obstetric or fetal outcomes Background . Due to the higher prevalence of obesity and diabetes mellitus ( DM ) , more pregnant women complicated with diabetes are in need of clinical care . Purpose . Compare the effect of including only low glycemic index ( GI ) carbohydrates ( CHO ) against all types of CHO on maternal glycemic control and on the maternal and newborn 's nutritional status of women with type 2 DM and gestational diabetes mellitus ( GDM ) . Methods . Women ( n = 107 , ≤29 weeks of gestation ) were r and omly assigned to one of two nutrition intervention groups : moderate energy and CHO restriction ( Group 1 : all types of CHO , Group 2 : low GI foods ) . Results . No baseline differences in clinical data were observed . Capillary glucose concentrations throughout pregnancy were similar between groups . Fewer women in Group 2 exceeded weight gain recommendations . Higher risk of prematurity was observed in women in Group 2 . No differences in glycemic control were observed between women with type 2 DM and those with GDM . Conclusions . Inclusion of low GI CHO as part of a comprehensive nutrition intervention is equally effective in improving glycemic control as compared to all types of CHO . This strategy had a positive effect in preventing excessive maternal weight gain but increased the risk of prematurity Although gestational diabetes mellitus ( GDM ) is associated with an increased risk of maternal and neonatal morbidity , there is no consensus as to the optimal approach of nutritional management in these patients . The present study was design ed to assess the effect of the Dietary Approaches to Stop Hypertension ( DASH ) eating plan on glucose tolerance and lipid profiles of pregnant women with GDM . The present r and omised controlled clinical trial was performed among thirty-four women diagnosed with GDM at 24 - 28 weeks of gestation . Subjects were r and omly assigned to consume either the control diet ( n 17 ) or the DASH eating pattern ( n 17 ) for 4 weeks . The control diet was design ed to contain 45 - 55 % carbohydrates , 15 - 20 % protein and 25 - 30 % total fat . The macronutrient composition of the DASH diet was similar to the control diet ; however , the DASH diet was rich in fruits , vegetables , whole grains and low-fat dairy products , and contained lower amounts of saturated fats , cholesterol and refined grains with a total of 2400 mg Na/d . Fasting blood sample s were taken at baseline and after 4 weeks of intervention to measure fasting plasma glucose , glycated Hb ( HbA1c ) and lipid profiles . Participants underwent a 3 h oral glucose tolerance tests and blood sample s were collected at 60 , 120 and 180 min to measure plasma glucose levels . Adherence to the DASH eating pattern , compared with the control diet , result ed in improved glucose tolerance such that plasma glucose levels reduced at 60 ( 21·86 v. 20·45 mmol/l , Pgroup = 0·02 ) , 120 ( 22·3 v. 0·2 mmol/l , Pgroup = 0·001 ) and 180 min ( 21·7 v. 0·22 mmol/l , Pgroup = 0·002 ) after the glucose load . Decreased HbA1c levels ( 20·2 v. 0·05 % , Pgroup = 0·001 ) was also seen in the DASH group compared with the control group . Mean changes for serum total ( 20·42 v. 0·31 mmol/l , Pgroup = 0·01 ) and LDL-cholesterol ( 20·47 v. 0·22 mmol/l , Pgroup = 0·005 ) , TAG ( 20·17 v. 0·34 mmol/l , Pgroup = 0·01 ) and total : HDL-cholesterol ratio ( 20·6 ( SD 0·9 ) v. 0·3 ( SD 0·8 ) , Pgroup = 0·008 ) were significantly different between the two diets . Additionally , consumption of the DASH diet favourably influenced systolic blood pressure ( 22·6 v. 1·7 mmHg , Pgroup = 0·001 ) . Mean changes of fasting plasma glucose ( 20·29 v. 0·15 mmol/l , Pgroup = 0·09 ) were nonsignificant comparing the DASH diet with the control diet . In conclusion , consumption of the DASH eating pattern for 4 weeks among pregnant women with GDM result ed in beneficial effects on glucose tolerance and lipid profiles compared with the control diet AIM The objectives of this pilot study were to determine the feasibility and effect on glycaemic control of a low-glycaemic-index ( GI ) diet in women with gestational diabetes or impaired glucose tolerance of pregnancy . METHODS participants , recruited from the Diabetes-in-Pregnancy Clinic of an inner-city teaching hospital serving a predominantly non-Caucasian population , were r and omized to a low-GI ( n=23 ) or control ( n=24 ) diet and followed from 28 weeks gestation until delivery .  Self-monitored-blood-glucose ( SMBG ) , maternal and infant weight were collected from medical charts .  Dietary intakes were assessed using diet records and question naires . RESULTS diet GI on control ( 58 , 95 % CI : 56,60 ) was significantly higher than on low-GI ( 49 , 95 % CI : 47,51 ; p=0.001 ) . Glycaemic control improved on both diets , but more postpr and ial glucose values were within target on low-GI ( 58.4 % of n=1891 ) than control ( 48.7 % of n=1834 ; p<0.001 ) . SMBG post-breakfast was directly related to pre-pregnancy BMI in the control , but not the low-GI group ( BMI * diet interaction ; p=0.021 ) . Participants accepted the study foods and were willing to consume them post-intervention . CONCLUSIONS a low-GI diet was feasible and acceptable in this sample and facilitated control of postpr and ial glucose . A larger study is needed to determine the effect of a low-GI diet on maternal and infant outcomes Summary : A r and omised controlled trial was design ed to determine the effect of moderate 30 % maternal dietary energy restriction on the requirement for maternal insulin therapy  and the incidence of macrosomia in gestational diabetes .  Although the control group restricted their intake to a level similar to that of the intervention group ( 6845 kiloJoules ( kJ ) versus 6579 kJ ) , the result ing cohort could not identify any adverse effect of energy restriction in pregnancy . Energy restriction did not alter the frequency of insulin therapy ( 17.5 % in the intervention group and 16.9 % in the control group ) . Mean birth weight  ( 3461 g in the intervention group and 3267 g in the control group ) was not affected . There was a trend in the intervention group towards later gestational age at commencement of insulin therapy ( 33 weeks versus 31 weeks ) and lower maximum daily insulin dose ( 23 units versus 60 units ) which did not reach statistical significance . Energy restriction did not cause an increase in ketonemia OBJECTIVE This study aims to determine the impact of increasing polyunsaturated fatty acid intake on blood glucose , lipid metabolism , and pregnancy outcomes of pregnant women with gestational diabetes mellitus . METHODS Under constant total energy and protein intake , 84 pregnant women with gestational diabetes mellitus were r and omly divided into the experimental and control groups , which were given oil-rich and conventional low-oil meals , respectively . RESULTS After the dietary intervention , the intake and energy supply of fat and the three fatty acids were significantly higher in the experimental group than the control group ( p<0.001 ) . The intake and energy supply of polyunsaturated fatty acids  increased significantly post-intervention in the experimental group but did not change in the control group . In both the intervention and the control group , fasting blood glucose , 2 h postpr and ial plasma glucose , and the insulin resistance index decreased significantly post-intervention ( p<0.05 ) ; the lipid changes were consistent between groups . Pregnancy outcomes did not differ significantly between the two groups ( p>0.05 ) . CONCLUSIONS An appropriate increase in polyunsaturated fatty acid intake benefits pregnant women with gestational diabetes mellitus as well as fetuses , as long as the diet therapy follows basic recommendations and total energy intake is strictly controlled BACKGROUND Women with gestational diabetes mellitus are rarely treated with a sulfonylurea drug , because of concern about teratogenicity and neonatal hypoglycemia . There is little information about the efficacy of these drugs in this group of women . METHODS We studied 404 women with singleton pregnancies and gestational diabetes that required treatment . The women were r and omly assigned between 11 and 33 weeks of gestation to receive glyburide or insulin according to an intensified treatment protocol . The primary end point was achievement of the desired level of glycemic control . Secondary end points included maternal and neonatal complications . RESULTS The mean ( + /-SD ) pretreatment blood glucose concentration as measured at home for one week was 114+/-19 mg per deciliter ( 6.4+/-1.1 mmol per liter ) in the glyburide group and 116+/-22 mg per deciliter ( 6.5+/-1.2 mmol per liter ) in the insulin group ( P=0.33 ) . The mean concentrations during treatment were 105+/-16 mg per deciliter ( 5.9+/-0.9 mmol per liter ) in the glyburide group and 105+/-18 mg per deciliter ( 5.9+/-1.0 mmol per liter ) in the insulin group ( P=0.99 ) . Eight women in the glyburide group ( 4 percent ) required insulin therapy . There were no significant differences between the glyburide and insulin groups in the percentage of infants who were large for gestational age ( 12 percent and 13 percent , respectively ) ; who had macrosomia , defined as a birth weight of 4000 g or more ( 7 percent and 4 percent ) ; who had lung complications ( 8 percent and 6 percent ) ; who had hypoglycemia ( 9 percent and 6 percent ) ; who were admitted to a neonatal intensive care unit ( 6 percent and 7 percent ) ; or who had fetal anomalies ( 2 percent and 2 percent ) . The cord-serum insulin concentrations were similar in the two groups , and glyburide was not detected in the cord serum of any infant in the glyburide group . CONCLUSIONS In women with gestational diabetes , glyburide is a clinical ly effective alternative to insulin therapy INTRODUCTION Nutrition therapy is an integral part of the management of gestational diabetes mellitus ( GDM ) . Most women with GDM are treated by nutritional management alone . The goal of our study was to compare low and high carbohydrate diets in their effectiveness , safety and tolerability in women with GDM . MATERIAL AND METHODS The study group consisted of 30 Caucasian women newly diagnosed with GDM , with a mean age of 28.7 + /- 3.7 years and pregnancy duration of 29.2 + /- 5.4 weeks . The patients were r and omised into two groups : those on a low and those on a high carbohydrate diet ( 45 % vs. 65 % respectively of energy supply coming from carbohydrates ) . The presence of urine ketones was controlled every day . After two weeks daily glucose profiles and compliance with the recommended diets were analysed . RESULTS Glucose concentration before implementation of the diet regimen did not differ between groups . No changes in fasting blood glucose were noticed in the group that had followed a low carbohydrate diet , although a significant decrease in glucose concentration was observed after breakfast ( 102 + /- 16 vs. 94 + /- 11 mg/dl ) , lunch ( 105 + /- 12 vs. 99 + /- 9 mg/dl ) and dinner ( 112 + /- 16 vs. 103 + /- 13 mg/dl ) ( p < 0.05 ) . In the high carbohydrate diet group fasting and after-breakfast glucose concentration did not change . A significant decrease in glycaemia was noticed after lunch ( 106 + /- 15 vs. 96 + /- 7 mg/dl ) and dinner ( 107 + /- 12 vs. 97 + /- 7 mg/dl ) ( p < 0.05 ) . Ketonuria was not observed in either group . Obstetrical outcomes did not differ between groups . CONCLUSIONS Both high and low carbohydrate diets are effective and safe . A diet with carbohydrate limitation should be recommended to women who experience the highest glycaemia levels after breakfast Five quantitative measures of diabetic control [ HbA1c determinations , mean 24-h plasma glucose values , mean amplitude of glycemic excursions ( MAGE ) , mean 24-h urinary loss of glucose , and daily exogenous insulin requirement ] were compared in 20 pregnant women who were r and omly assigned to either a high-carbohydrate , high-fiber diet ( HCF ) that was low in fat or to a control diet commonly prescribed for pregnancy . Eleven women followed the HCF diet and nine subjects , the control diet , from baseline entry into the study until delivery . Dietary compliance was excellent , with 78 % of the women in each group rated good or acceptable . HbA1c values were similar in both groups at baseline ( HCF : 11.0 ± 0.5 % versus control : 10.2 ± 0.6 % ) , with no different predelivery values ( 8.6 ± 0.4 % ) . Mean 24-h plasma glucose levels improved in patients on both diets , with lower values noted in the HCF group at predelivery . MAGE values and st and ard deviations did not differ significantly in the two groups . Glycosuria decreased markedly in both dietary groups , but differences between groups were not significant . Improved control of diabetes on the HCF diet was achieved with significantly lower increments in insulin dose during gestation ( HCF baseline : 32 ± 8 U/24 h to 66 ± 10 U/24 h versus control baseline : 27 ± 9 U/24 h to 108 ± 12 U/24 h , P < 0.03 ) . Outcome of pregnancy did not differ in the two groups of patients , but women on the HCF diet gained less weight than those on the control diet ( 26 ± 3 lb versus 35 ± 5 lb , P < 0.05 ) . Mean newborn gestational age was similar in the two groups ( HCF : 37.2 ± 0.7 wk versus control : 36.5 ± 0.7 wk ) . Mean birth weight in infants of HCF mothers ± was 3809 ± 248 g versus 3313 ± 278 g in infants of control mothers ( P < 0.05 ) . We conclude that although marked improvement of diabetic control occurred on both regimens , patients on the HCF diet achieved better control of diabetes with significantly lower increments in exogenous insulin Background : A low-glycemic index diet is effective in blood glucose control of diabetic subjects , reduces insulin requirement in women with gestation diabetes mellitus ( GDM ) and improves pregnancy outcomes when used from beginning of the second trimester . However there are limited reports to examine the effect of low glycemic load ( LGL ) diet and fiber on blood glucose control and insulin requirement of women with GDM . Therefore , the aim of this study was to examine the effect of low glycemic load diet with and without fiber on reducing the number of women with GDM requiring insulin . Material s and Methods : All GDM women ( n = 31 ) were r and omly allocated to consume either a LGL diet with Fiber or LGL diet . Results : We found that 7 ( 38.9 % ) of 18 women with GDM in Fiber group and 10 ( 76.9 % ) in “ Without Fiber ” group required insulin treatment . Conclusion : The LGL diet with added fiber for women with GDM dramatically reduced the number needing for insulin treatment
target: In general , when given alongside gestational weight gain advice , fasting glucose improved in most diets compared to diets that gave gestational weight gain advice only .
  However , fasting glucose increased in high unsaturated or monounsaturated fatty acids diets .
  In the absence of gestational weight gain advice , fasting glucose improved in DASH-style diets compared to st and ard of care .
  Although most were non-significant , similar trends were observed for these same diets for the other glycemic outcomes .
  /INTERPRETATION Alongside with gestational weight gain advice , most diets , with the exception of a high unsaturated or a high monounsaturated fatty acid diet , demonstrated a fasting glucose improvement compared with gestational weight gain advice only .
  When gestational weight gain advice was not given , the DASH-style diet appeared optimal on fasting glucose .
  However , a small number of trials were identified and most dietary comparisons were underpowered to detect differences in glycemic outcomes .
background: AIMS Evidence to support dietary modifications to improve glycemia during pregnancy is limited , and the benefits of diet beyond limiting gestational weight gain is unclear .
  Therefore , a systematic review and network meta- analysis of r and omized trials was conducted to compare the effects of various common diets , stratified by the addition of gestational weight gain advice , on fasting glucose and insulin , hemoglobin A1c ( HbA1c ) , and homeostatic model assessment for insulin resistance ( HOMA-IR ) in pregnant women .