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Low-glycemic index diet for gestational DM of little benefit

Clinical Question:
Does a low-glycemic index diet improve outcomes in women with gestational diabetes mellitus or their infants?

Bottom Line:
A low-glycemic index (LGI) diet does not significantly reduce the risk of macrosomia, insulin treatment, or adverse pregnancy outcomes in women with gestational diabetes mellitus. Women in the LGI diet group were less likely to have excessive weight gain than those following a conventional high-fiber diet. (LOE = 1b)

Reference:
Louie JC, Markovic TP, Perera N, 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):2341-2346.  [PMID:21900148]

Study Design:
Randomized controlled trial (single-blinded)

Funding:
Unknown/not stated

Allocation:
Concealed

Setting:
Outpatient (specialty)

Synopsis:
In this Australian study 92 women with gestational diabetes mellitus were randomized to follow either a LGI diet or a conventional high-fiber diet. Both diets contained 15% to 25% protein, 25% to 30% fat, and 40% to 45% carbohydrate. All women saw an endocrinologist weekly in addition to their primary care provider and were given insulin when their fasting glucose level exceeded 99 mg/dL or postprandial glucose level exceeded 135 mg/dL. The extent to which these results would be generalizable to a setting with less intensive intervention is uncertain. The study was powered to detect a 286 g mean difference in birthweight. Study personnel other than the person providing the initial dietary guidance were masked to study group allocation. The target glycemic index (GI) in the LGI intervention group was no more than 50. The LGI group indeed achieved a lower GI according to food diaries (mean GI = 47 vs 53; P < .001). Women in the LGI group were less likely to have excessive weight gain than women in the conventional diet group (25% vs 42%; P = .095). However, the primary outcome of mean birthweight did not differ between groups: 3.3 kg in each. The prevalence of infant macrosomia also did not differ between groups (2.1% vs 6.7%; P = .286).

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