Glycemic load and gestational diabetes -
Nutrient intakes were computed by multiplying the frequency response by the nutrient content of the specified portion sizes. Food composition values were obtained from the Harvard University Food Composition Database, which was derived from U.
Department of Agriculture sources 11 and supplemented with information from the manufacturer. In the U. Department of Agriculture database, dietary fiber was determined by enzymatic-gravimetric methods The glycemic index is a relative measure of the glycemic impact of the carbohydrates in different foods The glycemic index values for single food items were based on available databases and publications 14 , 15 , with white bread as the reference food.
Total glycemic load was calculated by first multiplying the carbohydrate content of each food by its glycemic index value, then by multiplying this value by the frequency of consumption and summing the values from all food.
Dietary glycemic load thus represents the quality and quantity of carbohydrate intake and the interaction between the two. Dietary fiber, magnesium, glycemic load, and glycemic index were energy adjusted using the residual method Intakes of carbohydrate, protein, and fatty acids were expressed as nutrient density percent of total energy intake.
Corrected correlation coefficients between the SFFQ and multiple dietary records for carbohydrate and fiber were 0. Correlations were also high for individual carbohydrate-rich food items e.
The ability of the SFFQ to assess dietary glycemic index and glycemic load was documented in a study that evaluated the relations of these two variables to plasma concentrations of HDL cholesterol and triacylglycerol in women The concept of glycemic load as a direct measure of postprandial glycemia in healthy subjects has also been previously validated Participants provided sociodemographic, clinical, and lifestyle information biennially, including age, weight, and smoking status.
We calculated BMI kilograms divided by the square of height in meters; the latter assessed at baseline only. Family history of diabetes was reported in only.
Diagnosis of GDM was based on self-reported information in the biennial questionnaire. A previous validation study of GDM based on medical record review in this cohort demonstrated a high validity of self-reported diagnosis of GDM 4 , In brief, we reviewed medical records among a sample of women in the cohort who corroborated on a supplementary questionnaire that they had a first diagnosis of GDM in a singleton pregnancy between and We also sent supplementary questionnaires to women reporting a pregnancy uncomplicated by GDM during the same interval.
In primary analyses, we created measures of cumulative average intakes of dietary fiber, dietary glycemic index, and glycemic load to present long-term intakes of these dietary variables of individual participants before GDM was reported.
For instance, the intake was used for the follow-up between and , and the average of the and intake was used for the follow-up between and to reduce within-person variation. Relative risks RRs of GDM for each category of nutrient or food intake compared with the lowest category were estimated using Cox proportional hazards analysis stratified by 5-year age categories.
We used information on covariates from the baseline or subsequent questionnaires in multivariate analyses. Because women with previous GDM were excluded from this study and women with a previous pregnancy uncomplicated by GDM are less likely than nulliparous women i.
Covariates were updated during follow-up by using the most recent data for each 2-year follow-up interval. The significance of linear trends across categories of dietary intake was evaluated using the median value for each category of dietary intake analyzed as a continuous variable in multivariate models.
All statistical analyses were performed by using SAS statistical software version 8. During 8 years of follow-up — , women reported a first diagnosis of GDM among the 13, study participants. Women who had a pregravid diet that was high in fiber and glycemic load were on average leaner, more physically active, and less likely to smoke.
In addition, dietary fiber and glycemic load were positively related to dietary carbohydrate, magnesium, total iron, vitamin C, and vitamin E and inversely related to alcohol, total fat, and saturated, monounsaturated, and trans fatty acids Table 1.
Dietary total fiber, in particular cereal and fruit fiber, intakes were strongly and inversely associated with GDM risk Table 2. The associations were most significant comparing women in the two extreme quintiles of dietary intakes. These inverse associations remained significant after further adjustment for the other sources of dietary fiber.
Additional adjustment for dietary magnesium, vitamin C, and vitamin E intake did not change the results materially; the multivariate RRs for the highest compared with the lowest quintile were 0. No significant associations were observed for vegetable fiber and GDM risk in multivariate analysis, although there appears to be a reduction in the risk in the upper quintile.
Dietary magnesium was inversely related to GDM risk after adjustment for BMI, but this inverse association was not statistically significant after further adjustment for other lifestyle and dietary factors especially dietary fiber.
In post hoc analyses, we evaluated whether the observed lower GDM risk was related to fiber from any specific food group. The lower risk appeared predominantly related to higher fiber intake from dark breads. Dietary fruit intakes were significantly and inversely associated with GDM risk; the multivariate RR for the highest compared with the lowest quintile was 0.
In stratified analyses, there was no evidence indicating that the inverse associations of GDM risk with total, cereal, and fruit fiber varied significantly according to BMI, physical activity, or family history of diabetes.
Additionally, we restricted our analysis to nulliparous women and obtained similar results. Dietary glycemic load was significantly and positively associated with GDM risk after adjustment for nondietary and dietary covariates.
When fat, protein, and total energy intake were held constant, dietary glycemic load represented the effect of substituting high—glycemic index carbohydrate for low—glycemic index carbohydrate on GDM risk model 2 for glycemic load, Table 2. Total carbohydrate intake was inversely associated with GDM risk after adjustment for age and BMI.
However, this association, which might be due to a more healthy diet and lifestyle related to the greater health consciousness typically associated with a low-fat high-carbohydrate diet, disappeared after additional adjustment for lifestyle and other dietary factors.
The association between dietary glycemic index alone and GDM risk was not statistically significant. We also examined the joint effect of dietary glycemic load and cereal fiber.
After adjustment for age, BMI, physical activity, dietary factors, and other covariates, compared with women with a high intake of cereal fiber and low dietary glycemic load, those with low cereal fiber intake and high glycemic load had a 2.
In this large prospective study of women, pregravid consumptions of dietary total fiber and cereal and fruit fiber were significantly and inversely associated with GDM risk. In contrast, dietary glycemic load was positively associated with GDM risk. These associations were most significant comparing women in the upper and lower quintiles of dietary intakes.
Uncomplicated pregnancy is characterized by progressive hyperlipidemia, insulin resistance, and a deterioration of glucose tolerance in the third trimester. When studied postpartum, women who had GDM have greater insulin resistance than women who had uncomplicated pregnancies 26 , Further, sequential measurements of insulin sensitivity performed in the same women before pregnancy, early in the second trimester, and in the third trimester have documented insulin resistance in both lean and obese women who developed GDM later These findings indicated that most women who develop GDM had underlying insulin resistance to which the insulin resistance of pregnancy was partially additive Pregnancy-related metabolic challenges unmask a predisposition to glucose metabolic disorders in some women.
Factors that contribute to insulin resistance or impaired insulin secretion before pregnancy and in early pregnancy can have a deleterious effect during pregnancy and be risk factors for GDM. There are several possible mechanisms that may explain the relationship between dietary fiber and glucose homeostasis.
Increased dietary fiber may reduce appetite and lower total energy intake, thus reducing adiposity and improving insulin sensitivity 29 , Fiber intake may also delay gastric emptying 30 and slow glucose absorption, resulting in lesser absorption of glucose and lesser increases in insulin levels 29 , The beneficial effect of fiber on glucose homeostasis may be also due to delayed gastric emptying rate, slowed digestion, and absorption of food rich in fiber 30 and the subsequently reduced rate of glucose absorption and plasma insulin levels 29 , These benefits have been attributed primarily to soluble fiber, which creates a gel-like substance in the stomach Whole-grain and bran products from wheat and corn, the major source of cereal fiber in our cohort, typically contain insoluble fiber.
Other characteristics of these sources of cereal fiber might also be important in glucose and lipid metabolism e. Epidemiological studies are unlikely to yield detailed evaluations of these pathways, and thus experimental studies are clearly warranted We are unaware of published studies that comprehensively examined the association of total dietary fiber and specific sources of fiber with GDM risk.
The inverse relationship between total fiber and cereal fiber and the risk of GDM in the present study is consistent with findings from those studies of type 2 diabetes 5 — In addition, an inverse association with circulating levels of C-reactive protein 34 , 35 and a positive association with adiponectin 36 have been reported for total dietary fiber and cereal fiber.
Both biomarkers have been associated with risks of GDM 37 , Notably, different from published studies on type 2 diabetes, fruit fiber was strongly associated with a reduced risk of GDM in the present study.
In addition to fruit fiber, fruits comprise other components that were associated with reductions in GDM risk. It is plausible that the observed association between fruit fiber and GDM risk may be mediated through other components. For example, dietary vitamin C and plasma ascorbic acid levels have been inversely associated with GDM risk However, the association between fruit fiber and GDM risk remained significant after adjustment for dietary intakes of vitamin C and E and magnesium in the present study, although the association was slightly attenuated.
Future studies are warranted to confirm these findings and decipher underlying mechanisms for the observed associations. Similar to most previous studies on type 2 diabetes 5 — 10 , we did not observe a significant association of vegetable fiber intakes with GDM risk.
Taken together, these findings suggest that effects of dietary fiber may vary depending on food source. Both dietary glycemic index and load were used to characterize the capability of diet to induce postprandial glycemia.
Although metabolic studies on the effect of glycemic index and load on insulin sensitivity and secretion have shown mixed results, regular consumption of meals higher in glycemic index was found to increase h blood glucose and insulin secretion levels 40 , Similarly, increases in dietary glycemic load induced both hyperglycemia and hyperinsulinemia Very few studies in this regard have been conducted among pregnant women.
An association of low dietary glycemic index with lower levels of plasma glucose and HbA 1c was reported among pregnant women in a clinical trial 42 and in an observational study Findings from large prospective epidemiological studies on the association between glycemic index and load and type 2 diabetes risk have also been inconsistent.
In joint analyses, the lowest risk of GDM was observed among those who consumed the highest amount of cereal fiber and lowest glycemic load. Misclassification of dietary exposure such as dietary fiber, glycemic index, and glycemic load is inevitable.
However, these dietary data could not have been influenced by the subsequent development of GDM because of the prospective design of this study; this would be expected to attenuate the observed associations and would not explain the positive results.
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The Generation R Study is conducted by the Erasmus Medical Center in close collaboration with the School of Law and Faculty of Social Sciences of the Erasmus University Rotterdam, the Municipal Health Service Rotterdam area, Rotterdam, the Rotterdam Homecare Foundation, Rotterdam, and the Stichting Trombosedienst and Artsenlaboratorium Rijnmond STAR , Rotterdam.
We gratefully acknowledge the contribution of participating mothers, general practitioners, hospitals, midwives, and pharmacies in Rotterdam. The Generation R Study is financially supported by the Erasmus Medical Center, Rotterdam, the Erasmus University Rotterdam, and the Netherlands Organization for Health Research and Development.
Romy Gaillard received funding from the Dutch Heart Foundation grant number T , the Dutch Diabetes Foundation grant number The Generation R Study Group, Erasmus MC, University Medical Center, Rotterdam, The Netherlands. Rama J. Wahab, Judith M. Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, The Netherlands.
You can also search for this author in PubMed Google Scholar. RW, JS, and RG designed and constructed the research, wrote the paper, and had primary responsibility for the final content.
RW, JS, and RG carried out the statistical analysis. All authors approved the final manuscript and agree to be accountable for all aspects of the work. Correspondence to Romy Gaillard. Open Access This article is licensed under a Creative Commons Attribution 4.
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Reprints and permissions. Wahab, R. Maternal early pregnancy dietary glycemic index and load, fetal growth, and the risk of adverse birth outcomes. Eur J Nutr 60 , — Download citation. Received : 30 January Accepted : 02 July Published : 14 July Issue Date : April Anyone you share the following link with will be able to read this content:.
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Download PDF. Abstract Purpose Maternal hyperglycemia is associated with adverse birth outcomes. Methods In a population-based cohort study of pregnant Dutch women, we assessed dietary glycemic index and load using a food frequency questionnaire at median Results Mean maternal early pregnancy dietary glycemic index and load were Conclusion Among pregnant women without an impaired glucose metabolism, a higher early pregnancy dietary glycemic load was associated with higher late-pregnancy fetal abdominal circumference and estimated fetal weight.
Maternal glycemic index and glycemic load in pregnancy and offspring metabolic health in childhood and adolescence—a cohort study of 68, mother—offspring dyads from the Danish National Birth Cohort Article 24 September Associations of dietary glycemic index and load during pregnancy with blood pressure, placental hemodynamic parameters and the risk of gestational hypertensive disorders Article Open access 15 September High maternal early-pregnancy blood glucose levels are associated with altered fetal growth and increased risk of adverse birth outcomes Article Open access 08 August Use our pre-submission checklist Avoid common mistakes on your manuscript.
Introduction Maternal hyperglycemia during pregnancy is a well-known risk factor for adverse birth outcomes, such as macro-somia and neonatal hypoglycemia [ 1 ].
Methods Study design and study sample This study was embedded in the Generation R study, a population-based prospective birth cohort study in Rotterdam, The Netherlands. Maternal dietary glycemic index and load We obtained information on maternal dietary intake during early pregnancy at a median of Fetal growth and adverse birth outcomes We performed fetal ultrasound examinations to assess fetal growth during mid- and late-pregnancy at a median gestational age of Statistical analyses First, we performed a non-response analysis comparing Dutch women with and without information available on early pregnancy dietary glycemic index and load.
Results Subject characteristics Mean maternal dietary glycemic index and load were Table 1 Population characteristics according to maternal dietary glycemic index quartiles Full size table.
Full size image. Table 2 Associations of maternal early pregnancy dietary glycemic index and load with fetal growth and birth characteristics Full size table. Table 3 Associations of maternal early pregnancy dietary glycemic index and load with the risks of adverse birth outcomes Full size table.
Discussion Among pregnant women without an impaired glucose metabolism, we observed that maternal early pregnancy dietary glycemic index across was not associated with fetal growth parameters, whereas a higher maternal early pregnancy dietary glycemic load was associated with a higher fetal abdominal circumference and estimated fetal weight in late-pregnancy only.
Strengths and limitations Strengths of this study were the prospective study design, large sample size, and repeatedly measured fetal growth data from mid-pregnancy onwards available.
Conclusion Among pregnant women without an impaired glucose metabolism, a higher maternal early pregnancy dietary glycemic load was associated with a higher fetal abdominal circumference and estimated fetal weight in late-pregnancy. References Farrar D, Simmonds M, Bryant M, Sheldon TA, Tuffnell D, Golder S, Dunne F, Lawlor DA Hyperglycaemia and risk of adverse perinatal outcomes: systematic review and meta-analysis.
i Article PubMed PubMed Central Google Scholar Catalano PM, Shankar K Obesity and pregnancy: mechanisms of short term and long term adverse consequences for mother and child. Talk to your care team about what weight gain is right for you. Spreading carbs out during the day, and not having a big portion in one go, can help keep your sugar levels stable between meals.
If you do need to snack when you have gestational diabetes, swap cake, biscuits, crisps and chocolate for:. In the law was changed so that manufacturers are no longer allowed to label food as diabetic or suitable for diabetics.
The glycaemic index GI is a measure of how quickly foods containing carbs affect your blood sugar levels after you eat them. Some foods affect sugars levels quickly and so have a high GI, and others take longer to affect blood sugar levels and so have a low GI.
To help you manage your blood sugar levels, go for carbs with a lower GI. And not all low GI foods are healthy, so make sure you read food labels and make a healthy choice.
If you gain too much weight in pregnancy it can make it harder to keep your blood sugar levels in the healthy range and can increase your blood pressure and affect your health.
Making changes to your diet and physical activity levels can help you avoid gaining too much weight, and your care team will help you with this. Making changes to your diet and physical activity levels can help you avoid gaining too much weight.
Breastfeeding is one of the ways you can help reduce your risk of developing type 2 diabetes after giving birth.
This will reduce your risk of developing gestational diabetes in future pregnancies. And it will also help to reduce your future risk of developing type 2 diabetes too.
Try to include protein foods and vegetables with each of your main meals, to help fill you up and help manage your sugar levels. You may need to split your usual breakfast into two sittings.
Many care teams recommend that you limit carbohydrate at breakfast to g and then have another g a few hours afterwards. Women find having 40g at breakfast causes their sugar levels to go higher than their target levels.
In practice this means a slice of toast at one sitting with the other a few hours afterwards. Try serving dinners with our Cauliflower pilaf instead of rice.
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Making changes to your diet and physical activity levels can help you avoid gaining too much weight, and your care team will help you with this. Making changes to your diet and physical activity levels can help you avoid gaining too much weight.
Breastfeeding is one of the ways you can help reduce your risk of developing type 2 diabetes after giving birth. This will reduce your risk of developing gestational diabetes in future pregnancies. And it will also help to reduce your future risk of developing type 2 diabetes too.
Try to include protein foods and vegetables with each of your main meals, to help fill you up and help manage your sugar levels. You may need to split your usual breakfast into two sittings. Many care teams recommend that you limit carbohydrate at breakfast to g and then have another g a few hours afterwards.
Women find having 40g at breakfast causes their sugar levels to go higher than their target levels. In practice this means a slice of toast at one sitting with the other a few hours afterwards.
Try serving dinners with our Cauliflower pilaf instead of rice. For each portion, you'll see how many carbs, sugars, fat, fibre, salt, fruit and veg portions, and calories there are.
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Breadcrumb Home Guide to diabetes Enjoy food Eating with diabetes Gestational diabetes. Save for later Page saved! You can go back to this later in your Diabetes and Me Close. What can I eat with gestational diabetes? Understanding your diet and eating healthily is an important part of your treatment for gestational diabetes.
Seven tips for eating well with gestational diabetes These healthy eating tips for women with gestational diabetes are general. Choose healthier carbohydrates carbs All carbs affect your blood sugar levels, so you need to know which foods contain carbs. Easy swaps for healthier carbs Swap white bread for multigrain, wholegrain, wholemeal, rye, linseed or pumpernickel.
Swap chapatti and roti made with white flour to those made with wholemeal flour. Swap white pittas for wholemeal pittas. Swap chips and mash for wholemeal pasta, baked plantain or sweet potato. Swap white rice for brown rice. Swap cereals like Cornflakes and Rice Krispies for porridge with jumbo oats, made with single cream and water Other healthier carbs Vegetables Pulses like chickpeas, beans and lentils Dairy like unsweetened yogurt and milk.
If you are using a non -dairy milk, check they are unsweetened and fortified with vitamins and minerals. Fruit — it's best to eat fruit in-between meals and avoid smoothies and fruit juice.
Cut down on sugar Cutting down on sugar is important to keep your blood sugar levels in the healthy range. Easy ways to cut down on excess sugar: Swap sugary drinks, energy drinks and fruit juices with water or decaffeinated tea and coffee. Try low or zero-calorie sweeteners, also known as artificial sweeteners, instead of using sugar.
Know the other names for sugar on the food label. These are sucrose, glucose, dextrose, fructose, lactose, maltose, honey, invert sugar, syrup, corn sweetener and molasses.
Perfect your portion sizes Use our tips on carb portion sizes. Plan for snack attacks Spreading carbs out during the day, and not having a big portion in one go, can help keep your sugar levels stable between meals.
Avoid diabetic foods In the law was changed so that manufacturers are no longer allowed to label food as diabetic or suitable for diabetics. Understand the glycaemic index The glycaemic index GI is a measure of how quickly foods containing carbs affect your blood sugar levels after you eat them.
Manage your weight If you gain too much weight in pregnancy it can make it harder to keep your blood sugar levels in the healthy range and can increase your blood pressure and affect your health. Meal and snack ideas for gestational diabetes Try to include protein foods and vegetables with each of your main meals, to help fill you up and help manage your sugar levels.
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: Glycemic load and gestational diabetes| 1. Introduction | Reprints and permissions. We, however, carefully controlled for major well-documented risk factors for GDM and still observed significant associations of dietary fiber and glycemic load with GDM risk. Vaginismus: Managing a Misunderstood and Underdiagnosed Condition. All women seen over a month period October —September were considered. The associations were most significant comparing women in the two extreme quintiles of dietary intakes. American Diabetes Association: Gestational diabetes mellitus. How a low GI lifestyle can help. |
| GI and Pregnancy | GI Foundation | Try serving dinners with our Cauliflower pilaf instead of rice. For each portion, you'll see how many carbs, sugars, fat, fibre, salt, fruit and veg portions, and calories there are. A company limited by guarantee registered in England and Wales with no. Skip to main navigation Skip to content. Breadcrumb Home Guide to diabetes Enjoy food Eating with diabetes Gestational diabetes. Save for later Page saved! You can go back to this later in your Diabetes and Me Close. What can I eat with gestational diabetes? Understanding your diet and eating healthily is an important part of your treatment for gestational diabetes. Seven tips for eating well with gestational diabetes These healthy eating tips for women with gestational diabetes are general. Choose healthier carbohydrates carbs All carbs affect your blood sugar levels, so you need to know which foods contain carbs. Easy swaps for healthier carbs Swap white bread for multigrain, wholegrain, wholemeal, rye, linseed or pumpernickel. Swap chapatti and roti made with white flour to those made with wholemeal flour. Swap white pittas for wholemeal pittas. Swap chips and mash for wholemeal pasta, baked plantain or sweet potato. Swap white rice for brown rice. Swap cereals like Cornflakes and Rice Krispies for porridge with jumbo oats, made with single cream and water Other healthier carbs Vegetables Pulses like chickpeas, beans and lentils Dairy like unsweetened yogurt and milk. If you are using a non -dairy milk, check they are unsweetened and fortified with vitamins and minerals. Fruit — it's best to eat fruit in-between meals and avoid smoothies and fruit juice. Cut down on sugar Cutting down on sugar is important to keep your blood sugar levels in the healthy range. Look at the food label to see the grams of total carbohydrate contained. Sugar alcohols may have a laxative effect or cause gas and bloating. The following are examples of sugar-alcohols:. Some products labeled "sugar-free" are indeed carbohydrate-free and will not affect your blood sugar, including diet sodas and sugar-free Jell-o. Be sure to record all of the foods and the amount that you eat each day, which will help you monitor your carbohydrate intake. Also, use measuring cups for accuracy when possible. UCSF Health medical specialists have reviewed this information. It is for educational purposes only and is not intended to replace the advice of your doctor or other health care provider. We encourage you to discuss any questions or concerns you may have with your provider. Gestational diabetes refers to diabetes that is diagnosed during pregnancy. Learn more. Counting your carbohydrate intake due to gestational diabetes? Use these menus, each of which contains 30 grams of carbohydrates, to simplify your dieting. During the last half of pregnancy, your body makes more red blood cells which can cause Anemia. Learn more about causes and prevention here. Pregnancy produces many physical changes. Aside from weight and body shape, other alterations in your body chemistry and function take place. Domestic violence is the most common health problem among women during pregnancy. It greatly threatens both the mother's and baby's health. Learn more here. It is important to get the nutrients you need both before getting pregnant and during your pregnancy. Find more nutrition information including macros here. Most women can, and should, engage in moderate exercise during pregnancy. Exercise can help you stay in shape and prepare your body for labor and delivery. Commonly asked questions regarding Prenatal Tests including, types available, positive screenings, diagnostic testing, health insurance coverage, and more. If you are pregnant, we recommend you be tested for the human immunodeficiency virus HIV even if you do not think you are at risk. Premature labor occurs between the 20th and 37th week of pregnancy, when uterine contractions cause the cervix to open earlier than normal. The pregnancy may alter how a woman and her partner feel about making love, and differences in sexual need may arise. While pregnant, it is best to eat well, stay healthy and avoid ingesting anything that might be harmful to the mother's or baby's health. If you give birth to a boy, you will be asked if you'd like him circumcised. This is a matter to be considered carefully before the baby is born. Get ready for the baby! Choose from a variety of classes that prepare moms and partners for pregnancy, birth, baby care, breastfeeding and parenting. Get support for all your breastfeeding needs. Troubleshoot with a lactation consultant, find equipment and supplies, join a support group and more. Access free health resources here, from classes and webinars to support groups and medical referrals, plus pregnancy, birth and breastfeeding services. Patient Education. How a low GI lifestyle can help. Low GI lifestyle tips. Research and further reading. Download resources. PRINT, DOWNLOAD, SHARE. Gestational diabetes Gestational diabetes GDM is a form of diabetes that occurs during pregnancy and usually disappears after the birth but may reoccur in the next pregnancy. How a low GI lifestyle can help A healthy low GI eating plan is one of the safest and most effective ways of ensuring the baby grows at a healthy rate. Low GI lifestyle tips Choose nutrient-dense foods packed with vitamins and minerals Avoid overloading on kilojoules Manage blood glucose levels with the right balance of protein and carbohydrates Focus on low GI carbohydrates Choose dense wholegrain bread Choose rolled oats or natural muesli instead of processed breakfast cereals Choose basmati or doongara varieties of rice Include more legumes such as chickpeas, lentils and kidney beans Snack on fruit and yoghurt Continue to be physically active in pregnancy Be mindful of weight gain. Your Guide to Eating Well during Pregnancy Factsheet. Glycemic Index and Pregnancy HCP Factsheet. Pregnancy Infographic. Share this page. Copy Link. Recommended for you. RECIPES Low GI meals made easy with SunRice. GI CERTIFIED PRODUCTS Organic Brushed Carisma® Potatoes 1. DIABETES Top Tips for Low GI Living. HEALTHY LIVING GI and Weight Management. |
| Best Diet for Gestational Diabetes | Both the American Diabetes Association ADA [ 68 ] and the National Institute for Health and Care Excellence NICE [ 69 ] recommend lifelong, annual glucose level evaluations. Schenk, S. Efthimia Vlachaki. Women within the higher dietary glycemic index quartiles were more likely to be younger, multiparous, lower educated, had a higher pre-pregnancy BMI, higher total energy intake, and smoked more often during pregnancy. High maternal glucose concentrations from early pregnancy onwards may cause alterations in embryonic and placental development, and lead to an increased transfer of glucose to the developing fetus, predisposing to increased fetal growth and fat deposition and alterations in fetal metabolism. |
| GI and Pregnancy | Nutrient intakes were computed by multiplying the frequency response by the nutrient content of the specified portion sizes. Food composition values were obtained from the Harvard University Food Composition Database, which was derived from U. Department of Agriculture sources 11 and supplemented with information from the manufacturer. In the U. Department of Agriculture database, dietary fiber was determined by enzymatic-gravimetric methods The glycemic index is a relative measure of the glycemic impact of the carbohydrates in different foods The glycemic index values for single food items were based on available databases and publications 14 , 15 , with white bread as the reference food. Total glycemic load was calculated by first multiplying the carbohydrate content of each food by its glycemic index value, then by multiplying this value by the frequency of consumption and summing the values from all food. Dietary glycemic load thus represents the quality and quantity of carbohydrate intake and the interaction between the two. Dietary fiber, magnesium, glycemic load, and glycemic index were energy adjusted using the residual method Intakes of carbohydrate, protein, and fatty acids were expressed as nutrient density percent of total energy intake. Corrected correlation coefficients between the SFFQ and multiple dietary records for carbohydrate and fiber were 0. Correlations were also high for individual carbohydrate-rich food items e. The ability of the SFFQ to assess dietary glycemic index and glycemic load was documented in a study that evaluated the relations of these two variables to plasma concentrations of HDL cholesterol and triacylglycerol in women The concept of glycemic load as a direct measure of postprandial glycemia in healthy subjects has also been previously validated Participants provided sociodemographic, clinical, and lifestyle information biennially, including age, weight, and smoking status. We calculated BMI kilograms divided by the square of height in meters; the latter assessed at baseline only. Family history of diabetes was reported in only. Diagnosis of GDM was based on self-reported information in the biennial questionnaire. A previous validation study of GDM based on medical record review in this cohort demonstrated a high validity of self-reported diagnosis of GDM 4 , In brief, we reviewed medical records among a sample of women in the cohort who corroborated on a supplementary questionnaire that they had a first diagnosis of GDM in a singleton pregnancy between and We also sent supplementary questionnaires to women reporting a pregnancy uncomplicated by GDM during the same interval. In primary analyses, we created measures of cumulative average intakes of dietary fiber, dietary glycemic index, and glycemic load to present long-term intakes of these dietary variables of individual participants before GDM was reported. For instance, the intake was used for the follow-up between and , and the average of the and intake was used for the follow-up between and to reduce within-person variation. Relative risks RRs of GDM for each category of nutrient or food intake compared with the lowest category were estimated using Cox proportional hazards analysis stratified by 5-year age categories. We used information on covariates from the baseline or subsequent questionnaires in multivariate analyses. Because women with previous GDM were excluded from this study and women with a previous pregnancy uncomplicated by GDM are less likely than nulliparous women i. Covariates were updated during follow-up by using the most recent data for each 2-year follow-up interval. The significance of linear trends across categories of dietary intake was evaluated using the median value for each category of dietary intake analyzed as a continuous variable in multivariate models. All statistical analyses were performed by using SAS statistical software version 8. During 8 years of follow-up — , women reported a first diagnosis of GDM among the 13, study participants. Women who had a pregravid diet that was high in fiber and glycemic load were on average leaner, more physically active, and less likely to smoke. In addition, dietary fiber and glycemic load were positively related to dietary carbohydrate, magnesium, total iron, vitamin C, and vitamin E and inversely related to alcohol, total fat, and saturated, monounsaturated, and trans fatty acids Table 1. Dietary total fiber, in particular cereal and fruit fiber, intakes were strongly and inversely associated with GDM risk Table 2. The associations were most significant comparing women in the two extreme quintiles of dietary intakes. These inverse associations remained significant after further adjustment for the other sources of dietary fiber. Additional adjustment for dietary magnesium, vitamin C, and vitamin E intake did not change the results materially; the multivariate RRs for the highest compared with the lowest quintile were 0. No significant associations were observed for vegetable fiber and GDM risk in multivariate analysis, although there appears to be a reduction in the risk in the upper quintile. Dietary magnesium was inversely related to GDM risk after adjustment for BMI, but this inverse association was not statistically significant after further adjustment for other lifestyle and dietary factors especially dietary fiber. In post hoc analyses, we evaluated whether the observed lower GDM risk was related to fiber from any specific food group. The lower risk appeared predominantly related to higher fiber intake from dark breads. Dietary fruit intakes were significantly and inversely associated with GDM risk; the multivariate RR for the highest compared with the lowest quintile was 0. In stratified analyses, there was no evidence indicating that the inverse associations of GDM risk with total, cereal, and fruit fiber varied significantly according to BMI, physical activity, or family history of diabetes. Additionally, we restricted our analysis to nulliparous women and obtained similar results. Dietary glycemic load was significantly and positively associated with GDM risk after adjustment for nondietary and dietary covariates. When fat, protein, and total energy intake were held constant, dietary glycemic load represented the effect of substituting high—glycemic index carbohydrate for low—glycemic index carbohydrate on GDM risk model 2 for glycemic load, Table 2. Total carbohydrate intake was inversely associated with GDM risk after adjustment for age and BMI. However, this association, which might be due to a more healthy diet and lifestyle related to the greater health consciousness typically associated with a low-fat high-carbohydrate diet, disappeared after additional adjustment for lifestyle and other dietary factors. The association between dietary glycemic index alone and GDM risk was not statistically significant. We also examined the joint effect of dietary glycemic load and cereal fiber. After adjustment for age, BMI, physical activity, dietary factors, and other covariates, compared with women with a high intake of cereal fiber and low dietary glycemic load, those with low cereal fiber intake and high glycemic load had a 2. In this large prospective study of women, pregravid consumptions of dietary total fiber and cereal and fruit fiber were significantly and inversely associated with GDM risk. In contrast, dietary glycemic load was positively associated with GDM risk. These associations were most significant comparing women in the upper and lower quintiles of dietary intakes. Uncomplicated pregnancy is characterized by progressive hyperlipidemia, insulin resistance, and a deterioration of glucose tolerance in the third trimester. When studied postpartum, women who had GDM have greater insulin resistance than women who had uncomplicated pregnancies 26 , Further, sequential measurements of insulin sensitivity performed in the same women before pregnancy, early in the second trimester, and in the third trimester have documented insulin resistance in both lean and obese women who developed GDM later These findings indicated that most women who develop GDM had underlying insulin resistance to which the insulin resistance of pregnancy was partially additive Pregnancy-related metabolic challenges unmask a predisposition to glucose metabolic disorders in some women. Factors that contribute to insulin resistance or impaired insulin secretion before pregnancy and in early pregnancy can have a deleterious effect during pregnancy and be risk factors for GDM. There are several possible mechanisms that may explain the relationship between dietary fiber and glucose homeostasis. Increased dietary fiber may reduce appetite and lower total energy intake, thus reducing adiposity and improving insulin sensitivity 29 , Fiber intake may also delay gastric emptying 30 and slow glucose absorption, resulting in lesser absorption of glucose and lesser increases in insulin levels 29 , The beneficial effect of fiber on glucose homeostasis may be also due to delayed gastric emptying rate, slowed digestion, and absorption of food rich in fiber 30 and the subsequently reduced rate of glucose absorption and plasma insulin levels 29 , These benefits have been attributed primarily to soluble fiber, which creates a gel-like substance in the stomach Whole-grain and bran products from wheat and corn, the major source of cereal fiber in our cohort, typically contain insoluble fiber. Other characteristics of these sources of cereal fiber might also be important in glucose and lipid metabolism e. Epidemiological studies are unlikely to yield detailed evaluations of these pathways, and thus experimental studies are clearly warranted We are unaware of published studies that comprehensively examined the association of total dietary fiber and specific sources of fiber with GDM risk. The inverse relationship between total fiber and cereal fiber and the risk of GDM in the present study is consistent with findings from those studies of type 2 diabetes 5 — In addition, an inverse association with circulating levels of C-reactive protein 34 , 35 and a positive association with adiponectin 36 have been reported for total dietary fiber and cereal fiber. Both biomarkers have been associated with risks of GDM 37 , Notably, different from published studies on type 2 diabetes, fruit fiber was strongly associated with a reduced risk of GDM in the present study. In addition to fruit fiber, fruits comprise other components that were associated with reductions in GDM risk. It is plausible that the observed association between fruit fiber and GDM risk may be mediated through other components. For example, dietary vitamin C and plasma ascorbic acid levels have been inversely associated with GDM risk However, the association between fruit fiber and GDM risk remained significant after adjustment for dietary intakes of vitamin C and E and magnesium in the present study, although the association was slightly attenuated. Future studies are warranted to confirm these findings and decipher underlying mechanisms for the observed associations. Similar to most previous studies on type 2 diabetes 5 — 10 , we did not observe a significant association of vegetable fiber intakes with GDM risk. Taken together, these findings suggest that effects of dietary fiber may vary depending on food source. Both dietary glycemic index and load were used to characterize the capability of diet to induce postprandial glycemia. Although metabolic studies on the effect of glycemic index and load on insulin sensitivity and secretion have shown mixed results, regular consumption of meals higher in glycemic index was found to increase h blood glucose and insulin secretion levels 40 , Similarly, increases in dietary glycemic load induced both hyperglycemia and hyperinsulinemia Very few studies in this regard have been conducted among pregnant women. An association of low dietary glycemic index with lower levels of plasma glucose and HbA 1c was reported among pregnant women in a clinical trial 42 and in an observational study Findings from large prospective epidemiological studies on the association between glycemic index and load and type 2 diabetes risk have also been inconsistent. In joint analyses, the lowest risk of GDM was observed among those who consumed the highest amount of cereal fiber and lowest glycemic load. Misclassification of dietary exposure such as dietary fiber, glycemic index, and glycemic load is inevitable. However, these dietary data could not have been influenced by the subsequent development of GDM because of the prospective design of this study; this would be expected to attenuate the observed associations and would not explain the positive results. Our use of cumulative averages of dietary intakes reduced the influence of random error. Emily S. Miller: Placental pathology and MVM evidence. Miller, with Northwestern Medicine in Chicago. Inactivated COVID vaccines in pregnancy: No impact on neonatal outcome, study finds. A comprehensive cohort study explored the impact of inactivated COVID vaccines administered within 3 months before conception, revealing reassuring findings that neonatal outcomes, including preterm birth and NICU admission, remain unaffected. Model for predicting cesarean delivery in gestational diabetes. A recent study unveils a pragmatic model, incorporating factors such as insulin requirements, preeclampsia, and maternal age, to effectively predict primary cesarean delivery risk in pregnancies complicated by gestational diabetes mellitus. Medical World News. Peer Exchange. Conference Coverage. Conference Listing. Digital Supplements. Physician Fact Sheets. Interactive Tools. Sponsored Media. Sponsored Resources. Supplements and Featured Publications. Print Subscription. Editorial Board. STIs Cervical Health RSV Roundtable CMV: In the Know Supplement: Closing the Gap in Cervical Cancer Screening Vaginismus: Managing a Misunderstood and Underdiagnosed Condition Why vNOTES Make Sense for My Patients. Media Podcasts. Conferences Conference Coverage. Resources Physician Fact Sheets. Subscribe Print Subscription. Vulvovaginal Disease. Life Transitions. The women randomly assigned to the high—glycemic index diet, who did not meet the criteria to start insulin and, hence, had no diet changes, had no significant change in glycemic index during the course of the study. The women randomly assigned to the high—glycemic index diet, who met the criteria to start insulin and were changed to a low—glycemic index diet usually at or shortly after visit 2 , achieved a significant reduction in glycemic index by visit 3 and had a glycemic index value similar to that of the original low—glycemic index group by the final visit. There were no significant differences between the women in either group with respect to weight gain from baseline to delivery, induction of labor, method of delivery, or gestational age at delivery data not shown. For women in the low—glycemic index group, the birth centile Overall, there were no significant differences in obstetric and fetal outcomes between the two groups. The obstetric and fetal outcomes were further analyzed with respect to comparing women who were and were not receiving insulin for 1 women consuming a low—glycemic index diet, 2 women consuming a high—glycemic index diet, and 3 the two groups combined. There were no significant differences with respect to induction of labor, method of delivery, fetal centile, and ponderal index data not shown. Two recent reports have shown the advantages of a low—glycemic index diet for the management of individuals with type 2 diabetes 12 , Although evidence about the usefulness of a low—glycemic index diet in pregnancy is limited 14 , we have previously shown that consumption of a low—glycemic index diet from the beginning of the second trimester resulted in better fetal outcomes 7. The usual practice in our clinic has been to encourage low—glycemic index choices when offering MNT to women with GDM. However, this recommendation was based on clinical experience and had not been formally examined. We therefore decided to extend the observations about the potential benefits of a low—glycemic index diet in pregnancy to women with GDM. It was impossible to blind women to the glycemic index concept, as it is widely known and discussed in the lay press. The study criteria excluded any woman who was unwilling to follow the prescribed diet. The standard literature about GDM that was provided to all women wasrewritten to remove reference to the glycemic index of food. During recruitment and the consent process, it was carefully explained to all women that the best diet for the treatment of GDM was not known and that finding the best diet was the purpose of the study. Women randomly assigned to receive a low—glycemic index diet were able to lower the glycemic index of their diet rapidly and maintain this lower level for the duration of pregnancy. Women who were consuming a higher—glycemic index diet and, because they met the criteria to start insulin, were advised to change to a low—glycemic index diet also achieved this lower level rapidly and were able to maintain it for the duration of the pregnancy. The final glycemic index in both groups consuming a low—glycemic index diet was not significantly different. Fiber intake, which sometimes has been a confounding variable in determining the potential advantages of a low—glycemic index diet, was similar in both groups. Both groups of women self-restricted their energy intake and weight gain by reducing the amount of CHOs consumed. Women randomly assigned to initially consume a low—glycemic index diet had a significantly lower rate of insulin use. All women consuming the higher glycemic index diet who met the criteria to start insulin were changed to a low—glycemic index diet, and about half no longer met the criteria to start insulin and thus were able to avoid its use. Insulin use for the women with higher glycemic levels resulted in fetal centile and ponderal indexes that were not significantly different from those in the diet-treated groups. In contrast to our previous study in normal women, the low—glycemic index diet for women with GDM did not result in a significantly lower fetal centile or ponderal index. It is very probable that this result was related to the shorter duration of the diet for women with GDM compared with women starting the diet during the first trimester. However, demonstration of a difference was not the primary aim of the study, and it was not powered for this purpose. Although a trend was apparent, it is possible that a longer duration of a low—glycemic index diet may be required. In summary, a low—glycemic index diet for women with GDM is safe, well tolerated, and sustainable. A low—glycemic index diet significantly reduces the need for the use of insulin without compromise of obstetric or fetal outcomes. The costs of publication of this article were defrayed in part by the payment of page charges. Section solely to indicate this fact. This study was funded by internal revenue from the Illawarra Diabetes Service and the University of Sydney. is a coauthor of The New Glucose Revolution book series Hodder and Stoughton, London; Marlowe and Co, New York; and Hodder Headline, Sydney and elsewhere ; President of the GI Foundation, a nonprofit glycemic index—based food endorsement program in Australia; and Director of the University of Sydney glycemic index testing service. Sign In or Create an Account. Search Dropdown Menu. header search search input Search input auto suggest. filter your search All Content All Journals Diabetes Care. Advanced Search. User Tools Dropdown. Sign In. Skip Nav Destination Close navigation menu Article navigation. Volume 32, Issue 6. Previous Article Next Article. RESEARCH DESIGN AND METHODS. Article Navigation. Can a Low—Glycemic Index Diet Reduce the Need for Insulin in Gestational Diabetes Mellitus? Moses, MD ; Robert G. Moses, MD. Corresponding author: Professor Robert G. Moses, robert. moses sesiahs. This Site. Google Scholar. Megan Barker, APD ; Megan Barker, APD. Meagan Winter, APD ; Meagan Winter, APD. Peter Petocz, PHD ; Peter Petocz, PHD. Jennie C. Brand-Miller, PHD Jennie C. Brand-Miller, PHD. Diabetes Care ;32 6 — Article history Received:. Get Permissions. toolbar search Search Dropdown Menu. |
| Dietary Recommendations for Gestational Diabetes | The costs of publication of this article Nutritious antioxidant vegetables defrayed diabrtes part by dlabetes payment of gestayional charges. Glycemic load and gestational diabetes dietary glycemic index in liad second half Goycemic pregnancy Glycemic load and gestational diabetes diabeetes with an increased risk of delivering a small-for-gestational-age infant diabtes 9 ]. Small interventions studies among pregnant women with gestational diabetes, impaired glucose tolerance or obesity, have already shown that a lower glycemic index diet from the second half of pregnancy onwards improves maternal glucose concentrations and lowers the risk of delivering a large-for-gestational-age infant [ 1934 ]. Care9, e Contrary to these findings, several studies suggested that GI and GL indices were not significantly associated with GDM risk [ 56 ] [ 57 ]. These fetal adaptations may, subsequently, predispose to increased risks of adverse birth outcomes [ 1 ]. |
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