Poster Presentation International Association of the Diabetes and Pregnancy Study Groups 2022 - Hosted by ADIPS

Does Providing Fruit and Vegetables, or Supermarket Vouchers Increase Adherence to a Reduced Carbohydrate Diet in Women with Gestational Diabetes? (#81)

Tutangi Amataiti 1 , Fiona Hood 1 , Jeremy D Krebs 1 , Mark Weatherall 1 , Rosemary M Hall 1
  1. University of Otago, Wellington, WELLINGTON, New Zealand

Background: Recommended carbohydrate (CHO) consumption in pregnancy is <175g/day; however many women consume significantly lower amounts1. Beneficial effects on glycaemic control and pregnancy weight gain have been reported in women with gestational diabetes (GDM) following a reduced carbohydrate (CHO) diet2–4, but maternal and fetal outcomes, or micronutrient adequacy, remain uncertain5,6.

Aims: To explore whether adherence to a reduced CHO diet is improved, and micronutrient adequacy met, by the provision of weekly fruit and vegetables or food vouchers, for those with GDM.

Participants/methods: A randomised controlled trial recruited women with newly diagnosed GDM, to one of three interventions: i) provision of weekly fruit and vegetables, provided at no cost or ii) weekly supermarket vouchers or iii) supermarket vouchers to an equivalent value provided at the end of the study. Participants had weekly reviews with a dietitian. The primary outcome variable was CHO intake assessed by a food diary, at baseline, and at 36 weeks gestation. Secondary outcomes were the evaluation of micronutrient adequacy by food diaries.  

Results: There were 20 participants recruited at a mean (SD) 30.9 (1.6) weeks gestation, age 34.7 (5.2) years, and pre-pregnancy BMI of 28.3 (5.8) kg/m2. There were no statistically significant differences in CHO or micronutrient intake between the three intervention groups. For all participants combined there was significant reduction in CHO intake at 36 weeks gestation, 136 (19) g/day compared to baseline, 165 (47) g/day; paired difference (95% CI) 29 (7.2 to 49.8), P=0.011. There was also a difference in sugar intake at 36 weeks gestation; 49 (14) g/day compared to baseline, 59 (23) g/day; paired difference 10 (0.06 to 20.7), P = 0.049. There were no significant differences in micronutrient, fibre, or energy intake at 36 weeks compared to baseline. The frequency of ketones remained unchanged during the intervention compared to baseline.

Conclusion: Providing fruit and vegetables at no cost did not increase adherence to a low CHO diet, compared to usual food provision. However, over all groups combined there was evidence of a 29 g/day reduction in CHO intake compared to baseline and an associated reduction in sugar intake of 10 g/day, with no detrimental effect on micronutrients. Dietitian support may be the most important factor to encourage women with GDM to successfully follow a low CHO diet.

  1. 1. Ásbjörnsdóttir B, Ronneby H, Vestgaard M, et al. Lower daily carbohydrate consumption than recommended by the Institute of Medicine is common among women with type 2 diabetes in early pregnancy in Denmark. Diabetes Res Clin Pract. 2019;152:88-95. doi:10.1016/j.diabres.2019.05.012
  2. 2. Moreno-Castilla C, Hernandez M, Bergua M, et al. Low-Carbohydrate Diet for the Treatment of Gestational Diabetes Mellitus: A randomized controlled trial. Diabetes Care. 2013;36(8):2233-2238. doi:10.2337/dc12-2714
  3. 3. Cypryk K, Kamińska P, Kosiński M, Pertyńska-Marczewska M, Lewiński A. A comparison of the effectiveness, tolerability and safety of high and low carbohydrate diets in women with gestational diabetes. Endokrynol Pol. 2007;58(4):314-319.
  4. 4. Major CA, Henry MJ, De Veciana M, Morgan MA. The effects of carbohydrate restriction in patients with diet-controlled gestational diabetes. Obstet Gynecol. 1998;91(4):600-604.
  5. 5. Sweeting A, Mijatovic J, Brinkworth GD, et al. The Carbohydrate Threshold in Pregnancy and Gestational Diabetes: How Low Can We Go? Nutrients. 2021;13(8):2599. doi:10.3390/nu13082599
  6. 6. Farabi SS, Hernandez TL. Low-Carbohydrate Diets for Gestational Diabetes. Nutrients. 2019;11(8). doi:10.3390/nu11081737