Effects of a low–glycemic load diet in overweight and obese pregnant women: a pilot randomized controlled trial1234

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

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From the Division of Endocrinology, Children's Hospital Boston, Boston, MA (ETR, DBP, CBE, HAF, MM Lovesky, EAC, MM Leidig, and DSL); the Department of Pediatrics, Harvard Medical School, Boston, MA (ETR, CBE, HAF, and DSL); the Juvenile Diabetes Research Foundation, St Leonards, Australia (DBP); the Department of Obstetrics, Gynecology, and Reproductive Biology, Beth Israel Deaconess Medical Center, Boston, MA (TCT); and the Floating Hospital for Children at Tufts Medical Center, Boston, MA (MM Leidig).

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ETR and DBP contributed equally as first authors.

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Supported by grants from the National Institute of Diabetes, Digestive and Kidney Diseases (R03DK073335); the Thrasher Research Fund; the National Institutes of Health (M01-RR01032, Beth Israel Deaconess Medical Center General Clinical Research Center); and the New Balance Foundation. Additional support to investigators included the National Institute of Diabetes, Digestive and Kidney Diseases grant K24DK082730. The funders played no role in the planning, implementation, data analysis, or interpretation of the research. Solo GI Nutrition Inc, British Columbia, Canada, supplied the Solo low–glycemic index snack bars used in the study.

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Address correspondence to DS Ludwig, Division of Endocrinology, Children's Hospital Boston, 300 Longwood Avenue, Boston, MA 02115. E-mail:[email protected].

Copyright © 2010 American Society for Nutrition. Published by Elsevier Inc. All rights reserved.