Division of Endocrinology, Children's Hospital Boston, Boston, MA, USA.
Am J Clin Nutr. 2010 Dec;92(6):1306-15. doi: 10.3945/ajcn.2010.30130. Epub 2010 Oct 20.
The optimal diet for pregnancy that is complicated by excessive weight is unknown.
We aimed to examine the effects of a low-glycemic load (low-GL) diet in overweight and obese pregnant women.
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.
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].
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.
超重或肥胖孕妇孕期的最佳饮食尚不清楚。
本研究旨在探讨低血糖负荷（low-GL）饮食对超重或肥胖孕妇的影响。
本研究将 46 名超重或肥胖孕妇随机分为低 GL 或低脂饮食组。通过上门投递或研究访问为参与者提供富含碳水化合物的食物、脂肪和零食。主要结局为出生体重 z 评分。其他终点包括婴儿人体测量指标、妊娠持续时间、产妇体重增加和产妇代谢参数。
两组间出生体重 z 评分或其他婴儿肥胖指标均无显著差异。然而，与低脂饮食组相比，低 GL 饮食组的妊娠持续时间更长（均值 ± SD：39.3 ± 1.1 周比 37.9 ± 3.1 周；P = 0.05），且发生 ≤ 38.0 周分娩的比例更低（13%比 48%，P = 0.02；不包括计划剖宫产分娩：5%比 53%；P = 0.002）。低 GL 饮食组婴儿头围更大（35.0 ± 0.8 cm 比 34.2 ± 1.3 cm，P = 0.01）。低 GL 组的甘油三酯[中位数（四分位数间距）：49（19，70）比 93（34，129）mg/dL；P = 0.03]和总胆固醇[13（0，36）比 33（22，56）mg/dL，P = 0.04]的增加幅度更小，C 反应蛋白[2.5（-5.5，-0.7）比-0.4（-1.4，1.5）mg/dL，P = 0.007]的降幅更大。
低 GL 饮食可延长妊娠时间，增加婴儿头围，并改善产妇心血管危险因素。需要开展大规模研究来评估孕期以降低 GL 为目标的饮食干预是否有助于预防早产和其他母婴不良结局。本试验在 clinicaltrials.gov 注册，编号为 NCT00364403。
