School of Life and Environmental Sciences, The University of Sydney, Sydney, Australia.
Boden Collaboration Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
Am J Clin Nutr. 2020 Aug 1;112(2):284-292. doi: 10.1093/ajcn/nqaa137.
Lower carbohydrate diets have the potential to improve glycemia but may increase ketonemia in women with gestational diabetes (GDM). We hypothesized that modestly lower carbohydrate intake would not increase ketonemia.
To compare blood ketone concentration, risk of ketonemia, and pregnancy outcomes in women with GDM randomly assigned to a lower carbohydrate diet or routine care.
Forty-six women aged (mean ± SEM) 33.3 ± 0.6 y and prepregnancy BMI 26.8 ± 0.9 kg/m2 were randomly assigned at 28.5 ± 0.4 wk to a modestly lower carbohydrate diet (MLC, ∼135 g/d carbohydrate) or routine care (RC, ∼200 g/d) for 6 wk. Blood ketones were ascertained by finger prick test strips and 3-d food diaries were collected at baseline and end of the intervention.
There were no detectable differences in blood ketones between completers in the MLC group compared with the RC group (0.1 ± 0.0 compared with 0.1 ± 0.0 mmol/L, n = 33, P = 0.31, respectively), even though carbohydrate and total energy intake were significantly lower in the intervention group (carbohydrate 165 ± 7 compared with 190 ± 9 g, P = 0.04; energy 7040 ± 240 compared with 8230 ± 320 kJ, P <0.01, respectively). Only 20% of participants in the MLC group met the target intake compared with 65% in the RC group (P <0.01). There were no differences in birth weight, rate of large-for-gestational-age infants, percent fat mass, or fat-free mass between groups.
An intervention to reduce carbohydrate intake in GDM did not raise ketones to clinical significance, possibly because the target of 135 g/d was difficult to achieve in pregnancy. Feeding studies with food provision may be needed to assess the benefits and risks of low-carbohydrate diets. This trial was registered at www.anzctr.org.au as ACTRN12616000018415.
低碳水化合物饮食有可能改善血糖水平，但可能会增加患有妊娠糖尿病（GDM）的女性的酮血症。我们假设适度减少碳水化合物的摄入不会增加酮血症。
比较随机分配到低碳水化合物饮食或常规护理的 GDM 女性的血液酮浓度、酮血症风险和妊娠结局。
46 名年龄（平均值±SEM）为 33.3±0.6 岁、孕前 BMI 为 26.8±0.9 kg/m2 的女性在 28.5±0.4 孕周时被随机分配到适度低碳水化合物饮食（MLC，约 135 g/d 碳水化合物）或常规护理（RC，约 200 g/d）组，干预时间为 6 周。通过指尖采血试验条检测血液酮，在基线和干预结束时收集 3 天的食物日记。
在 MLC 组完成干预的女性与 RC 组相比，血液酮水平没有差异（0.1±0.0 与 0.1±0.0 mmol/L，n=33，P=0.31），尽管干预组的碳水化合物和总能量摄入显著降低（碳水化合物 165±7 与 190±9 g，P=0.04；能量 7040±240 与 8230±320 kJ，P<0.01）。只有 20%的 MLC 组参与者达到目标摄入量，而 RC 组为 65%（P<0.01）。两组间的出生体重、巨大儿发生率、体脂肪百分比或去脂体重无差异。
在 GDM 中减少碳水化合物摄入的干预措施并未使酮体升高到临床显著水平，可能是因为 135 g/d 的目标难以在妊娠期间达到。可能需要进行提供食物的喂养研究来评估低碳水化合物饮食的益处和风险。该试验在 www.anzctr.org.au 注册，注册号为 ACTRN12616000018415。
