Zhu Tianli, Liu Jingjing, Fan Tuyan, Gao Hui, Yan Shuangqin, Jia Xiaomin, Yang Fengyu, Ding Ziwei, Wang Le, Zhao Lanfang, Zhu Peng, Tao Fangbiao, Zhu Beibei
Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei, 230032, Anhui, China.
Key Laboratory of Population Health Across Life Cycle, Anhui Medical University, Ministry of Education of the People's Republic of China, No. 81 Meishan Road, Hefei, 230032, Anhui, China.
Acta Diabetol. 2025 Aug;62(8):1247-1259. doi: 10.1007/s00592-025-02445-y. Epub 2025 Jan 31.
While guidelines recommend bedtime snacks for women with gestational diabetes mellitus (GDM), there is insufficient evidence championed those recommendation.
To evaluate if bedtime snacking is effective in preventing high fasting blood glucose incidence among women with GDM.
An open-label, parallel-group, randomized controlled trial was conducted from December 2023 to July 2024 at Ma'anshan Maternal and Child Health Care Center, Anhui, China.
A total of 62 GDM cases at the nutrition clinics were enrolled, and were randomly and equally allocated to groups of bedtime snacks (25 g nuts, intervention group) and no bedtime snacks (control group). The intervention was lasted for 8 weeks, during which fasting blood glucose was measured 3 times per week, 1-hour postprandial glucose and 2-hour postprandial glucose 2 times per week with a home glucometer. In the late pregnancy (approximately at 34 weeks), the glycated haemoglobin, high-density lipoprotein, low-density lipoprotein, triglycerides, total cholesterol were measured in the laboratory and birth outcomes information (birth weight, gestational weeks at delivery, delivery mode) were collected.
The primary outcomes were the level of fasting blood glucose and the hyper-fasting blood glucose incidence during 8-week duration. The secondary outcomes were the level of the glycated haemoglobin, high-density lipoprotein, low-density lipoprotein, triglycerides and total cholesterol in the late pregnancy. Generalized estimating equations and analysis of covariates were conducted for the analysis of the primary outcomes. The multivariate linear regression was conducted for the analysis of the secondary outcomes. Post-hoc analysis was also conducted for the indicators of 1-hour postprandial glucose, 2-hour postprandial glucose and perinatal outcomes applying generalized estimating equations, analysis of covariates, the multivariate linear regression and logistics regression.
After adjusting for maternal age, pre-pregnancy body mass index, mid-pregnancy glucose, mid-pregnancy blood lipids and diet in late pregnancy, neither the average fasting blood glucose (control group: 4.90 mmol l, intervention group: 4.96 mmol l) (β = 0.05, [95%CI-0.22 to 0.31], P = 0.720) nor hyper-fasting blood glucose incidence (control group: 0.19, intervention group:0.26) (β = 0.07, [95%CI-0.07 to 0.20], P = 0.335) were significant different between the two groups. And we found low-density lipoprotein level were higher in the intervention group (3.21 mmol l) compared to the control group (2.52 mmol l) (β = 0.70, [95%CI0.07 to 1.34], P = 0.031). Additionally, post-hoc analysis showed that the incidence of elevated 1-hour postprandial glucose was significantly higher in the intervention group (0.42) than in the control group (0.28) (β = 0.14, [95%CI0.01 to 0.27], P = 0.036). No difference was found regarding any perinatal outcomes between the two groups.
Bedtime snack did not reduce the risk of morning hyperglycaemia and adverse perinatal outcomes in women with gestational diabetes mellitus, but exacerbated lipid markers and the 1-hour postprandial glucose profile. Our study did not support clinicians and relevant guidelines to recommend bedtime snacking as a form of glycaemic control in women with GDM. Clinical trial identification number: ChiCTR2300078399. URL of the registration site: https://www.chictr.org.cn/bin/project/edit?pid=210400 .
虽然指南建议为妊娠期糖尿病（GDM）女性提供睡前小吃，但支持该建议的证据不足。
评估睡前吃小吃对预防GDM女性空腹血糖升高发生率是否有效。
2023年12月至2024年7月在中国安徽马鞍山妇幼保健中心进行了一项开放标签、平行组、随机对照试验。
营养门诊共纳入62例GDM病例，随机等分为睡前吃小吃组（25克坚果，干预组）和不吃睡前小吃组（对照组）。干预持续8周，在此期间，每周用家用血糖仪测量3次空腹血糖，每周测量2次餐后1小时血糖和餐后2小时血糖。在妊娠晚期（约34周），在实验室测量糖化血红蛋白、高密度脂蛋白、低密度脂蛋白、甘油三酯、总胆固醇，并收集分娩结局信息（出生体重、分娩孕周、分娩方式）。
主要结局为8周期间空腹血糖水平和空腹血糖升高发生率。次要结局为妊娠晚期糖化血红蛋白、高密度脂蛋白、低密度脂蛋白、甘油三酯和总胆固醇水平。采用广义估计方程和协变量分析对主要结局进行分析。采用多元线性回归对次要结局进行分析。还采用广义估计方程、协变量分析、多元线性回归和逻辑回归对餐后1小时血糖、餐后2小时血糖指标和围产期结局进行事后分析。
在调整了产妇年龄、孕前体重指数、孕中期血糖、孕中期血脂和妊娠晚期饮食后，两组之间的平均空腹血糖（对照组：4.90 mmol/L，干预组：4.96 mmol/L）（β = 0.05，[95%CI - 0.22至0.31]，P = 0.720）和空腹血糖升高发生率（对照组：0.19，干预组：0.26）（β = 0.07，[95%CI - 0.07至0.20]，P = 0.335）均无显著差异。并且我们发现干预组的低密度脂蛋白水平（3.21 mmol/L）高于对照组（2.52 mmol/L）（β = 0.70，[95%CI 0.07至1.34]，P = 0.031）。此外，事后分析显示，干预组餐后1小时血糖升高的发生率（0.42）显著高于对照组（0.28）（β = 0.14，[95%CI 0.01至0.27]，P = 0.036）。两组之间的任何围产期结局均未发现差异。
睡前吃小吃并不能降低妊娠期糖尿病女性早晨高血糖风险和不良围产期结局，反而会加重脂质指标和餐后1小时血糖情况。我们的研究不支持临床医生和相关指南推荐睡前吃小吃作为GDM女性血糖控制的一种方式。临床试验识别号：ChiCTR2300078399。注册网站网址：https://www.chictr.org.cn/bin/project/edit?pid=210400 。
