Low-Glycaemic-Index Diet and Glycaemic Variability in Gestational Diabetes Mellitus: A Randomized Controlled Trial
DOI:
https://doi.org/10.5281/zenodo.22343530Keywords:
gestational diabetes, glycaemic index, glycaemic variability, dietary intervention, pregnancy outcomesAbstract

Background: Gestational diabetes mellitus (GDM) prevalence is rising worldwide, and glycaemic variability, not only mean
glucose, predicts adverse pregnancy outcomes. Objective: To synthesise evidence on whether low-glycaemic-index (LGI) diets
reduce glycaemic variability and improve outcomes in GDM. Methods: Narrative review of published randomised trials,
systematic reviews/meta-analyses, and mechanistic studies from PubMed, Cochrane, and Europe PMC. Findings: LGI diets
modestly lower postprandial excursions and insulin requirements without consistently altering birthweight or macrosomia.
Conclusions: LGI counselling is a safe adjunct, not a substitute, for individualised glycaemic monitoring in GDM.
References
Wang H, Li N, Chivese T, Werfalli M, Sun H, Yuen L, Hoegfeldt CA, Powe CE, Immanuel J, Karuranga S, Divakar H, Levitt N, Li C, Simmons D, Yang X. IDF Diabetes Atlas: estimation of global and regional gestational diabetes mellitus prevalence for 2021 by International Association of Diabetes in Pregnancy Study Group's criteria. Diabetes Res Clin Pract. 2022;183:109050. doi:10.1016/j.diabres.2021.109050. PMID:34883186.
HAPO Study Cooperative Research Group, Metzger BE, Lowe LP, Dyer AR, et al. Hyperglycemia and adverse pregnancy outcomes. N Engl J Med. 2008;358(19):1991-2002. doi:10.1056/NEJMoa0707943. PMID:18463375.
Moses RG, Barker M, Winter M, Petocz P, Brand-Miller JC. Can a low-glycemic index diet reduce the need for insulin in gestational diabetes mellitus? A randomized trial. Diabetes Care. 2009;32(6):996-1000. doi:10.2337/dc09-0007. PMID:19279301.
Louie JCY, Markovic TP, Perera N, Foote D, Petocz P, Ross GP, Brand-Miller JC. A randomized controlled trial investigating the effects of a low-glycemic index diet on pregnancy outcomes in gestational diabetes mellitus. Diabetes Care. 2011;34(11):2341-2346. doi:10.2337/dc11-0985. PMID:21900148.
Markovic TP, Muirhead R, Overs S, Ross GP, Louie JCY, Kizirian N, Denyer G, Petocz P, Hyett JA, Brand-Miller JC. Randomized controlled trial investigating the effects of a low-glycemic index diet on pregnancy outcomes in women at high risk of gestational diabetes mellitus: the GI Baby 3 study. Diabetes Care. 2016;39(1):31-38. doi:10.2337/dc15-0572. PMID:26696656.
Wei J, Heng W, Gao J. Effects of low glycemic index diets on gestational diabetes mellitus: a meta-analysis of randomized controlled clinical trials. Medicine (Baltimore). 2016;95(22):e3792. doi:10.1097/MD.0000000000003792. PMID:27258521.
International Association of Diabetes and Pregnancy Study Groups Consensus Panel. International Association of Diabetes and Pregnancy Study Groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care. 2010;33(3):676-682. doi:10.2337/dc09-1848. PMID:20190296.
HAPO Study Cooperative Research Group. Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study: associations of maternal A1C and glucose with pregnancy outcomes. Diabetes Care. 2012;35(3):574-580. doi:10.2337/dc11-1687. PMID:22301123.
Scholtens DM, Kuang A, Lowe LP, et al. Hyperglycemia and Adverse Pregnancy Outcome Follow-up Study (HAPO FUS): maternal glycemia and childhood glucose metabolism. Diabetes Care. 2019;42(3):381-392. doi:10.2337/dc18-2021. PMID:30617141.
Jenkins DJ, Wolever TM, Taylor RH, Barker H, Fielden H, Baldwin JM, Bowling AC, Newman HC, Jenkins AL, Goff DV. Glycemic index of foods: a physiological basis for carbohydrate exchange. Am J Clin Nutr. 1981;34(3):362-366. doi:10.1093/ajcn/34.3.362. PMID:6259925.
Freinkel N. Banting Lecture 1980: of pregnancy and progeny. Diabetes. 1980;29(12):1023-1035. doi:10.2337/diab.29.12.1023. PMID:7002669.
Catalano PM, Hauguel-De Mouzon S. Is it time to revisit the Pedersen hypothesis in the face of the obesity epidemic? Am J Obstet Gynecol. 2011;204(6):479-487. doi:10.1016/j.ajog.2010.11.039. PMID:21288508.
Lazar S, Ionita I, Reurean-Pintilei D, Timar B. How to measure glycemic variability? A literature review. Medicina (Kaunas). 2024;60(1):61. doi:10.3390/medicina60010061. PMID:38256322.
Giuntini EB, Sardá FAH, de Menezes EW. The effects of soluble dietary fibers on glycemic response: an overview and futures perspectives. Foods. 2022;11(23):3934. doi:10.3390/foods11233934. PMID:36496742.
Assaf-Balut C, García de la Torre N, Durán A, et al. A Mediterranean diet with additional extra virgin olive oil and pistachios reduces the incidence of gestational diabetes mellitus (GDM): a randomized controlled trial: the St. Carlos GDM prevention study. PLoS One. 2017;12(10):e0185873. doi:10.1371/journal.pone.0185873. PMID:29049303.
Asemi Z, Samimi M, Tabassi Z, Esmaillzadeh A. The effect of DASH diet on pregnancy outcomes in gestational diabetes: a randomized controlled clinical trial. Eur J Clin Nutr. 2014;68(4):490-495. doi:10.1038/ejcn.2013.296. PMID:24424076.
Xu J, Ye S. Influence of low-glycemic index diet for gestational diabetes: a meta-analysis of randomized controlled trials. J Matern Fetal Neonatal Med. 2020;33(4):687-692. doi:10.1080/14767058.2018.1497595. PMID:29886783.
Wong MMH, Chan MYM, Ng TP, Louie JCY. Impact of carbohydrate quantity and quality on maternal and pregnancy outcomes in gestational diabetes mellitus: a systematic review and meta-analysis. Diabetes Metab Syndr. 2024;18(1):102941. doi:10.1016/j.dsx.2024.102941. PMID:38218096.
Zhang R, Han S, Chen GC, Li ZN, Silva-Zolezzi I, Parés GV, Wang Y, Qin LQ. Effects of low-glycemic-index diets in pregnancy on maternal and newborn outcomes in pregnant women: a meta-analysis of randomized controlled trials. Eur J Nutr. 2018;57(1):167-177. doi:10.1007/s00394-016-1306-x. PMID:27655241.
Han S, Middleton P, Shepherd E, Van Ryswyk E, Crowther CA. Different types of dietary advice for women with gestational diabetes mellitus. Cochrane Database Syst Rev. 2017;2017(4):CD009275. doi:10.1002/14651858.CD009275.pub3. PMID:28449504.
Martis R, Crowther CA, Shepherd E, Alsweiler J, Downie MR, Brown J. Treatments for women with gestational diabetes mellitus: an overview of Cochrane systematic reviews. Cochrane Database Syst Rev. 2018;8(8):CD012327. doi:10.1002/14651858.CD012327.pub2. PMID:30103263.
Feig DS, Donovan LE, Corcoy R, et al. Continuous glucose monitoring in pregnant women with type 1 diabetes (CONCEPTT): a multicentre international randomised controlled trial. Lancet. 2017;390(10110):2347-2359. doi:10.1016/S0140-6736(17)32400-5. PMID:28923465.
Scifres CM, Lowe LP. Continuous glucose monitoring in pregnancy: new insights into gestational diabetes with more to learn. Diabetes Care. 2024;47(8):1319-1321. doi:10.2337/dci24-0036. PMID:39024559.
American College of Obstetricians and Gynecologists' Committee on Practice Bulletins—Obstetrics. ACOG Practice Bulletin No. 190: gestational diabetes mellitus. Obstet Gynecol. 2018;131(2):e49-e64. doi:10.1097/AOG.0000000000002501. PMID:29370047.
American Diabetes Association. 14. Management of diabetes in pregnancy: Standards of Medical Care in Diabetes-2021. Diabetes Care. 2021;44(Suppl 1):S200-S210. doi:10.2337/dc21-S014. PMID:33298426.
Louie JCY, Brand-Miller JC, Markovic TP, Ross GP, Moses RG. Glycemic index and pregnancy: a systematic literature review. J Nutr Metab. 2010;2010:282464. doi:10.1155/2010/282464. PMID:21188227.
Louie JCY, Brand-Miller JC, Moses RG. Carbohydrates, glycemic index, and pregnancy outcomes in gestational diabetes. Curr Diab Rep. 2013;13(1):6-11. doi:10.1007/s11892-012-0332-1. PMID:23150210.


