Writing in the journal Diabetes Research and Clinical Practice, researchers said an adaptable, economical approach to nutrition that effectively controls maternal glycaemia – while also promoting normal foetal growth – would have ‘far-reaching implications.’
“The conventional focus has been to rigidly limit all types of carbohydrate,” noted the team – led by Teri Hernandez from the University of Colorado. “While controlling glucose, this approach fosters maternal anxiety and is a primary barrier to adherence.”
Furthermore, the team noted that many mothers simply substitute fat for carbohydrate, which can unintentionally enhance the breakdown and release of free fatty acids (FFA), and worsen maternal insulin resistance (IR).
“Nutrition that worsens IR may facilitate nutrient shunting across the placenta, promoting excess foetal fat accretion,” said the authors.
Indeed, the US-based experts suggest recent evidence shows a less carbohydrate-restricted approach that focuses on higher quality carbohydrates may not only improve adherence to diets that aim to beat gestational diabetes (GDM), but could also result in lower fat intakes and ‘appropriate caloric intake.’
“A less carbohydrate-restrictive approach to nutrition therapy in GDM can be adapted to fit cultural diet preferences, lessening diagnosis-provoked anxiety, boosting compliance, and avoiding unintended consequences associated with compensatory higher fat intake,” they report.
Furthermore, Hernandez and colleagues suggest that research is needed to better understand the effect of macronutrient composition on the placenta and gut microbiome, and whether precision-nutrition is beneficial in pregnancy.
“Nutrition directly affects the maternal gut microbiome, which is passed to the infant and has been shown to promote an obesigenic phenotype with a high fat simple carbohydrate diet; extensive research is underway and will likely be highly informative,” they confirmed.
“Newer research in personalized medicine may revolutionize our ability to optimize nutrition therapy in GDM,” they added. “However, until this is achievable, we can at least attempt to maximise cultural adaptability, better address the socioeconomic considerations, and adopt a less restrictive approach that allows greater flexibility in choosing healthier foods designed to stabilize weight and promote good metabolic health far beyond the gestational window.”
Source: Diabetes Research and Clinical Practice
Published online ahead of print, doi: 10.1016/j.diabres.2018.04.004
“Nutrition therapy within and beyond gestational diabetes”
Authors: Teri L. Hernandez, et al