Effect of Macronutrient Preload Intervention on Glycaemic Control
and Pregnancy Outcome in Gestational Diabetes, GDM
Magnus Sederholm, Peng Liu, Jingjing Cai, Qianying Guo, Boshi Wang, Gunnar Norstedt
Clinical Nutrition Department, Peking University People’s Hospital. CMM Karolinska Institutet, Stockholm, Sweden
Objective
To compare the effect of macronutrient preload with
conventional nutritional intervention in patients with GDM.
Conclusions, clinical value
Our study show that macronutrient preload treatment can
safely be given to patients with GDM. We demonstrate that
elevated blood glucose is stabilized faster at a lower level in
the preload treated group compared to the control group,
significant in women >30 years and in those with high pregestational BMI. The earlier stabilization of blood sugar is
related to lower birth weight, and is shown to reduce various
risks both during birth, such as caesarean delivery, and long
term such as T2DM, for the mother, foetus and child.
Future perspectives
Macronutrient preload is a promising method for treatment of
gestational diabetes, GDM
GDM – Increasing prevalence - risks for mother and child
Gestational diabetes mellitus (GDM) is defined as any degree
of glucose intolerance with onset or first discovery during
pregnancy. The reported prevalence of GDM differs greatly
between countries, ranging from 2-14 %. Untreated GDM is
associated with serious risks for the mother and child,
including long-term risks. GDM screening has become more
established and new diagnostic criteria are introduced
worldwide. Medical Nutrition Therapy (MNT) can control the
blood glucose level of patients with type 2 diabetes mellitus
and should be tested as first line treatment in GDM as to
reduce the need for insulin and reduce gestational and
perinatal complications.
Methods
40 patients (24-28 gestational weeks, single live birth) with
GDM were selected randomly and 25 subjects were placed in
the experimental group that was given macronutrient preload
treatment in addition to health education and dietary
guidance. A control group of 15 subjects was given health
education and dietary guidance. Macronutrient preload was
given three times a day, 30 minutes before each regular meal.
The preload treatment consisted of a mixture of high quality
nutrients and was provided continued until term. Participants
were subjected to different analytical procedures including
general physical examination and laboratory analysis (HbA1c,
fasting blood sugar every morning and 2-hour postprandial
blood sugar after each meal) and pregnancy outcome
(delivery mode, fetal macrosomia, birth weight etc).
Macronutrient Preload
Macronutrient preload treatment provides a small amount of
nutrients before regular meals. This has been shown to
induce the release of incretin hormones such as GLP-1 and
GIP earlier, with the result that pancreas releases insulin
earlier. As a consequence the plasma glucose response is
attenuated, and the AUC is lower compared to controls.
Pregnancy Outcome and Blood Glucose Control of Different Age
* P<0.05
Pregnancy Outcome and Blood Glucose Control of Different BMI
* P<0.05
References
Ma J, Stevens JE, Cukier K, et, al. Effects of a protein preload on gastric emptying, glycemia, and gut hormones after a carbohydrate meal in diet-controlled type 2 diabetes. Diabetes Care. 2009, 32(9):1600-1602
Li Li, Jing Xu, Wenyi Zhu, Rong Fan, Qian Bai, Chen Huang, Jun Liu, Zhen Li, Magnus Sederholm, Gunnar Norstedt, Jian Wang. Effect of a macronutrient preload on blood glucose level and pregnancy outcome in
gestational diabetes. Journal of Clinical & Translational Endocrinology 5 (2016) 36–4
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