title: Macronutrient Composition or Social Determinants? Impact on Infant Outcomes With Gestational Diabetes Mellitus.
abstract: The purpose of this study was to examine, through a randomized, controlled trial, the effects of a maternal carbohydrate-restricted diet on maternal and infant outcomes in gestational diabetes mellitus (GDM). Women diagnosed with GDM were randomly allocated into one of two groups: an intervention group that was placed on a lower-carbohydrate diet (35-40% of total calories) or a control group that was placed on the usual pregnancy diet (50-55% carbohydrate). A convenience sample of participants diagnosed with GDM (ages 18-45 years) was recruited from two different sites: one urban and low-income and the other suburban and more affluent. Individual face-to-face diet instruction occurred with certified diabetes educators at both sites. Participants tested their blood glucose four times daily. Specific socioeconomic status indicators included enrollment in the Supplemental Nutrition Program for Women, Infants and Children or Medicaid-funded health insurance, as well as cross-sectional census data. All analyses were based on an intention to treat. Although there were no differences found between the lower-carbohydrate and usual-care diets in terms of blood glucose or maternal-infant outcomes, there were significant differences noted between the two sites. There was a lower mean postprandial blood glucose (100.59 ± 7.3 mg/dL) at the suburban site compared to the urban site (116.3 ± 15 mg/dL) (P <0.01), even though there was no difference in carbohydrate intake. There were increased amounts of protein and fat consumed at the suburban site (P <0.01), as well as lower infant complications (P <0.01). Further research is needed to determine whether these disparities in outcomes were the result of macronutrient proportions or environmental conditions.
authors.affiliation: University of Pennsylvania School of Nursing, Philadelphia, PA.
authors.forename: Kimberly K
authors.initials: KK
authors.lastname: Trout
authors.affiliation: Temple University School of Medicine, Philadelphia, PA.
authors.forename: Carol J
authors.initials: CJ
authors.lastname: Homko
authors.affiliation: Villanova University, Villanova, PA.
authors.forename: Lisa
authors.initials: L
authors.lastname: Wetzel-Effinger
authors.affiliation: Temple University School of Medicine, Philadelphia, PA.
authors.forename: Wadia
authors.initials: W
authors.lastname: Mulla
authors.affiliation: Drexel University, Philadelphia, PA.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Mora
authors.affiliation: Villanova University, Villanova, PA.
authors.forename: Joanna
authors.initials: J
authors.lastname: McGrath
authors.affiliation: University of Pennsylvania Health System, Philadelphia, PA.
authors.forename: Lisa
authors.initials: L
authors.lastname: Basel-Brown
authors.affiliation: Villanova University, Villanova, PA.
authors.forename: Angelina
authors.initials: A
authors.lastname: Arcamone
authors.affiliation: Temple University School of Medicine, Philadelphia, PA.
authors.forename: Parichehr
authors.initials: P
authors.lastname: Sami
authors.affiliation: Georgetown University, Washington, DC.
authors.forename: Kepher H
authors.initials: KH
authors.lastname: Makambi