Nutrition during pregnancy has a profound impact on the health of both, the mother and her child. Pregnant women begin thinking for two, and often become more conscious and dedicated to following a healthier diet. Besides the supply of essential nutrients and energy, a healthy and balanced nutrition during pregnancy should aim for stable blood sugar levels as well, with lower blood glucose excursions after meals and throughout the day. With 1 in 7 births affected by gestational diabetes mellitus (GDM) worldwide, maternal blood sugar management becomes increasingly relevant (IDF 2017).
Relevance of gestational diabetes to mother and child
Gestational diabetes mellitus (DGM) describes a form of diabetes mellitus which is characterized by a “glucose intolerance with onset or first recognition during pregnancy.“ The number of people developing gestational diabetes increases worldwide with the rising type 2 diabetes epidemic. Other risk factors include obesity, the occurrence of previous GDM, a family history of diabetes mellitus, and ethnic background (IDF 2017).
While gestational diabetes mellitus commonly ceases after giving birth, it increases the risk of developing type-2 diabetes mellitus after birth (5-10% of GDM women), or later in life (35%-60% of GDM women). Also the infant can be affected by elevated maternal blood sugar levels. Adverse outcomes include the development of fetal hyperinsulinemia, high birth weight and excess growth, or an increased future risk of developing obesity, diabetes mellitus, and cardiovascular diseases (CVD) (Louie et al 2013, Zhang et al 2016). In light of this, the International Diabetes Federation advises:
“Pregnant women with diabetes or at high risk of GDM should manage their glycaemia throughout their pregnancy to avoid long-term consequences for themselves and their children” (IDF 2018).
Figure: Gestational diabetes mellitus (GDM) risk factors and adverse health outcomes (adopted from Louie et al 2013)
Preference for a diet with low GI carbohydrates
Scientific evidence supports the value of following a carbohydrate-based, low glycemic diet during pregnancy: It can reduce the risk of developing gestational diabetes mellitus , improve maternal management of gestational diabetes mellitus, and reduce negative outcome in infants.
For instance, Zhang et al (2006) found that the risk for gestational diabetes mellitus was significantly higher when women consumed a high-glycemic diet. Moses et al (2009, 2006, 2007) reported that a low-glycemic diet significantly reduced the need for insulin, and found a significantly higher birth weight percentile in infants of mothers with a high-glycemic diet. After 2 years, toddlers from the high-glycemic group were still heavier. Many more studies have been published since then, which were reviewed by Zhang et al in 2018. His meta-analysis over 11 trials and in total nearly 2000 women confirm the benefits of low-GI diets for maternal blood glucose control, with significant reductions in fasting and 2-h postprandial glucose levels, and for the infant outcome, showing reduce gestational weight gain and birth weight, and a lower proportion of babies born large for gestational age.
In accordance with the science, the IDF Global Guidelines on Pregnancy and Diabetes (2009) advise: “Changing the nature of the carbohydrates consumed, particularly with respect to the use of foods with a low glycaemic index (GI), can reduce the postprandial excursions.“ They further state that “whenever possible, carbohydrate intake should include foods with a low glycemic index”.
Reducing blood sugar levels with isomaltulose
With its low effect on blood glucose levels and insulin, isomaltulose serves as a suitable option to support blood sugar management during pregnancy. Consuming isomaltulose in place of high-GI carbohydrates can reduce blood sugar spikes after a meal, and so contribute to a low-glycemic diet, In healthy conditions and also in conditions of impaired glucose tolerance and diabetes mellitus. Furthermore, isomaltulose creates a lower and smoother endocrine profile and an improved metabolic profile for healthy development during pregnancy, as well as the prevention and management of gestational diabetes.
References
IDF International Diabetes Federation (2009) Global Guideline on Pregnancy and Diabetes. Brussels, Belgium. Link: https://www.idf.org/e-library/guidelines/84-pregnancy-and-diabetes.html
IDF International Diabetes Federation (2017) IDF Diabetes Atlas, 8th ed. Brussels, Belgium. Link: http://www.diabetesatlas.org/
IDF International Diabetes Federation (2018) Care & prevention – improving the quality of life of people with diabetes and those at risk: Gestational Diabetes. Website information retrieved in October 2018. Link: https://www.idf.org/our-activities/care-prevention/gdm
Louie JC, Brand-Miller JC, Moses RG (2013) Carbohydrates, glycemic index, and pregnancy outcomes in gestational diabetes. Curr Diab Rep 13(1):6-11. doi: 10.1007/s11892-012-0332-1.
Maresch CC, Petry SF, Theis S, Bosy-Westphal A, Linn T (2017) Low glycemic index prototype isomaltulose – update of clinical trials. Nutrients 9(4). pii: E381-393. doi: 10.3390/nu9040381.
Moses RG, Barker M, Winter M, Petocz P, Brand-Miller JC (2009) Can a low-glycemic index diet reduce the need for insulin in gestational diabetes mellitus? A randomized trial. Diabetes Care 32(6):996-1000. doi: 10.2337/dc09-0007.
Moses RG, Luebcke M, Davis WS, Coleman KJ, Tapsell LC, Petocz P, Brand-Miller JC (2006) Effect of a low-glycemic-index diet during pregnancy on obstetric outcomes. Am J Clin Nutr 84(4):807-12.
Moses RG, Luebke M, Petocz P, Brand-Miller JC (2007) Maternal diet and infant size 2 y after the completion of a study of a low-glycemic-index diet in pregnancy. Am J Clin Nutr 86(6):1806.
Zhang C, Liu S, Solomon CG, Hu FB (2006) Dietary fiber intake, dietary glycemic load, and the risk for gestational diabetes mellitus. Diabetes Care 29(10):2223-30.
Zhang R, Han S, Chen GC, Li ZN, Silva-Zolezzi I, Pares GV, Wang Y, Qin LQ (2018) 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 57(1):167–177. https://doi.org/10.1007/s00394-016-1306-x