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Lower glycemic load meals reduce diurnal glycemic oscillations in women with risk factors for gestational diabetes
  1. Nathalie V Kizirian1,2,
  2. Janina Goletzke1,2,3,
  3. Shannon Brodie1,2,4,
  4. Fiona S Atkinson1,2,
  5. Tania P Markovic4,5,
  6. Glynis P Ross5,6,
  7. Anette Buyken3,
  8. Jennie C Brand-Miller1,2,4
  1. 1Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
  2. 2School of Life and Environmental Sciences, The University of Sydney, Sydney, New South Wales, Australia
  3. 3IEL-Nutritional Epidemiology, University of Bonn, DONALD Study, Dortmund, Germany
  4. 4Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, The University of Sydney, Sydney, New South Wales, Australia
  5. 5Department of Endocrinology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
  6. 6Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
  1. Correspondence to Professor Jennie C Brand-Miller; jennie.brandmiller{at}


Objective Maternal glycemia plays a key role in fetal growth. We hypothesized that lower glycemic load (GL) meals (lower glycemic index, modestly lower carbohydrate) would substantially reduce day-long glucose variability in women at risk of gestational diabetes mellitus (GDM).

Research design and methods A crossover study of 17 women (mean±SD age 34.8±4 years; gestational weeks 29.3±1.3; body mass index 23.8±4.7 kg/m2) who consumed a low GL or a high GL diet in random order, 1-day each, over 2 consecutive days. Diets were energy-matched and fiber-matched with 5 meals per 24 hours. All food was provided. Continuous glucose monitoring was used to assess diurnal glycemia.

Results Maternal glucose levels were 51% lower on the low GL day with lower incremental area under the curve (iAUC±SEM 549±109 vs 1120±198 mmol/L min, p=0.015). Glycemic variability was significantly lower on the low GL day, as demonstrated by a lower average SD (0.7±0.1 vs 0.9±0.1, p<0.001) and lower mean amplitude of glycemic excursions (2.1±0.2 vs 2.7±0.2 mmol/L, p<0.001).

Conclusions A lower GL meal plan in pregnancy acutely halves day-long maternal glucose levels and reduces glucose variability, providing further evidence to support the utility of a low GL diet in pregnancy.

  • Gestational Diabetes Mellitus
  • Continuous Glucose Monitoring
  • Pregnancy
  • Glycemic Index

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  • Contributors JPB-M, NVK, AB, JG, GPR, and TPM conceived and designed the study; NVK and JG researched the data; NVK analyzed the data and wrote the manuscript; SB designed the diets; and FSA was involved in the design of the diets and generated the incremental area under the curve. All authors reviewed and approved the final manuscript. JPB-M is the guarantor of this work and takes responsibility for the contents of the article.

  • Competing interests JPB-M is the President of the Glycemic Index Foundation, Director of the Sydney University Glycemic Index Research Service and author of popular books about the glycemic index of foods. FSA is a director of the Glycemic Index Foundation, manages the Sydney University Glycemic Index Research Service and is a coauthor of popular books about the glycemic index of foods. No other potential conflicts of interest relevant to this article are declared.

  • Ethics approval Sydney South West Area Health Service (RPAH Zone).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.

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