(P20-046-23) A Higher Complex-Carbohydrate Diet Lowers Metabolically Unfavorable Markers Associated With Gestational Diabetes Mellitus

Objectives: First-line, conventional dietary treatment for gestational diabetes (GDM) recommends a carbohydrate-restricted, higher fat diet to reduce postprandial glucose and mitigate glucose-mediated fetal macrosomia. However, a higher fat maternal diet may worsen insulin resistance (IR), impairing glucose uptake. Emerging studies have identified potentially impactful diet-sensitive metabolites associated with GDM, such as elevated aspartate and decreased deoxycholic acid have been associated with GDM risk and may confer worse IR.

Methods: We performed a targeted metabolomic analysis in a subset from the “Choosing Healthy Options in Carbohydrate Energy” (CHOICE) study which randomized GDM women to a CHOICE (60% complex carb/25% fat/15% protein) or a conventional diet (CONV, 40% carb/45% fat/15%) from diagnosis to delivery. All meals were provided, diets were eucaloric, and fiber content was similar. Plasma was collected at baseline (31 wks) and 36 wks (n=20 CHOICE; n=17 CONV) and subjected to targeted metabolomic analysis (n=527 metabolites; n=12 short chain fatty acids).

Results: Thirty-one metabolites were significantly different between diets (p < 0.05): species of ceramides (n=4), cholesterol esters (n=2), lysophosphatidyl choline (n=5), phosphatidyl choline (n=10), and triglycerides (n=6) as well as sphingomyelin C26:1, hexosylceramide d18:1/16:0, deoxycholic acid, and aspartate. Aspartate and one triglyceride species significantly decreased on CHOICE, but increased on CONV. The remaining 29 metabolites were increased in women on CHOICE. In contrast, CONV resulted in a slight decrease in concentration of these metabolites, and a smaller increase of the ceramide species than CHOICE.

Conclusions: These results suggest the CHOICE diet improves metabolic markers associated with GDM and IR compared to conventional GDM diet treatments.

Funding Sources: This study was supported by the National Institute of Diabetes, Digestive, and Kidney Diseases, American Diabetes Association/Glaxo Smith Kline Targeted Research Award, and Janssen Pharmaceuticals.