Trial of Diet in Gestational Diabetes Mellitus: Metabolic Consequences to Mother and Offspring (CHOICE)

The rapidly rising risk of gestational diabetes pregnant women demands that an effective diet strategy be developed due to the high risk of fetal overgrowth, which places the newborn at increased risk for childhood obesity and metabolic syndrome. The aims of this randomized clinical trial are to compare the effects of an 8-wk isocaloric higher complex carbohydrate/lower fat diet vs. a conventional lower carbohydrate (higher fat) diet on glycemic and lipid profiles, maternal insulin resistance, placenta nutrient transporters, the maternal microbiome, neonatal intrahepatic fat, and neonatal total adiposity (primary outcome). The investigators will then follow the infants for 1-yr and measure maternal breast milk and infant microbiome composition to observe if they impact net fat mass gain differently in infants exposed to one diet vs. the other. Identifying a diet for gestational diabetes mellitus women that can effectively alter maternal/fetal metabolism is critical to reducing short- and long-term metabolic risk in this growing cohort of mothers and infants and has the potential to be applicable to overweight/obese pregnant women.

妊娠糖尿病（Gestational Diabetes Mellitus）孕妇的患病风险正快速攀升，且该疾病会带来胎儿过度生长的高风险，进而使新生儿日后罹患儿童肥胖与代谢综合征的风险显著升高，因此亟需开发有效的饮食干预策略。本随机对照试验（Randomized Clinical Trial）旨在比较8周等热量高复合碳水化合物/低脂肪饮食与传统低碳水化合物（高脂肪）饮食对血糖与血脂谱、母体胰岛素抵抗、胎盘营养转运蛋白、母体微生物组（microbiome）、新生儿肝内脂肪含量及新生儿总体脂肪量的影响（主要结局指标）。随后研究者将对受试婴儿进行为期1年的随访，检测母体母乳与婴儿微生物组的组成，以观察两种饮食暴露组婴儿的体脂净增长是否存在差异。针对妊娠糖尿病孕妇开发可有效调节母体与胎儿代谢的饮食方案，对于降低这一规模不断扩大的母婴队列群体的短期及长期代谢风险至关重要，且该方案有望推广应用于超重/肥胖孕妇人群。