Impact of Carbohydrate Counting Method during Pregnancy in Women with Pregestational Diabetes Mellitus: A Controlled Clinical Trial

Oliveira, Larissa Mello de; Belfort, Gabriella Pinto; Padilha, Patricia de Carvalho; Rosado, Eliane Lopes; Silva, Letícia Barbosa Gabriel da; Fagherazzi, Sanmira; Zajdenverg, Lenita; Zagury, Roberto Luís; Saunders, Claudia

doi:10.1055/s-0042-1742291

Larissa Mello de Oliveira

Programa de Pós-graduação em Nutrição do Instituto de Nutrição Josué de Castro da Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro - RJ, Brazil

http://orcid.org/0000-0001-9870-2358

Gabriella Pinto Belfort

Programa de Pós-graduação em Nutrição do Instituto de Nutrição Josué de Castro da Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro - RJ, Brazil

http://orcid.org/0000-0003-2066-7446

Patricia de Carvalho Padilha

Programa de Pós-graduação em Nutrição do Instituto de Nutrição Josué de Castro da Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro - RJ, Brazil

http://orcid.org/0000-0003-0221-7732

Eliane Lopes Rosado

Programa de Pós-graduação em Nutrição do Instituto de Nutrição Josué de Castro da Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro - RJ, Brazil

http://orcid.org/0000-0003-0889-4662

Letícia Barbosa Gabriel da Silva

Programa de Pós-graduação em Nutrição do Instituto de Nutrição Josué de Castro da Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro - RJ, Brazil

http://orcid.org/0000-0003-2205-0212

Sanmira Fagherazzi

Maternidade Escola da UFRJ, Rio de Janeiro - RJ, Brazil

http://orcid.org/0000-0001-5137-9389

Lenita Zajdenverg

Maternidade Escola da UFRJ, Rio de Janeiro - RJ, Brazil

http://orcid.org/0000-0002-1579-3299

Roberto Luís Zagury

Maternidade Escola da UFRJ, Rio de Janeiro - RJ, Brazil

http://orcid.org/0000-0003-0438-223X

Claudia Saunders

Programa de Pós-graduação em Nutrição do Instituto de Nutrição Josué de Castro da Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro - RJ, Brazil

Maternidade Escola da UFRJ, Rio de Janeiro - RJ, Brazil

http://orcid.org/0000-0001-8815-6736

Address for correspondence
Programa de Pós-graduação em Nutrição do Instituto de Nutrição Josué de Castro da, Universidade Federal do Rio de Janeiro (UFRJ). Av., Carlos Chagas Filho, 373, bl. J, 2° andar, sala 26, Rio de Janeiro, RJ, 21941.590, Brazil (e-mail: belfortgabriella@hotmail.com).

Contributions

Oliveira L. M., Padilha P. C. and Saunders C. designed and planned the study; Oliveira L. M., Padilha P. C., Zagury R. L. and Saunders C. collected the data; Oliveira L. M., Padilha P. C., Rosado E. L., Belfort G. P. and Saunders C. analyzed the data; and Oliveira L. M., Belfort G. P., Padilha P. C., Rosado E. L., Fagherazzi S., Zajdenverg L., Zagury R. L., da Silva L. B. G. and Saunders C. participated in thewriting and revision of the final version of the manuscript.

Conflict of Interests

The authors have no conflict of interests to declare.

Maternal characteristics	TM group	CCM group	p-value
Diabetes, type (n, %)			0.12
Type 1	18 (47.4)	17 (33.3)
Type 2	15 (39.5)	29 (56.9)
Others^* * others: Diabetes MODY, LADA or without classification.	5 (13.1)	5 (9.8)
Occupation (n,%)
Works	19 (50)	32 (61.7)	0.28^a a p-value to compare proportions was obtained by the Chi-squared test.
Does not work	19 (50)	19 (38.3)
Marital status (n, %)
Stable union / married	28 (73.7)	39 (76.5)	0.81^a a p-value to compare proportions was obtained by the Chi-squared test.
Single, divorced or widowed	10 (26.3)	12 (23.5)
Level of education (n,%)
Incomplete high school	8 (34.8)	17 (34.0)	1.00^a a p-value to compare proportions was obtained by the Chi-squared test.
Complete high school	15 (65.2)	33 (66.0)
Housing sanitation conditions (n,%)^ adequate housing with regular garbage collection, treatment of sewage and piped water, inadequate - when one of the services was absent.
Inadequate	8 (21.1)	4 (7.8)	0.12^a a p-value to compare proportions was obtained by the Chi-squared test.
Adequate	30 (78.9)	47 (92.2)
Skin color (n, %)
Brown or black	7 (43.8)	29 (61.7)	0.25^a a p-value to compare proportions was obtained by the Chi-squared test.
White	9 (56.2)	18 (38.3)
Maternal age at delivery, years old			0.01^b b p-value for median was obtained by the Mann-Whitney test.
Median (IQR)	28.47 (24.00–32.00)	32.07 (27.00–37.00)
N	36	51
Pregestational BMI, kg/m². Median (IQR)	25.69 (21.34–28.69)	27.77 (23.50–32.67)	0.10^b b p-value for median was obtained by the Mann-Whitney test.
N	37	51
Diagnostic time of diabetes, years Median (IQR)N	8.20 (3.00–13.00)37	8.30 (2.00–12.25)50	0.89^b b p-value for median was obtained by the Mann-Whitney test.
Gestational age at the first prenatal visit, weeks Median (IQR)N	12.21 (9.00–13.25)38	12.60 (9.00–16.00)51	0.73^b b p-value for median was obtained by the Mann-Whitney test.
Number of prenatal care Consultations.Median (IQR)N	12.84 (11.00–15.25)38	12.61 (9.00–16.00)51	0.25^b b p-value for median was obtained by the Mann-Whitney test.
Number of consultations with the nutritionist			0.13^b b p-value for median was obtained by the Mann-Whitney test.
Median (IQR)N	5.66 (3.00–7.25)38	6.39 (5.00–7.00)51

Outcomes	TM group				CCM group
	n	Median	IQR	p^a a p-value obtained by the Wilcoxon test for the intragroup evaluation.	n	Median	IQR	p^a a p-value obtained by the Wilcoxon test for the intragroup evaluation.	p^b b p-value obtained by the Mann Whitney test for the between groups evaluation.
Fasting blood glucose, 1^st trimester (mg/dL)	25	95.0	81.5-129.5	-	39	135.0	113.0–160.0	-	0.01
Fasting blood glucose, 2^nd trimester (mg/dL)	37	104.0	78.8–140.5	0.14	48	110.5	91.1–141.5	0.01
Fasting blood glucose, 3^rd trimester (mg/dL)	37	90.0	79.0–122.0	0.20	46	91.6	82.1–114.8	0.00
Mean change of fasting blood glucose during study (mg/dL)^* * Results expressed in mean change and standard deviation of fasting blood glucose between the 1st and 3rd gestational trimesters.	24		22.1 ± 58.7		35		39.01 ± 41.9		0.20

Characteristics	TM group	CCM group	p-value
Birthweight, grams(mean, SD)	3193.8 (648.30)	3248.1 (641.50)	0.69^a a Student t-test.
n	38	48
Gestational age at birth,weeks (median, IQR)	38.00 (37.00- 39.00)	38.00 (36.00–38.00)	0.61^b b Mann-Whitney test
n	38	48
Cephalic perimeter, cm(median, IQR)	34.50 (33.00–36.00)	34.00 (33.00–36.00)	0.97^b b Mann-Whitney test
n	38	42
Length, cm(mean, SD)	48.04 (3.18)	48.08 (3.14)	0.95^a a Student t-test.
n	38	42
Apgar, 1^st minute(median, IQR)	8.00 (8.00–9.00)	8.00 (7.25–9.00)	0.74^b b Mann-Whitney test
n	38	48
Apgar, 5^th minute(median, IQR)	9.00 (9.00–9.00)	9.00 (9.00–9.00)	0.64^b b Mann-Whitney test
n	38	48
Gestational weight gain, kg(median, IQR)	13.34 (9.53–17.47)	11.00 (8.90–15.35)	0.14^b b Mann-Whitney test
n	36	49
Hypertensive disorders of pregnancy (n, %)
Yes	11 (28.9)	23 (45.1)	0.12^c c Chi-squared test.
No	27 (71.1)	28 (54.9)
Pre-eclampsia (n, %)
Yes	7 (18.4)	13 (25.5)	0.43^c c Chi-squared test.
No	31 (81.6)	38 (74.5)
Type of delivery (n, %)
Vaginal	9 (23.7)	5 (10.2)	0.09^c c Chi-squared test.
Cesarean	29 (76.3)	44 (89.8)
Macrosomia (n, %)
Yes	5 (13.2)	4 (8.3)	0.50^c c Chi-squared test.
No	33 (86.8)	44 (91.7)

[1] Address for correspondence
Programa de Pós-graduação em Nutrição do Instituto de Nutrição Josué de Castro da, Universidade Federal do Rio de Janeiro (UFRJ). Av., Carlos Chagas Filho, 373, bl. J, 2° andar, sala 26, Rio de Janeiro, RJ, 21941.590, Brazil (e-mail: belfortgabriella@hotmail.com).

Brasil

Brasil

Impact of Carbohydrate Counting Method during Pregnancy in Women with Pregestational Diabetes Mellitus: A Controlled Clinical Trial

Impacto do método de contagem de carboidratos em gestantes com diabetes mellitus prévio: Um ensaio clínico controlado

Abstract

Objective

Methods

Results

Conclusion