Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
| Name | Class |
|---|---|
| Canadian Diabetes Association | OTHER |
| Canadian Institutes of Health Research (CIHR) | OTHER_GOV |
| Canadian Foundation for Dietetic Research (CFDR) | OTHER |
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
MAIN STUDY: Low glycaemic index (GI) diets are recommended by the Canadian Diabetes Association for treating type 1 and 2 diabetes mellitus (DM), but the role of GI in the management of gestational diabetes(GDM)is not yet clear. The main purpose of this study is to determine the effect of a low GI diet on blood sugar control in women with GDM. The effect of a low GI diet on maternal oxidative stress, pregnancy and delivery outcomes and markers of risk for diabetes after birth in both the mother and baby will also be assessed. SUB-STUDY: The main purpose of the sub-study is to determine if the breast milk (BM) of women with GDM consuming a low GI diet will have a higher antioxidant capacity than the BM of women receiving a medium-high GI diet (control/standard care). The effect of a low glycaemic index diet on maternal dietary intake of specific nutrient-antioxidants (i.e. vitamin C, E, and beta-carotene) (prenatal and postpartum) and concentration of vitamin C, E, and beta-carotene in participants' transitional and mature BM will also be assessed. The ORAC (Oxygen radical absorbance capacity) assay will be used to assess overall antioxidant capacity. The antioxidant capacity of BM in women with GDM will also be compared with that of women without GDM.
Hypotheses:
MAIN: The use of low-GI foods in the management of GDM reduces postprandial BG and oxidative stress; thereby reducing maternal and infant perinatal complications.
SUB-STUDY: Breast milk (BM) of women with GDM consuming a low GI diet will have higher BM antioxidant than women receiving the medium to high GI diet. BM of women with GDM will have lower antioxidant capacity than that of women without GDM.
MAIN STUDY: Use of low GI education is currently accepted by the Canadian Diabetes Association in treatment of type 1 and 2 DM, but is not included in the clinical practice guidelines(CPG) for management of GDM. Data collected to date support use of low GI in treatment of GDM, but more data are needed to influence CPG. In this study the effect of a low GI diet on maternal and neonatal markers of glycaemic control and postpartum diabetes risk in mother and baby will be determined. This study will also assess the role that maternal oxidative stress may play in this relationship.
Hypothesis: The use of low-GI foods in the management of GDM reduces postprandial BG and oxidative stress; thereby reducing maternal and infant perinatal complications.
SUB-STUDY: Breast milk (BM) is accepted as the optimal source of nutrition for infants. A wealth of literature on BM composition exists. This work includes measurement of antioxidants in BM. Women diagnosed with gestational hyperglycaemia have decreased antioxidant capacity in comparison to normoglycaemic pregnant women. A direct relationship exists between postprandial glycaemic response and oxidative stress. Low GI carbohydrate is converted to blood glucose (BG) more slowly than medium to high GI carbohydrate
Hypotheses: Breast milk (BM) of women with GDM consuming a low GI diet will have higher BM antioxidant than women receiving the medium to high GI diet. BM of women with GDM will have lower anti-oxidant capacity than that of women without GDM.
Not provided
Not provided
Not provided
Not provided
| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Standard Care | Placebo Comparator | Standard care dietary advice to emphasize high fiber foods with a moderate to high GI |
|
| Low GI Diet | Experimental | Low GI dietary advice in addition to standard care |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Standard Care | Other | Standard dietary advice for women with GDM with special emphasis on use of high fiber or whole grain carbohydrate foods with a medium to high GI. What's on Your Plate? and 3-dimensional food models will be used to teach servings size and meal planning. This groups will be provided with food substitution lists (key-foods method) composed of medium to high GI foods. |
| Measure | Description | Time Frame |
|---|---|---|
| MAIN STUDY: Percentage of postprandial self monitored blood glucose (SMBG) values within the target range | SMBG values are obtained 4 times daily (1 fasting and 3 postprandial) throughout the study from the randomization to delivery. The endpoint is a single value for each participant - namely the percentage of all the postprandial SMBG values within the target range recommended by the Canadian Diabetes Association (5.0 to 6.6 mmol/L) | From randomization to delivery |
| SUB-STUDY (n=75): Oxygen Radical Absorbance Capacity (ORAC) (Antioxidant Capacity) of transitional and mature breast milk. | Breast milk samples (25 mL) will be collected 1 week and 8 weeks after birth from a complete breast milk collection. Measures will be compared between and within groups. | 1 week and 8 weeks postpartum |
| Measure | Description | Time Frame |
|---|---|---|
| MAIN STUDY: Infant birth weight | Weight of the baby at delivery in grams. | At delivery |
| MAIN STUDY: Percentage of self-monitored fasting glucose values within the target range | SMBG values are obtained 4 times daily (1 fasting and 3 postprandial) throughout the study from the start of the intervention to delivery. The endpoint is a single value for each participant - namely the percentage of all the fasting SMBG values within the target range recommended by the Canadian Diabetes Association (3.8 to 5.2 mmol/L) |
Not provided
MAIN STUDY
Inclusion Criteria:
Women:
Exclusion Criteria:
Women:
SUB-STUDY control group (women without GDM) Same as for Main study except absence of GDM
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
| Name | Affiliation | Role |
|---|---|---|
| Thomas MS Wolever, MD, PhD | University of Toronto/ St Michael's Hospital | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| MAIN STUDY ONLY: St Joseph's Heathcare Hamilton, 50 Charlton Avenue East | Hamilton | Ontario | L8N 4A6 | Canada | ||
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 9272613 | Background | Ceriello A. Acute hyperglycaemia and oxidative stress generation. Diabet Med. 1997 Aug;14 Suppl 3:S45-9. doi: 10.1002/(sici)1096-9136(199708)14:3+3.3.co;2-i. | |
| 9545118 | Background | Ceriello A. The emerging role of post-prandial hyperglycaemic spikes in the pathogenesis of diabetic complications. Diabet Med. 1998 Mar;15(3):188-93. doi: 10.1002/(SICI)1096-9136(199803)15:33.0.CO;2-V. No abstract available. |
Not provided
Not provided
Not provided
| ID | Term |
|---|---|
| D016640 | Diabetes, Gestational |
| D006943 | Hyperglycemia |
| ID | Term |
|---|---|
| D011248 | Pregnancy Complications |
| D005261 | Female Urogenital Diseases and Pregnancy Complications |
| D000091642 | Urogenital Diseases |
| D003920 | Diabetes Mellitus |
Not provided
Not provided
| ID | Term |
|---|---|
| D059039 | Standard of Care |
| D038321 | Glycemic Index |
| ID | Term |
|---|---|
| D019984 | Quality Indicators, Health Care |
| D011787 | Quality of Health Care |
| D006298 | Health Services Administration |
| D017530 | Health Care Quality, Access, and Evaluation |
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
|
|
| Low GI diet | Other | Nutrition education according to standard care similar to the control group with supplementary GI-education. GI-education will be taught using the "Stop-Light-Method". This groups will be provided with food substitution lists (key-foods method) composed of low-GI carbohydrate-containing food. The GI-education tool(s) will build on standard care education where patients are taught which food groups contain carbohydrate. |
|
|
| From randomization to delivery |
| MAIN STUDY: Glucose variability | SMBG values are obtained 4 times daily (1 fasting and 3 postprandial) throughout the study from the randomization to delivery. This endpoint is the coefficient of variation of all the SMBG values obtained (CV = 100*SD/mean), where SD is standard deviation; a single value for each participant. | From randomization to delivery |
| MAIN STUDY: Insulin prescription incidence | Proportion of women prescribed insulin during the intervention | From randomization to delivery |
| MAIN STUDY: Mean fasting glucose | SMBG values are obtained 4 times daily (1 fasting and 3 postprandial) throughout the study from the randomization to delivery. The endpoint is the mean of all fasting SMBG values obtained - a single value for each participant. | From randomization to delivery |
| MAIN STUDY: Mean postprandial glucose | SMBG values are obtained 4 times daily (1 fasting and 3 postprandial) throughout the study from the randomization to delivery. This endpoint is the mean of all postprandial SMBG values obtained; a single value for each participant. | From randomization to delivery |
| MAIN STUDY: Mean post-breakfast glucose | SMBG values are obtained 4 times daily (1 fasting and 3 postprandial) throughout the study from the randomization to delivery. This endpoint is the mean of all SMBG values 2 hours after breakfast; a single value in each participant. | From randomization to delivery |
| MAIN STUDY: Mean post-lunch blood glucose | SMBG values are obtained 4 times daily (1 fasting and 3 postprandial) throughout the study from the randomization to delivery. This endpoint is the mean of all SMBG values 2 hours after lunch; a single value in each participant. | From randomization to delivery |
| MAIN STUDY: Mean post-dinner blood glucose | SMBG values are obtained 4 times daily (1 fasting and 3 postprandial) throughout the study from the randomization to delivery. This endpoint is the mean of all SMBG values 2 hours after dinner; a single value in each participant. | From randomization to delivery |
| MAIN STUDY: Change in LDL oxidation at 4 weeks | Difference between LDL oxidation measured in fasting venous blood at randomization and 4 weeks. | Change from randomization in LDL oxidation at 4 weeks. |
| MAIN STUDY: LDL oxidation 6-8 weeks after delivery | LDL oxidation measured in fasting venous blood 6-8 weeks after delivery. | 6-8 weeks after delivery |
| MAIN STUDY: Change in Oxygen Radical Absorbance Capacity (ORAC) of plasma at 4 weeks | Difference in Oxygen Radical Absorbance Capacity (ORAC) of plasma measured in venous serum at randomization and 4 weeks. | Change from randomization to 4 weeks |
| MAIN STUDY: Change in c-reactive protein (CRP) at 4 weeks | Difference in c-reactive protein concentration in venous serum from baseline at 4 weeks. | Change in CRP from randomization at 4 weeks |
| MAIN STUDY: Post-partum CRP | Concentration of venous serum c-reactive protein 6-8 weeks after delivery. | 6-8 weeks after delivery |
| MAIN STUDY: Post-partum fasting serum glucose | Venous fasting serum glucose 6-8 weeks after delivery | 6-8 weeks after delivery |
| MAIN STUDY: Post-partum serum glucose concentration 2 hours after consumption of 75g oral glucose (2hrPC serum glucose). | Venous serum glucose concentration 2 hours after consumption of 75g oral glucose (oral glucose tolerance test). | 6-8 weeks after delivery |
| MAIN STUDY: Incidence of post-partum impaired glucose tolerance | Proportion of women with venous serum glucose concentration 2 hours after a 75g oral glucose tolerance test between 7.8 and 11.0 mmol/L, inclusive. | 6-8 weeks after delivery |
| MAIN STUDY: Incidence of post-partum diabetes mellitus | Proportion of women with diabetes 6-8 weeks after delivery. Diabetes is defined as fasting serum glucose greater than or equal to 7.0 mmol/L and/or serum glucose 2 hours after 75g oral glucose tolerance test greater than or equal to 11.1mmol/L. | 6-8 weeks after delivery |
| MAIN STUDY: Maternal weight gain | Difference between reported pre-pregnancy body weight and last body weight measured before delivery. | From pre-pregnancy to delivery: up to 9 months |
| MAIN STUDY: Rate of maternal weight gain | Difference between maternal body weight at randomization and last body weight measured before delivery divided by the number of weeks between the measurements. | From randomization to delivery |
| MAIN STUDY: Change in infant weight | Difference between infant birthweight and weight 6-8 weeks after delivery. | Change in infant body weight from birth to 6- 8 weeks |
| MAIN STUDY & SUB-STUDY (n=75): Maternal dietary intake | Dietary analysis will be conducted using software containing the Canadian Nutrient File, supplemented with data that used standardized GI testing methodology. Comparison will be made between and within groups. | From randomization to 6- 8 weeks post-partum |
| SUB-STUDY (n=75): Concentration of vitamin C, E, and Beta-carotene in transitional breast milk | Concentration of vitamin C, vitamin E and beta-carotene in breast milk collected 1 week after delivery. Comparison will be made between and within study groups. | 1 week after delivery |
| SUB-STUDY (n=75): Concentration of vitamin C, E, and Beta-carotene in mature breast milk | Concentration of vitamin C, vitamin E and beta-carotene in breast milk collected 6-8 weeks after delivery. Comparison will be made between and within study groups. | 6-8 weeks after delivery |
| MAIN STUDY: Infant demographics | Collection of infant demographics, such as gestational age at birth, sex, incidence and type of complications as noted in maternal or infant chart, mode of delivery, length of stay in hospital | Delivery to 6-8 weeks postpartum |
| MAIN STUDY: Change in infant body measurements from birth to 6-8 weeks post-partum | Weight, head circumference, and height/length | Change in infant body measurements from delivery to 6-8 weeks post-partum |
| MAIN STUDY: Infant APGAR score at delivery | Infant APGAR score at delivery as recorded in maternal medical chart. | Delivery |
| MAIN STUDY: Change in maternal blood pressure and resting pulse from randomization to 4 weeks | Difference between maternal blood pressure and resting pulse from randomization at4 weeks. | Change from randomization to 4 weeks. |
| MAIN STUDY: Maternal blood pressure and resting pulse at 6-8 weeks post-partum | Maternal blood pressure and resting pulse at 6-8 weeks post-partum. | 6-8 weeks after delivery |
| MAIN STUDY: Infant waist circumference at 6-8 weeks | Infant waist circumference at 6-8 weeks. | 6-8 weeks after delivery |
| MAIN STUDY: Change in ultrasound measurements from randomization to delivery. | Difference between infant ultrasound measurements (Bi-parietal diameter, head circumference, abdominal circumference, and femur length) from baseline to delivery. | Change from randomization to delivery |
| MAIN STUDY: Maternal height at baseline | Maternal height at baseline | Baseline |
| MAIN STUDY: Maternal medical history | Maternal medical history | Baseline |
| MAIN STUDY: Maternal medical complications from baseline to 6-8 weeks post-partum | Incidence and type of maternal medical complications from baseline to 6-8 weeks post-partum | Baseline to 6-8 weeks after delivery |
| MAIN STUDY: Change in maternal weight from delivery at 6-8 weeks post-partum | Difference in maternal weight from delivery at 6-8 weeks postpartum. | Difference between delivery and 6-8 weeks post-partum |
| MAIN STUDY: Maternal pre-natal demographic information | Maternal pre-natal demographic information (e.g. ethnicity, language used at home, household food preparation and purchasing, education obtained, employment status, treatment of diabetes, prior exposure to a registered dietitian, cigarette, recreational drug, and alcohol use before and during pregnancy, and physical activity) using a pre-tested, face-validated questionnaire. | Baseline |
| MAIN STUDY: Maternal post-partum socio-demographic data related to infant feeding practices | Socio-demographic factors previously identified in the literature as affecting infant feeding practices; including access to breastfeeding education while in hospital. | 6-8 weeks after delivery |
| MAIN STUDY: Length of time between delivery and maternal breast fullness | Length of time between delivery and maternal breast fullness. | Time after delivery |
| MAIN STUDY: Change in conjugated dienes at 4 weeks | Difference between conjugated dienes of plasma measured in venous serum at baseline and 4 weeks. | change from baseline to 4 weeks. |
| MAIN STUDY: Conjugated dienes post-partum | Conjugated dienes in fasting venous blood 6-8 weeks after delivery | 6-8 weeks after delivery |
| MAIN STUDY: Oxygen Radical Absorbance Capacity (ORAC) of venous plasma post-partum | ORAC measured in fasting venous blood 6-8 weeks after delivery | 6-8 weeks after delivery |
| MAIN STUDY: Change in full lipid profile at 4 weeks | Difference in full lipid profile of fasting venous blood at baseline and 4 weeks. | Change in full lipid profile of plasma from baseline at 4 weeks |
| MAIN STUDY: Full lipid profile post-partum | Full lipid profile of fasting venous blood at 6-8 weeks post-partum | 6-8 weeks after delivery |
| MAIN STUDY: Change in incidence and severity of symptoms from baseline to 6-8 weeks postpartum | Difference in the incidence and severity of maternal symptoms present from baseline to 6-8 weeks postpartum using a standardised questionnaire. | Change from baseline to 6-8 weeks postpartum |
| MAIN STUDY: Infant feeding practices | Maternal infant feeding practices from delivery to 6-8 weeks postpartum | 6-8 weeks after delivery |
| MAIN STUDY: Participant satisfaction of baseline education class | Participant reactions and opinions on baseline education class using a face-validated, pre-tested questionnaire. | Baseline |
| MAIN STUDY: Change in participant knowledge of GI from baseline to 6-8 weeks after delivery | Difference in participant knowledge of GI from randomization pre-education class) to 6-8 weeks after delivery using a face-validated, pre-tested questionnaire. | Change in GI knowledge from randomization to 6-8 weeks after delivery |
| MAIN STUDY: Participant knowledge of GI at baseline | Participant knowledge of GI at baseline (pre-education class)using a validated questionnaire. | Baseline |
| MAIN STUDY: Change in participant opinion on availability and acceptability of study diet foods | Difference in participant opinion on availability and acceptability of study diet foods from 2 weeks to 6-8 weeks after delivery using a validated questionnaire. | Change in opinion from 2 weeks to 6-8 weeks after delivery |
| MAIN STUDY: Difference in dietary GI between study groups. | Difference in dietary GI between study groups from baseline to 6-8 weeks post delivery using a short-form semi-quantitative food frequency questionnaire (FFQ). The FFQ collects dietary intake data on the 3 months preceding administration. The FFQ has been standardised and evaluated for readability by nutrition professionals, clinicians and/or researchers with experience in surveying, and has been face-validated and pre-tested. | From baseline to 6-8 weeks after delivery |
| MAIN STUDY: Change in behaviour from baseline (pre-class) to 6-8 weeks after delivery. | Difference in behaviour within and between groups from baseline (pre-class) to 6-8 weeks after delivery using face-validated, pre-tested questionnaires, including a short-form semi-quantitative food frequency questionnaire (FFQ). The FFQ collects dietary intake data on the 3 months preceding administration. The FFQ has been standardised and evaluated for readability by nutrition professionals, clinicians and/or researchers with experience in surveying. | Change in behaviour from baseline (pre-class) to 6-8 weeks after delivery |
| St. Michael's Hospital |
| Toronto |
| Ontario |
| M5B 1W8 |
| Canada |
| Mt Sinai Hospital | Toronto | Ontario | M5G 1X5 | Canada |
| Sunnybrook Health Sciences Centre | Toronto | Ontario | Room H145, 2075 Bayview Avenue | Canada |
| 15769103 | Background | Huang D, Ou B, Prior RL. The chemistry behind antioxidant capacity assays. J Agric Food Chem. 2005 Mar 23;53(6):1841-56. doi: 10.1021/jf030723c. |
| Background | Saenz AT, Elisia I, Innis SM, Friel JK, and Kitts DD. Use of ORAC to assess antioxidant capacity of human milk. Journal of Food Composition and Analysis 22:694-698, 2009 |
| 22128211 | Background | Elisia I, Kitts DD. Quantification of hexanal as an index of lipid oxidation in human milk and association with antioxidant components. J Clin Biochem Nutr. 2011 Nov;49(3):147-52. doi: 10.3164/jcbn.10-142. Epub 2011 Sep 3. |
| Background | Wolever, TMS. The Glycaemic Index: A Physiological Classification of Dietary Carbohydrate. Ontario, Canada: CABI, 2006. |
| 22254100 | Background | Grant SM, Wolever TMS. Perceived barriers to application of glycaemic index: valid concerns or lost in translation? Nutrients. 2011 Mar;3(3):330-340. doi: 10.3390/nu3030330. Epub 2011 Feb 28. |
| D044882 | Glucose Metabolism Disorders |
| D008659 | Metabolic Diseases |
| D009750 | Nutritional and Metabolic Diseases |
| D004700 | Endocrine System Diseases |
| D009753 | Nutritive Value |
| D009747 | Nutritional Physiological Phenomena |
| D000066888 | Diet, Food, and Nutrition |
| D010829 | Physiological Phenomena |
| D063427 | Food Quality |
| D005524 | Food Technology |
| D019649 | Food Industry |
| D007221 | Industry |
| D013676 | Technology, Industry, and Agriculture |
| D011634 | Public Health |
| D004778 | Environment and Public Health |