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CC BY 4.0 · Rev Bras Ginecol Obstet 2022; 44(03): 220-230
DOI: 10.1055/s-0042-1742291
Original Article
High Risk Pregnancy

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
Larissa Mello de Oliveira 
1   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
,
Gabriella Pinto Belfort 
1   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
,
Patricia de Carvalho Padilha 
1   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
,
Eliane Lopes Rosado 
1   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
,
Letícia Barbosa Gabriel da Silva 
1   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
,
Sanmira Fagherazzi 
2   Maternidade Escola da UFRJ, Rio de Janeiro – RJ, Brazil
,
Lenita Zajdenverg 
2   Maternidade Escola da UFRJ, Rio de Janeiro – RJ, Brazil
,
Roberto Luís Zagury 
2   Maternidade Escola da UFRJ, Rio de Janeiro – RJ, Brazil
,
Claudia Saunders 
1   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
2   Maternidade Escola da UFRJ, Rio de Janeiro – RJ, Brazil
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Abstract

Objective To evaluate the effect of the carbohydrate counting method (CCM) on glycemic control, maternal, and perinatal outcomes of pregnant women with pregestational diabetes mellitus (DM).

Methods Nonrandomized controlled clinical trial performed with 89 pregnant women who had pregestational DM and received prenatal care in a public hospital in Rio de Janeiro, state of Rio de Janeiro, Brazil, between 2009 and 2014, subdivided into historic control group and intervention group, not simultaneous. The intervention group (n = 51) received nutritional guidance from the carbohydrate counting method (CCM), and the historical control group (n = 38), was guided by the traditional method (TM). The Mann-Whitney test or the Wilcoxon test were used to compare intra- and intergroup outcomes and analysis of variance (ANOVA) for repeated measures, corrected by the Bonferroni post-hoc test, was used to assess postprandial blood glucose.

Results Only the CCM group showed a reduction in fasting blood glucose. Postprandial blood glucose decreased in the 2nd (p = 0.00) and 3rd (p = 0.00) gestational trimester in the CCM group, while in the TM group the reduction occurred only in the 2nd trimester (p = 0.015). For perinatal outcomes and hypertensive disorders of pregnancy, there were no differences between groups. Cesarean delivery was performed in 82% of the pregnant women and was associated with hypertensive disorders (gestational hypertension or pre-eclampsia; p = 0.047).

Conclusion Both methods of nutritional guidance contributed to the reduction of postprandial glycemia of women and no differences were observed for maternal and perinatal outcomes. However, CCM had a better effect on postprandial glycemia and only this method contributed to reducing fasting blood glucose throughout the intervention.

ReBEC Clinical Trials Database The present study was registered in the ReBEC Clinical Trials Database (Registro Brasileiro de Ensaios Clínicos, number RBR-524z9n).

Resumo

Objetivo Avaliar o efeito do método de contagem de carboidratos no controle glicêmico, desfechos maternos e perinatais de gestantes com diabetes mellitus (DM) pré-gestacional.

Métodos Ensaio clínico controlado não randomizado realizado com 89 gestantes com DM pré-gestacional atendidas em hospital público do Rio de Janeiro, RJ, Brasil, entre 2009 e 2014, divididas em grupo controle histórico e grupo intervenção. O grupo intervenção (n = 51) recebeu orientação nutricional com base no método de contagem de carboidratos (CCM) e o grupo controle histórico (n = 38) foi orientado pelo método tradicional (MT). Os testes de Mann-Whitney ou de Wilcoxon foram usados para comparar os desfechos intra- e intergrupos e, para avaliar a glicemia pós-prandial, análise de variância (ANOVA, na sigla em inglês) para medidas repetidas foi usada.

Resultados Somente o grupo com método CCM apresentou redução da glicemia de jejum. A glicemia pós-prandial diminuiu no 2° (p = 0,00) e 3° (p = 0,00) trimestres gestacionais no grupo com método CCM, e no grupo com método tradicional, a redução ocorreu apenas no 2° trimestre (p = 0,015). Para os resultados perinatais e distúrbios hipertensivos da gravidez, não houve diferenças entre os grupos. O parto cirúrgico foi realizado em 82% das gestantes e esteve associado a distúrbios hipertensivos gestacionais (p = 0,047).

Conclusão Ambos os métodos de orientação nutricional contribuíram para a redução da glicemia pós-prandial e não foram observadas diferenças para os resultados maternos e perinatais. No entanto, o método CCM apresentou melhor efeito sobre a glicemia pós-prandial e foi o único que induziu redução da glicemia de jejum.

Keywords

pregnancy - diabetes mellitus - prenatal care - nutrition therapy

Palavras-chave

gravidez - diabetes mellitus - cuidado pré-natal - terapia nutricional

Ethical Issues

The present study was approved by the Research Ethics Committee of the maternity teaching hospital (Maternidade Escola) of the Universidade Federal do Rio de Janeiro (CAAE – 0017.0.361.361–10). It was registered in the ReBEC Clinical Trials Database (Registro Brasileiro de Ensaios Clínicos, number RBR-524z9n). All participants who agreed to participate in the study signed a free and informed consent form.


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 the writing and revision of the final version of the manuscript.




Publikationsverlauf

Eingereicht: 26. Februar 2021

Angenommen: 03. November 2021

Artikel online veröffentlicht:
09. Februar 2022

© 2022. Federação Brasileira de Ginecologia e Obstetrícia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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