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Diabetes and Vascular Disease

SAT-523 - A Pilot Randomized Controlled Trial of Low- Versus Standard-Carbohydrate Diets in Women with Gestational Diabetes Mellitus: Effects on Maternal Ketone Levels, Glycemic Control, and Obstetric Outcomes

Saturday, June 13, 2026
9:30 AM - 4:30 PM CT
Location: ENDOExpo; Poster Floor
Disclosure(s):
Kim Goldberg Politzer, RD, MAN: No financial relationships to disclose


Objective: To evaluate the feasibility, short-term safety, and early metabolic and perinatal effects of a supervised moderately low-carbohydrate diet (~120 g/day) compared with the standard recommended 175 g/day diet among pregnant women with gestational diabetes mellitus (GDM).

Methods: This single-center, open-label pilot randomized controlled trial enrolled 20 women with GDM at 24–28 weeks’ gestation. Participants were randomized 1:1 to a standard-carbohydrate diet (NCD, 175 g/day) or a moderately low-carbohydrate diet (LCD, ~120 g/day). Both groups received Mediterranean-style medical nutrition therapy and bi-weekly dietitian follow-up until delivery. The primary outcome was maternal capillary ketone (β-hydroxybutyrate) concentration. Secondary outcomes included self-monitored blood glucose (SMBG), initiation of pharmacologic therapy, gestational weight gain, fetal biometry, and obstetric and neonatal outcomes.

Results: Median blood ketone (β-hydroxybutyrate) concentrations were low in both groups and slightly higher in the LCD group (0.25 vs 0.16 mmol/L; P=0.029), all remaining substantially below upper physiological thresholds, with no ketone-associated adverse events.
Mean carbohydrate intake differed significantly between groups (119 g/day LCD vs 168 g/day NCD; P< 0.001), with high adherence. Rates of pharmacologic therapy initiation were similar (36% LCD vs 44% NCD). Fasting and postprandial glucose values were comparable, with directionally lower levels in the LCD group. Maternal outcomes—including gestational weight gain, cesarean delivery, preterm birth, and preeclampsia—did not differ between groups. Fetal growth percentiles were similar; large-for-gestational-age occurred in 0% of LCD vs 33% of NCD infants (P=0.074). Neonatal outcomes, including Apgar scores and neonatal hypoglycemia, were comparable between groups. Four non-serious adverse events occurred in the LCD group.

Conclusion: A supervised moderately low-carbohydrate diet (~120 g/day) appears feasible, acceptable, and safe for women with GDM, maintaining maternal ketone concentrations within physiological ranges while demonstrating favorable trends in glycemic control and fetal growth.

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