{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T17:56:37Z","timestamp":1792173397174,"version":"4.4.0"},"reference-count":63,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2021,7,28]],"date-time":"2021-07-28T00:00:00Z","timestamp":1627430400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["R01DK101659"],"award-info":[{"award-number":["R01DK101659"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000925","name":"National Health and Medical Research Council","doi-asserted-by":"publisher","award":["GNT1148952"],"award-info":[{"award-number":["GNT1148952"]}],"id":[{"id":"10.13039\/501100000925","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>The original nutrition approach for the treatment of gestational diabetes mellitus (GDM) was to reduce total carbohydrate intake to 33\u201340% of total energy (EI) to decrease fetal overgrowth. Conversely, accumulating evidence suggests that higher carbohydrate intakes (60\u201370% EI, higher quality carbohydrates with low glycemic index\/low added sugars) can control maternal glycemia. The Institute of Medicine (IOM) recommends \u2265175 g\/d of carbohydrate intake during pregnancy; however, many women are consuming lower carbohydrate (LC) diets (&lt;175 g\/d of carbohydrate or &lt;40% of EI) within pregnancy and the periconceptual period aiming to improve glycemic control and pregnancy outcomes. This report systematically evaluates recent data (2018\u20132020) to identify the LC threshold in pregnancy in relation to safety considerations. Evidence from 11 reports suggests an optimal carbohydrate range of 47\u201370% EI supports normal fetal growth; higher than the conventionally recognized LC threshold. However, inadequate total maternal EI, which independently slows fetal growth was a frequent confounder across studies. Effects of a carbohydrate intake &lt;175 g\/d on maternal ketonemia and plasma triglyceride\/free fatty acid concentrations remain unclear. A recent randomized controlled trial (RCT) suggests a higher risk for micronutrient deficiency with carbohydrate intake \u2264165 g\/d in GDM. Well-controlled prospective RCTs comparing LC (&lt;165 g\/d) and higher carbohydrate energy-balanced diets in pregnant women are clearly overdue.<\/jats:p>","DOI":"10.3390\/nu13082599","type":"journal-article","created":{"date-parts":[[2021,7,28]],"date-time":"2021-07-28T11:12:52Z","timestamp":1627470772000},"page":"2599","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":52,"title":["The Carbohydrate Threshold in Pregnancy and Gestational Diabetes: How Low Can We Go?"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6843-6247","authenticated-orcid":false,"given":"Arianne","family":"Sweeting","sequence":"first","affiliation":[{"name":"Sydney Medical School, The University of Sydney, Sydney, NSW 2006, Australia"},{"name":"Charles Perkins Centre, Boden Initiative, University of Sydney, NSW 2006, Australia"},{"name":"Department of Endocrinology, Royal Prince Alfred Hospital, Sydney, NSW 2050, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3810-561X","authenticated-orcid":false,"given":"Jovana","family":"Mijatovic","sequence":"additional","affiliation":[{"name":"Charles Perkins Centre, Boden Initiative, University of Sydney, NSW 2006, Australia"},{"name":"NHMRC Clinical Trials Unit, University of Sydney, Sydney, NSW 2006, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Grant D.","family":"Brinkworth","sequence":"additional","affiliation":[{"name":"Commonwealth Scientific and Industrial Research Organisation\u2014Health and Biosecurity, Sydney, NSW 2113, Australia"},{"name":"School of Health Sciences, The University of Sydney, Sydney, NSW 2006, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tania P.","family":"Markovic","sequence":"additional","affiliation":[{"name":"Sydney Medical School, The University of Sydney, Sydney, NSW 2006, Australia"},{"name":"Charles Perkins Centre, Boden Initiative, University of Sydney, NSW 2006, Australia"},{"name":"Metabolism & Obesity Services, Royal Prince Alfred Hospital, Sydney, NSW 2050, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Glynis P.","family":"Ross","sequence":"additional","affiliation":[{"name":"Sydney Medical School, The University of Sydney, Sydney, NSW 2006, Australia"},{"name":"Department of Endocrinology, Royal Prince Alfred Hospital, Sydney, NSW 2050, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6797-8754","authenticated-orcid":false,"given":"Jennie","family":"Brand-Miller","sequence":"additional","affiliation":[{"name":"School of Life and Environmental Sciences and Charles Perkins Centre, The University of Sydney, Sydney, NSW 2006, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7024-5017","authenticated-orcid":false,"given":"Teri L.","family":"Hernandez","sequence":"additional","affiliation":[{"name":"College of Nursing, Anschutz Medical Campus, University of Colorado, Aurora, CO 80045, USA"},{"name":"Department of Medicine, Division of Endocrinology, Metabolism, and Diabetes, Anschutz Medical Campus, University of Colorado, Aurora, CO 80045, USA"},{"name":"Children\u2019s Hospital Colorado, Aurora, CO 80045, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,7,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1346","DOI":"10.2337\/dc18-0102","article-title":"Gestational diabetes mellitus and diet: A systematic review and meta-analysis of randomized controlled trials examining the impact of modified dietary interventions on maternal glucose control and neonatal birth weight","volume":"41","author":"Yamamoto","year":"2018","journal-title":"Diabetes Care"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1016\/j.diabres.2018.04.004","article-title":"Nutrition therapy within and beyond gestational diabetes","volume":"145","author":"Hernandez","year":"2018","journal-title":"Diabetes Res. 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