Claire Louise Meek

OBJECTIVE: The optimal dietary carbohydrate intake for pregnant women is disputed internationally. Many authorities recommend a minimum of 175 g/day of carbohydrates primarily to support maternal brain glucose requirements and normal fetal brain development. We assessed whether low (<175 g/day) or very low (<120 g/day) carbohydrate intake was associated with altered nutrient intake, glycemia, or pregnancy outcomes in women with gestational diabetes mellitus (GDM). RESEARCH DESIGN AND METHODS: Women recruited to the Dietary Intervention in Gestational Diabetes Trial (DiGest) completed masked continuous glucose monitoring and a 24-h dietary recall at baseline before random assignment to receive either a standard- (2,000 kcal/day) or reduced-energy diet (1,200 kcal/day) from ∼29–36 weeks’ gestation. RESULTS: At baseline, 215 women completed a dietary assessment, of whom 66 (30.7%), 74 (34.4%), and 75 (34.9%) reported standard (≥175 g/day), low (120–175 g/day), and very low carbohydrate intake (<120 g/day), respectively. Women consuming fewer carbohydrates consumed less energy, less dietary fiber, and fewer vitamins (B and E) and minerals but proportionally more protein and fat. Consumption of 120 mg/dL (−6.8% [95% CI −13.4% to −0.2%]; P = 0.044) and lower birth weight (−9.6 [95% CI −18.7 to −0.6] centiles; P = 0.037), but no difference in large- or small-for-gestational-age birth weight was observed. Low carbohydrate intake as a proportion of total energy intake (<35%) without energy restriction was associated with reduced TAR but not with a difference in birth weight. CONCLUSIONS: Lower carbohydrate intake at baseline was associated with modestly improved glycemia before random assignment in women with GDM, but vigilance to maintain adequate intake of micronutrients and fiber is required.

OBJECTIVE: Energy restriction and weight loss are evidence-based, safe, and well-tolerated methods for lowering glycemia in type 2 diabetes. We assessed if imposed energy restriction or natural weight loss in the third trimester in women with gestational diabetes was associated with maternal and offspring weight postnatally. RESEARCH DESIGN AND METHODS: Women with gestational diabetes and BMI ≥25 kg/m2 were randomized to a standard- (2,000 kcal/day) or reduced-energy (1,200 kcal/day) diet from ∼29 to –36 weeks’ gestation, with follow-up to 12 months postnatally. We performed both trial and cohort analyses, using adjusted linear and logistic regression and a Super-Imposition by Translation and Rotation model. RESULTS: Allocation to energy restriction did not alter antenatal or postnatal growth, with infants in both randomized groups having normal weight for age throughout the first year of life. In cohort analysis, women who lost weight in pregnancy (average loss of 3 kg) had lower adjusted weight at 3 but not 12 months. Infants exposed to pregnancy weight loss had lower risk of large-for-gestational age at birth and lower fat mass at 3 months, and no higher prevalence of low infant weight (<5% had weight for age < −2 SD). Infants exposed to weight loss in pregnancy showed no evidence of growth faltering or excessive catch-up or catch-down growth. CONCLUSIONS: Among women with gestational diabetes and high BMI, energy restriction or weight loss in pregnancy were associated with no adverse effects on offspring weight or growth in the first year. Future work will assess associations with child obesity at 3 years.

Background: Clinical services for adults with early‐onset type 2 diabetes (EOT2D) are in urgent need of improvement. Methods: We evaluated a multi‐disciplinary clinic for individuals with EOT2D at high risk (HbA1c >9%/triglyceride >20 mmol/L), providing 2–3 flexibly arranged consultations per individual between March 2024 and September 2025. Nurse‐led case‐finding in primary care supported identification and targeted referral of high‐risk individuals. On 3 November 2025, electronic medical records were used to evaluate change in cardiometabolic outcomes at 6‐ and 12‐months from baseline and evaluate service activity, including proportions with recorded health information and prescriptions. The paired t ‐test (continuous) and McNemar's test (proportions) were used to assess change in outcomes. Patient feedback was obtained using questionnaires. Results: In total, 159 individuals received an appointment (45% women; median age 34 years). At both 6‐ and 12‐months post‐baseline, HbA1c (at 12‐months: −2.53% [95% CI: −3.13, −1.93]/−28 mmol/mol [−34, 21]), systolic (−5.89 mmHg [−9.88, −1.91]) and diastolic (−2.72 mmHg [−5.34, −0.10]) blood pressure, body mass index (BMI; −1.49 kg/m ² [−2.31, −0.67]) and weight (−3.52 kg [−6.32, −0.72]) were significantly lower. Triglycerides were lower at 12‐months only (−1.12 mmol/L [−1.89, −0.34]). The proportion with BMI or smoking status recorded, and with a glucagon‐like peptide‐1 receptor‐based treatment, was higher at 12‐months than at baseline, whereas creatinine and retinal screening measurements were less frequent. A limited amount of patient feedback was positive. Discussion: Case‐finding and invitation to flexibly run multidisciplinary clinics were associated with improvements in cardiometabolic outcomes and positive patient feedback. Similar services are immediately required given the rising prevalence of EOT2D and associated complications.

Aims: Research to inform, co‐develop and evaluate optimal care for women with early‐onset type 2 diabetes (EOT2D) before, during and after pregnancy is lacking. Informed by patient perspectives and the results of the James Lind Alliance priority‐setting partnership in diabetes in pregnancy, we aimed to develop a consensus statement to guide future research efforts to meet the needs of women with EOT2D in the preconception, pregnancy and postnatal periods. Methods: Results from three systematic reviews covering interventional, observational and qualitative studies were presented at the Diabetes UK annual professional conference in Glasgow in February 2025. The results were discussed by an expert panel with audience participation. Results: There is very limited research to guide care for women with EOT2D, especially in the preconception and postnatal periods. In pregnancy, there have been limited studies assessing interventions, mainly encompassing medication and glucose sensor use, but most are small and have limited generalisability. Observational data suggests that managing glycaemia, addressing maternal BMI and preventing excessive gestational weight gain improve outcomes for women with EOT2D in pregnancy. Qualitative data highlight the negative impact of EOT2D on pregnancy and the need for optimised support. Targeted, innovative and cross‐cultural studies across the reproductive life course are urgently needed to address the short and longer‐term maternal and offspring risks for individuals with EOT2D. Conclusions: Given the rising prevalence of EOT2D and the risk of adverse pregnancy outcomes for women with EOT2D and their children, prioritising research in the preconception, pregnancy and postnatal periods is vital to ensure that care needs are met to improve health outcomes for women and their children.

Purpose: To determine whether early gestational diabetes (GDM) differs from later GDM in maternal characteristics and perinatal outcomes. Methods: This is a secondary analysis of an energy-restricted dietary intervention in GDM (DiGest) randomized controlled trial. We compared maternal weight, glycemia, and pregnancy/neonatal outcomes between the early GDM (< 20 weeks, n = 118) and standard GDM diagnosis (21–28 weeks, n = 299) groups. Results: Early GDM was associated with higher antenatal (40 vs. 38 mmol/mol; p = 0.017) and postnatal HbA1c (38 vs. 36 mmol/mol; p = 0.002) and higher risk of diabetes/prediabetes postnatally (19 vs. 6%; p = 0.003). Despite higher medication requirements, perinatal outcomes did not differ. Lower gestational weight gain (2.5 vs. 5.3 kg, p = 0.003) and comparable glycemia at 36 weeks were found. Timing of diagnosis did not impact the effect of the DiGest intervention. Conclusion: Early GDM reflects more severe underlying hyperglycemia, but timely treatment and reduced gestational weight gain can offset adverse perinatal risks.

Context: Polycystic ovary syndrome (PCOS) is a risk factor for gestational diabetes mellitus (GDM) due to shared pathophysiological associations with insulin resistance and adiposity, and may increase the risk of suboptimal perinatal outcomes in GDM. It is unclear if this excess risk upon outcomes is attributable to PCOS, more severe hyperglycemia, higher maternal BMI or reduced efficacy of dietary interventions. Objective: To assess associations of PCOS, dietary intervention and gestational weight loss with maternal and neonatal outcomes in women with GDM. Methods/Design: A secondary analysis from the DiGest double-blind randomized controlled trial. Data on self-reported PCOS status were collected at baseline. Participants: Pregnant women with GDM and BMI ≥25 kg/m2 from 8 UK centers (N = 425; 50 with PCOS and 375 without PCOS). Intervention: Reduced-energy intervention diet (1200 kcal/day) or standard-energy control diet (2000 kcal/day) from enrollment (29 weeks) until delivery. Main Outcome Measures: Pregnancy outcomes, including maternal weight and continuous glucose metrics, physical and dietary data, and infant birthweight and jaundice, were compared between women with and without PCOS using univariate tests and multivariable regression models were applied for adjusted analysis. Results: Women with GDM and PCOS had similar baseline characteristics, glycemia, BMI, and pregnancy outcomes compared with women with GDM alone, but their infants had higher rates of neonatal jaundice (24.4% vs 8.9%, P = .002). Outcomes across the dietary interventions were similar in women with and without PCOS. Conclusion: In women with GDM, PCOS was not associated with increased risks for most suboptimal pregnancy outcomes or reduced efficacy of a dietary intervention in this cohort where BMI and glycemia were comparable.

Background: Gestational diabetes (GDM) is associated with increased future obesity risk in affected mothers and children. Objective: We assessed if dietary behaviours learnt during a GDM pregnancy positively impact maternal and child health 3 years postpartum. Method: In a secondary analysis, we included women with obesity recruited to the UPBEAT randomised controlled trial with 3‐year follow‐up postnatally ( n = 441). Maternal and offspring anthropometry and dietary data were recorded antenatally and at follow‐up. Data were assessed using linear/logistic regression, adjusting for confounders. Results: Women with GDM (22%) had higher BMI (median 35.6 vs. 34.2 kg/m ² ; p = 0.049) and energy intake (1738.2 vs. 1551.6 kcal/day; p = 0.005) at ~16 weeks' gestation compared to unaffected women, but lower gestational weight gain (4.5 kg vs. 6.6 kg; p < 0.001). However, at 3 years postpartum BMI was similar between groups (35.8 vs. 35.2 kg/m ² ; p > 0.5). GDM‐exposed infants had a higher birthweight (55.4 vs. 45.9th centile; p = 0.008) than unexposed infants and at 3 years of age were more likely to be overweight/obese (International Obesity Task Force, IOTF, standards; OR 2.32; 95% CI 1.38, 3.91) but with similar skinfold thicknesses and dietary patterns. Conclusion: Women with GDM demonstrated reduced gestational weight gain, and despite a higher BMI than women without GDM in early pregnancy, this difference was not evident at 3 years postpartum. However, while maternal and offspring dietary behaviours were comparable between groups, exposed offspring were at increased risk of overweight/obesity at 3 years of age.

Aim: Type 2 diabetes (T2D) in pregnancy is increasingly common and associated with suboptimal outcomes for these women and their children. We aimed to synthesize observational evidence on associations of modifiable preconception, pregnancy and postpartum risk factors with perinatal outcomes among women with pregestational T2D. Methods: Searches were conducted in six databases (September 2023). Observational studies among women with pregestational T2D were included if they reported associations of modifiable risk factors with maternal and/or child outcomes. Screening, data extraction and quality assessments were conducted by two reviewers. Findings were synthesized through random effects meta‐analysis or narrative synthesis when results were too few or heterogeneous to pool. Results: Searches identified 15,578 results; 58 studies were included. Meta‐analysis showed excessive gestational weight gain (GWG) was associated with large for gestational age (LGA) (OR 2.39, 95%CI 1.74–3.29) but not small for gestational age (SGA). Meta‐analysis demonstrated no associations between preconception care or metformin use with adverse pregnancy, birth and neonatal outcomes. However, narrative synthesis showed preconception care was associated with increased use of folic acid and vitamin D, and reduced GWG. Further narrative synthesis findings showed that higher BMI was associated with multiple suboptimal pregnancy, birth and neonatal outcomes. Excessive GWG was associated with increased insulin requirements and increased likelihood of neonatal hypoglycaemia. The use of metformin/oral hypoglycaemic medications was associated with reduced GWG and fewer caesarean deliveries. There was mixed or no evidence of association for other reported exposures and outcomes. Conclusion: Based on observational evidence, increasing access to preconception care could be beneficial to optimize maternal nutrition and weight‐related outcomes, and addressing obesity and GWG has the potential to improve maternal and neonatal outcomes in pregnancies affected by T2D.