1. LOW GLYCEMIC INDEX & HYPOCALORIC DIET THERAPY VS CONVENTIONAL APPROACH IN GDM/OAV, AFTER MEDICAL NUTRITIONAL THERAPY FAILURE A.Napoli, A.Napoli, C.Festa, G.Merola, M.Bongiovanni, A.Colatrella, L.Mattei, V.Toscano Sapienza University, Rome S.Andrea University Hospital, Sapienza University, Rome Aim: we compared the Efficacy of a Low Glycemic Index, Hypocaloric diet vs a Conventional approach in terms of fetal- Maternal Outcome in 111 GDM & OAV, after conventional Medical Nutritional Therapy (MNT) Failure: FBG:>90 mg/dl & Post-Prandial BG 130mg/dl in 30% of each time point Methods: Prospective Randomized open-label Study Conventional MNT based on pregestational BMI (ADiet: ~30 Cal/kg, 50-55% CHO) was shifted to: Low Glycemic Index & Hypocaloric Diet therapy B (~27 cal/kg, 40-45% CHO) Insulin I

2. Diet A conventional MNT N. 111 Diet A conventional MNT N. 111 Fasting BG 90 mg/dl & post-prandial BG130 mg/dl Fasting BG 90 mg/dl &/or post-prandial BG 130 mg/dl in 30% of each time point Fasting BG 105 mg/dl &/or post-prandial BG 160 mg/dl diet A until the delivery N. 23 diet A until the delivery N. 23 Diet B hypocaloric and low glycaemic index N. 35 Fasting BG 90 mg/dl & post-prandial BG 130 mg/dl 30% of each time point Ethically Insulin N. 20 Ethically Insulin N. 20 Insulin N. 33 METHODS B-Insulin N. 11 R

3. Women kept being under diet A until delivery 20,7% of all pregnant women `Normoweight` BMI= 24,7±4 kg/m2 Diagnosis ´OGTT´´ 28.1±4.8 wk, Latest Lower Fasting BG levels 82.9±12.1 Women Ethically treated by Insulin EI from the beginning 18 % of all pregnant women Overweight, BMI= 26.5±3 kg/m2 Women kept being under diet BB until delivery 68,57% of ´B ´ `Thinner ` BMI= 24,2±4 kg/m2 Diagnosis ´OGTT´´ 27.1±2.9 wk, Later Lowest Fasting BG levels: 82.4±6.1mg/dl Women shifted from ´B´ to Insulin ´BI´ 31,42 % of ´B ´ Obese, BMI= 30.2±7 kg/m2 Diagnosis ´OGTT´´ 21.5±6.5 wk, Earlier RESULTS

4. Maternal Outcome No difference in Week and Type of Delivery between groups BG levels during pregnancy: ´B´ better than´I´ the best profile in ´A´ Weight Gain: EI*~A*> B> I> BI during pregnancy Neonatal Outcome Neonatal Weight / Ponderal Index significantly Higher in ´A´ group, Lower in ´I´ group significant A or EI vs I Macrosomia = 3% (1I & 2A). SGA= 0% ´APGAR´ : No difference Neonatal Hypos n=6 (6,2% ) (EI= 4, I=2) Neonatal Hypocalcemia* n=3 (3,1%) (I=3) RESULTS AND CONCLUSIONS Conclusions: A Low glycemic index & slightly hypocaloric diet is effective up to the end of gestation in >2/3 of normo/overweight GDM/OAV & Recommendable to all GDM/OAV

5. Previous pregnancies EI >all; A<all;A*<EI 1 st visit gestational age BI<I<EI<B<A.A*vs all, BI* <B Before randomization, with diet A, Fasting BG BI>EI>I>B>A A*vs BI and EI; BI*vs I & B POST Prandial & Mean 24hrBG A< all RESULTS AgeBMIHbA1c 3th tr Weig ht FBGOGT T IRI0OGT T HOMABG 120OGTT week A34.7± 5 24,7± 4 4,6±0,912.4±482.9±12. 1 6,9±3,71.2±0,9 145.8 ±31 28.1 ±4.8 B35.9± 4 24.2± 4 4.7±0.68.9±482.4±6.18.8±5.11.4±1.2 168.1 32 27.3±2.9 BI33±330.2± 7 5±1,17.6±690.4±12. 6 16.7±10. 8 3.1±2,9 143.7 28 21.5±6.5 I34.3± 5 24.5± 5 4,8±0.98.8±583.9±13. 2 9,9±8,32±2.1 164.6 31 25.7±6.1 EI35.1± 5 26.5± 3 5±1,112.8±693.1±31. 4 12,5±13, 7 3.1±3.2 155.6 46 26.3±7.8 pn.s.BI*>A>I >B EI>B* nsA*and EI*>B>I >BI BI>BA<BIn.s.A < allBI*<I<EI<B *<A*