Development and testing of a reduced carbohydrate intervention for the management of obesity and reduction of gestational diabetes (RECORD): protocol for a feasibility randomised controlled trial

• Published in: BMJ open Vol. 12; no. 9; p. e060951
• Main Authors: Michalopoulou, Moscho, Jebb, Susan A, MacKillop, Lucy H, Dyson, Pamela, Hirst, Jane E, Wire, Amy, Astbury, Nerys M
• Format: Journal Article
• Language: English
• Published: England British Medical Journal Publishing Group 01.09.2022; BMJ Publishing Group LTD; BMJ Publishing Group
• Series: Protocol
• Subjects: Body mass index; Carbohydrates; diabetes in pregnancy; Diabetes, Gestational - prevention & control; Diet; Diet, Carbohydrate-Restricted; Dietary Carbohydrates; Energy intake; Feasibility Studies; Female; Gastrointestinal surgery; Gestational diabetes; Glucose; Humans; Hyperglycemia; Infant, Newborn; Intervention; nutrition & dietetics; Nutrition and Metabolism; Obesity; Obesity - epidemiology; Obesity - prevention & control; obstetrics; Participation; Pregnancy; Prenatal care; Randomized Controlled Trials as Topic; Ultrasonic imaging; Womens health; United Kingdom > UK; diabetes in pregnancy; obstetrics; nutrition & dietetics
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2022-060951

IntroductionPrevious trials of dietary interventions to prevent gestational diabetes mellitus (GDM) have yielded only limited success. Low-carbohydrate diets have shown promise for the treatment of type 2 diabetes, but there is no evidence to support their use in pregnancy. The aim of this study is to explore the feasibility of a moderately reduced-carbohydrate dietary intervention delivered from mid-pregnancy alongside routine antenatal care.Methods and analysisThis is a feasibility randomised controlled trial (RCT) with embedded qualitative study. Sixty women who are pregnant <20 weeks’ gestation, with body mass index ≥30 kg/m2 at their antenatal booking appointment, will be randomised 2:1 intervention or control (usual care) and followed up until delivery. The intervention is a moderately reduced-carbohydrate diet (~130–150 g total carbohydrate/day), designed to be delivered alongside routine antenatal appointments. Primary outcomes are measures of adoption of the diet and retention of participants. Secondary outcomes include incidence of GDM, change in markers of glycaemic control, gestational weight gain, total carbohydrate and energy intake. Process outcomes will examine resources and management issues. Exploratory outcomes include further dietary changes, quality of life, maternal and neonatal outcomes, and qualitative measures.Ethics and disseminationThis trial was reviewed and approved by the South-Central Oxford B Research Ethics Committee NHS National Research Ethics Committee and the Health Research Authority (Reference: 20/SC/0442). The study results will inform whether to progress to a full-scale RCT to test the clinical effectiveness of the RECORD programme to prevent GDM in women at high risk. The findings will be published in peer-reviewed journals and presented at conferences.Trial registration numberISRCTN16235884.