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A high protein low glycemic index diet attenuates gestational weight gain in pregnant women with obesity: the APPROACH randomized controlled trial
Nina R W Geiker, Faidon Magkos, Helle Zingenberg, Jens Svare, Elizaveta Chabanova, Henrik S Thomsen, Christian Ritz, Arne Astrup
The American Journal of Clinical Nutrition, nqab405, https://doi.org/10.1093/ajcn/nqab405
Published: 15 December 2021

Abstract
Background
Pre-pregnancy overweight and excessive gestational weight gain (GWG) increase the risk of complications and offspring obesity.
Objectives
To investigate the effect of a high protein low glycemic index (HPLGI) diet on GWG, birthweight, and risk of gestational complications in pregnant women with obesity.
Design
A total of 279 women with pre-pregnancy overweight or obesity (BMI 28-45 kg/m2), between 18–45 years and in their late first trimester with singleton pregnancies, were randomly assigned to one of two ad libitum diets: a high protein low glycemic index diet (HPLGI: 25–28% of energy from protein and glycemic index ≤ 55) and a moderate protein moderate glycemic index diet (MPMGI: 15–18% of energy from protein and glycemic index ∼60). Diets were consumed from gestational week 15 and throughout pregnancy. Participants received dietary guidance by a clinical dietician nine times to facilitate adherence.
Results
Out of 141 and 138 women randomized to the HPLGI and MPMGI diets, 105 and 104, respectively, completed the intervention (75%). In the available case analyses, GWG was 6.8 ± 1.3 kg among women assigned the HPLGI diet and this was significantly lower by –1.7 kg (95%CI –2.8, –0.5; P = 0.004) than the GWG of 8.5 ± 1.3 kg among women assigned the MPMGI diet. There were no significant differences between diets on major neonatal outcomes (birthweight and other anthropometric measures). The incidence of composite pregnancy complications was lower in the HPLGI compared with the MPMGI diet (35.4% vs. 53.7%, respectively; P = 0.009) including delivery by cesarean section (15.4% vs. 28.8%, respectively; P = 0.03). There were no reported maternal, fetal or neonatal deaths. Incidence of miscarriages (1–2%) did not differ between groups.
Conclusion
A moderate increase in dietary protein in conjunction with a reduction in glycemic index during the last two trimesters of pregnancy reduced GWG and limited complications and deliveries by cesarean section among women with overweight or obesity.