Gestational diabetes and nutritional recommendations

Abstract

The goals of medical nutrition therapy for gestational diabetes mellitus (GDM) are to meet the maternal and fetal nutritional needs, as well as to achieve and maintain optimal glycemic control. Nutrition requirements during pregnancy are similar for women with and without GDM. The American Diabetes Association and the American College of Obstetrics and Gynecology recommend nutrition therapy for GDM that emphasizes food choices to promote appropriate weight gain and normoglycemia without ketonuria, and moderate energy restriction for obese women. Current controversies in GDM nutrition therapy involve manipulation of dietary composition (amounts and types of carbohydrates and fats), gestational weight gain, and energy and carbohydrate restriction. Randomized controlled trials are needed to determine which dietary compositions and patterns promote normoglycemia as well as optimal maternal and infant outcomes. Until better evidence is available, nutrition therapy will remain a cornerstone of GDM management with potential benefits that cannot be fully realized in clinical practice.

Systematic review of the effect of individual and combined nutrition and exercise interventions on weight, adiposity and metabolic outcomes after delivery: evidence for developing behavioral guidelines for post-partum weight control

“…More than 78 million adults age 20 years and older in the United States are obese; 41 million are women [1]. The post-partum period may be a critical period for long-term weight gain and development of obesity for women [2, 3]. Physiological changes of childbirth may contribute to weight retention and weight gain [4, 5].…”

“…Physiological changes of childbirth may contribute to weight retention and weight gain [4, 5]. Compared with weight gain during other life intervals, excess weight retained after childbirth appears to be particularly harmful, as evidence suggests that weight retained in the post-partum tends to be distributed centrally, and therefore, may increase the risk of developing chronic disease [2, 6]. Post-partum interventions that target dietary intake and exercise may help women to achieve a healthy weight after delivery and improve their overall health status.…”

The controversy continues: Nutritional management of the pregnancy complicated by diabetes

“…Although nutrient requirements for women with and without diabetes are similar, the complication of diabetes during pregnancy adds the need to achieve and maintain optimal glycemic control with the absence of urinary ketones [2]. The American Diabetes Association (ADA) and the American College of Obstetrics and Gynecology recommend MNT for GDM that emphasizes food choices to promote appropriate weight gain and normoglycemia without ketonuria, and moderate energy restriction for obese women [3]. Although weight gain varies according to the pre-pregnancy weight, there are no data on optimal MNT and weight gain for women with GDM [4•].…”

Diet and weight gain characteristics of pregnant women with gestational diabetes

“…The cornerstone of the management of GD is nutrition therapy (Metzger and Coustan 1998;Gunderson, 2004). The goal of dietary intervention is to attain normoglycaemia and to maintain a moderate weight gain (around 6-8 kg) through pregnancy (Gunderson, 2004;Hasunen et al, 2004).…”

“…The goal of dietary intervention is to attain normoglycaemia and to maintain a moderate weight gain (around 6-8 kg) through pregnancy (Gunderson, 2004;Hasunen et al, 2004). However, those who fail to respond to the glycaemic targets through diet receive insulin in conjunction with nutrition therapy.…”