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Gestational diabetes and nutritional recommendations

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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.

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References and Recommended Reading

  1. Metzger BE, Coustan DR: Summary and recommendations of the Fourth International Workshop-Conference on Gestational Diabetes Mellitus. The Organizing Committee. Diabetes Care 1998, 21(suppl2):B161-B167.

    PubMed  Google Scholar 

  2. Gunderson EP: Intensive nutrition therapy for gestational diabetes. Rationale and current issues. Diabetes Care 1997, 20:221–226.

    PubMed  CAS  Google Scholar 

  3. Ratner RE: Clinical review 47: Gestational diabetes mellitus: after three international workshops do we know how to diagnose and manage it yet? J Clin Endocrinol Metab 1993, 77:1–4.

    Article  PubMed  CAS  Google Scholar 

  4. American Diabetes Association: Evidence-based nutrition principles and recommendations for the treatment and prevention of diabetes and related complications. Diabetes Care 2002, 25:202–212. New recommendations and rationale for GDM, including calorie and carbohydrate restriction.

    Article  Google Scholar 

  5. Tuomilehto J, Lindstrom J, Eriksson JG, et al.: Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med 2001, 344:1343–1350.

    Article  PubMed  CAS  Google Scholar 

  6. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulindependent diabetes mellitus. The Diabetes Control and Complications Trial Research Group [no authors listed]. N Engl J Med 1993, 329:977–986.

    Article  Google Scholar 

  7. Buchanan TA, Metzger BE, Freinkel N: Accelerated starvation in late pregnancy: a comparison between obese women with and without gestational diabetes mellitus. Am J Obstet Gynecol 1990, 162:1015–1020.

    PubMed  CAS  Google Scholar 

  8. Metzger BE, Freinkel N: Accelerated starvation in pregnancy: implications for dietary treatment of obesity and gestational diabetes mellitus. Biol Neonate 1987, 51:78–85.

    PubMed  CAS  Google Scholar 

  9. Franz MJ, Bantle JP, Beebe CA, et al.: Evidence-based nutrition principles and recommendations for the treatment and prevention of diabetes and related complications. Diabetes Care 2002, 25:148–198.

    Article  PubMed  Google Scholar 

  10. Dornhorst A, Frost G: The principles of dietary management of gestational diabetes: reflection on current evidence. J Hum Nutr Diet 2002, 15:145–156.

    Article  PubMed  CAS  Google Scholar 

  11. Tuffnell DJ, West J, Walkinshaw SA: Treatments for gestational diabetes and impaired glucose tolerance in pregnancy. Cochrane Database Syst Rev 2003, (3)CD003395.

    PubMed  Google Scholar 

  12. Naeye RL: The outcome of diabetic pregnancies: a prospective study. Ciba Found Symp 1978, 227–241.

  13. Institute of Medicine: Nutrition During Pregnancy. Washington, DC: National Academy of Sciences; 1990.

    Google Scholar 

  14. Franz MJ, Horton ES Sr, Bantle JP, et al.: Nutrition principles for the management of diabetes and related complications. Diabetes Care 1994, 17:490–518.

    PubMed  CAS  Google Scholar 

  15. Langer O: Management of gestational diabetes. Clin Perinatol 1993, 20:603–617.

    PubMed  CAS  Google Scholar 

  16. Snyder J, Gray-Donald K, Koski KG: Predictors of infant birth weight in gestational diabetes. Am J Clin Nutr 1994, 59:1409–1414.

    PubMed  CAS  Google Scholar 

  17. Catalano PM, Roman NM, Tyzbir ED, et al.: Weight gain in women with gestational diabetes. Obstet Gynecol 1993, 81:523–528.

    PubMed  CAS  Google Scholar 

  18. Durnin JV: Energy requirements of pregnancy: an integration of the longitudinal data from the five-country study. Lancet 1987, 2:1131–1133.

    Article  PubMed  CAS  Google Scholar 

  19. King JC: Physiology of pregnancy and nutrient metabolism. Am J Clin Nutr 2000, 71:1218S-1225S.

    PubMed  CAS  Google Scholar 

  20. Food and Nutrition Board, Institute of Medicine: Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids.Washington, DC: The National Academies Press; 2002.

    Google Scholar 

  21. Gestational diabetes mellitus. American Diabetes Association [no authors listed]. Diabetes Care 1986, 9:430–431.

  22. Nutrition recommendations and principles for people with diabetes mellitus [no authors listed]. Diabetes Care 1994, 17:519–522.

  23. American Diabetes Association: Gestational diabetes mellitus. Diabetes Care 2000, 23(suppl 1):S77-S79.

    Google Scholar 

  24. American Diabetes Association: Nutrition principles and recommendations in diabetes. Diabetes Care 2004, 27(suppl 1):S36-S46.

    Google Scholar 

  25. American College of Obstetricians and Gynecologists: Diabetes and Pregnancy. ACOG Technical Bulletin #200. Washington, DC: 1994.

  26. American College of Obstetricians and Gynecologists Committee on Practice Bulletins—Obstetrics: ACOG Practice Bulletin. Clinical management guidelines for obstetrician-gynecologists. Number 30, September 2001 (replaces Technical Bulletin Number 200, December 1994). Gestational diabetes. Obstet Gynecol 2001, 98:525–538.

  27. Gabbe SG, Graves CR: Management of diabetes mellitus complicating pregnancy. Obstet Gynecol 2003, 102:857–868. Review of the evidence and current recommendations for medical and nutritional management of GDM.

    Article  PubMed  Google Scholar 

  28. Garg A, Bantle JP, Henry RR, et al.: Effects of varying carbohydrate content of diet in patients with non-insulindependent diabetes mellitus. JAMA 1994, 271:1421–1428.

    Article  PubMed  CAS  Google Scholar 

  29. Jovanovic-Peterson L, Peterson CM: Dietary manipulation as a primary treatment strategy for pregnancies complicated by diabetes. J Am Coll Nutr 1990, 9:320–325.

    PubMed  CAS  Google Scholar 

  30. Jovanovic-Peterson L, Peterson CM: Rationale for prevention and treatment of glucose-mediated macrosomia: a protocol for gestational diabetes. Endocr Pract 1996, 2:118–129.

    PubMed  CAS  Google Scholar 

  31. Dornhorst A, Nicholls JS, Probst F, et al.: Calorie restriction for treatment of gestational diabetes. Diabetes 1991, 40(suppl 2):161–164.

    PubMed  Google Scholar 

  32. Maresh M, Gillmer MD, Beard RW, et al.: The effect of diet and insulin on metabolic profiles of women with gestational diabetes mellitus. Diabetes 1985, 34(suppl 2):88–93.

    PubMed  Google Scholar 

  33. Knopp RH, Magee MS, Raisys V, Benedetti T: Metabolic effects of hypocaloric diets in management of gestational diabetes. Diabetes 1991, 40(suppl 2):165–171.

    PubMed  Google Scholar 

  34. Algert S, Shragg P, Hollingsworth DR: Moderate caloric restriction in obese women with gestational diabetes. Obstet Gynecol 1985, 65:487–491.

    PubMed  CAS  Google Scholar 

  35. Gillmer MD, Maresh M, Beard RW, et al.: Low energy diets in the treatment of gestational diabetes. Acta Endocrinol Suppl (Copenh) 1986, 277:44–49.

    CAS  Google Scholar 

  36. Magee MS, Knopp RH, Benedetti TJ: Metabolic effects of 1200-kcal diet in obese pregnant women with gestational diabetes. Diabetes 1990, 39:234–240.

    Article  PubMed  CAS  Google Scholar 

  37. Rae A, Bond D, Evans S, et al.: A randomised controlled trial of dietary energy restriction in the management of obese women with gestational diabetes. Aust N Z J Obstet Gynaecol 2000, 40:416–422.

    PubMed  CAS  Google Scholar 

  38. Wechter DJ, Kaufmann RC, Amankwah KS, et al.: Prevention of neonatal macrosomia in gestational diabetes by the use of intensive dietary therapy and home glucose monitoring. Am J Perinatol 1991, 8:131–134.

    Article  PubMed  CAS  Google Scholar 

  39. Jovanovic L: American Diabetes Association's Fourth International Workshop-Conference on Gestational Diabetes Mellitus: summary and discussion. Therapeutic interventions. Diabetes Care 1998, 21(suppl 2):B131-B137.

    PubMed  Google Scholar 

  40. Kitzmiller JL, Hoedt LA, Gunderson EP, et al.: Macrosomia and birth trauma in infants of diet treated gestational diabetic women. In Gestational Diabetes. Edited by Weiss P, Coustan DR. New York: Springer-Verlag; 1988:160–166.

    Google Scholar 

  41. Drexel H, Bichler A, Sailer S, et al.: Prevention of perinatal morbidity by tight metabolic control in gestational diabetes mellitus. Diabetes Care 1988, 11:761–768.

    Article  PubMed  CAS  Google Scholar 

  42. Goldman M, Kitzmiller JL, Abrams B, et al.: Obstetric complications with GDM. Effects of maternal weight. Diabetes 1991, 40(suppl 2):79–82.

    PubMed  Google Scholar 

  43. Langer O, Rodriguez DA, Xenakis EM, et al.: Intensified versus conventional management of gestational diabetes. Am J Obstet Gynecol 1994, 170:1036–1046.

    PubMed  CAS  Google Scholar 

  44. Major CA, Henry MJ, De Veciana M, Morgan MA: The effects of carbohydrate restriction in patients with diet-controlled gestational diabetes. Obstet Gynecol 1998, 91:600–604.

    Article  PubMed  CAS  Google Scholar 

  45. Lauszus FF, Rasmussen OW, Henriksen JE, et al.: Effect of a high monounsaturated fatty acid diet on blood pressure and glucose metabolism in women with gestational diabetes mellitus. Eur J Clin Nutr 2001, 55:436–443.

    Article  PubMed  CAS  Google Scholar 

  46. Peterson CM, Jovanovic-Peterson L: Percentage of carbohydrate and glycemic response to breakfast, lunch, and dinner in women with gestational diabetes. Diabetes 1991, 40(suppl 2):172–174.

    PubMed  Google Scholar 

  47. Romon M, Nuttens MC, Vambergue A, et al.: Higher carbohydrate intake is associated with decreased incidence of newborn macrosomia in women with gestational diabetes. J Am Diet Assoc 2001, 101:897–902.

    Article  PubMed  CAS  Google Scholar 

  48. Ilic S, Jovanovic L, Pettitt DJ: Comparison of the effect of saturated and monounsaturated fat on postprandial plasma glucose and insulin concentration in women with gestational diabetes mellitus. Am J Perinatol 1999, 16:489–495.

    PubMed  CAS  Google Scholar 

  49. Hollingsworth DR, Ney DM: Caloric restriction in pregnant diabetic women: a review of maternal obesity, glucose and insulin relationships as investigated at the University of California, San Diego. J Am Coll Nutr 1992, 11:251–258.

    PubMed  CAS  Google Scholar 

  50. Landon MB, Gabbe SG, Sachs L: Management of diabetes mellitus and pregnancy: a survey of obstetricians and maternal-fetal specialists. Obstet Gynecol 1990, 75:635–640.

    PubMed  CAS  Google Scholar 

  51. McFarland MB, Langer O, Conway DL, Berkus MD: Dietary therapy for gestational diabetes: how long is long enough? Obstet Gynecol 1999, 93:978–982.

    Article  PubMed  CAS  Google Scholar 

  52. Butte NF: Carbohydrate and lipid metabolism in pregnancy: normal compared with gestational diabetes mellitus. Am J Clin Nutr 2000, 71:1256S-1261S.

    PubMed  CAS  Google Scholar 

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Gunderson, E.P. Gestational diabetes and nutritional recommendations. Curr Diab Rep 4, 377–386 (2004). https://doi.org/10.1007/s11892-004-0041-5

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