Solving the Riddle of Gestational Diabetes: Inconsistencies Among Medical Nutrition Therapy Recommendations

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                Gestational diabetes (GDM), a type of diabetes experienced during the second half of pregnancy, mimics traditional diabetes mellitus (DM) through increased blood glucose levels and other characteristic symptoms.  However, the incidence of GDM has more widespread and long-term effects, impacting both mother and child.  Negative outcomes for the mother include an increased risk of preeclampsia, cesarean deliveries, type 2 diabetes, and cardiovascular disease, while the child is at risk for macrosomia, neonatal hypoglycemia, type 2 diabetes, and obesity.  In light of the numerous and dangerous risks for both mother and child, interventions must be identified to alleviate potential negative outcomes.  Traditionally, medical nutrition therapy (MNT) in the form of diet and exercise has been used as the first line of defense for GDM; however, multiple healthcare agencies throughout the world now use inconsistent guidelines that impede the decision-making and implementation process for practitioners.
In an effort to untangle the web of inconsistent recommendations, researchers have compiled GDM guidelines from international agencies and have found a lack of consensus for MNT interventions.  Despite inconsistencies, some common themes were identified.  All groups agreed that energy intake throughout pregnancy should follow non-GDM guidelines and specifically warn against severe calorie restriction for weight loss purposes.  Carbohydrate intake recommendations vary from as little as 35% of total calories up to 50% of total calories; however, agencies do agree that fiber, fat, and protein intake, as well as number of meals and CHO distribution, should conform with general guidelines for DM management.  Many agencies recommended the use of a dietitian and daily food logs to aid in the management of GDM.  Others implicated glycemic index (GI) as a major contributor to GDM, indicating that mothers should avoid high GI foods.
                In general, recommendations for the management of GDM do not differ from guidelines for those with DM or healthy pregnant women, suggesting “a broader approach commonly known as a healthy diet, which is based on low GI, high complex CHO and fiber intake, and with a low amount of sugar and saturated fat.”1

1Moreno-Castilla, C., Mauricio, D., & Hernandez, M. (2016). Role of Medical Nutrition Therapy in the Management of Gestational Diabetes Mellitus. Current Diabetes Reports, 16(4), 1-9. doi:10.1007/s11892-016-0717-7

LH

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