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