Gestational Diabetes

Gestational Diabetes Nutrition Guideline: An Overview

The 2016 Academy of Nutrition and Dietetics (AND) guideline for gestational diabetes mellitus (GDM) serves as a reminder that individualized nutrition is crucial in the management of this condition, says Lisa Moloney, MS, RDN, nutrition researcher with AND’s Evidence Analysis Center.

Moloney, along with a 6-member expert work group, several analysts, and a project manager, developed the latest guideline. Moloney and colleagues assessed all of the topics covered in the 2008 guideline for medical nutrition therapy (MNT) in GDM and developed a set of research questions to address new areas in the updated guideline.

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Systematic reviews were conducted for each research question, which included data from observational studies and randomized controlled trials that assessed the impact of a nutrition intervention in patients with GDM. All evidence was graded based on strength and quality, with most of the evidence being “fair” on average, Moloney noted.

“Individualization is a major component of the GDM nutrition guideline. This was a result of the heterogeneity of the available evidence, confounding factors, and the overall complexity of nutrition science. RDNs should individualize nutrition care based on a thorough nutrition assessment and recommended allowances,” she said.

Among the recommendations in the 2016 guideline were:

  • Pregnant women with a diagnosis of GDM should be referred to a registered dietitian nutritionist (RDN) for individualized MNT (strong, imperative recommendation).
  • RDNs should assess GDM patients’ food and nutrition-related history, including calorie intake, carbohydrate intake, service sizes, meal and snack patterns, and related factors (consensus, imperative).
  • RDNs should assess anthropometric measurements in women with GDM including, but not limited to, height, current weight, pre-pregnancy weight, body mass index, and weight changes during pregnancy (consensus, imperative).
  • RDNs should assess available data regarding patient history and nutrition-focused physical findings of women with GDM including, but not limited to, their medical and family history, age, single or multiple fetuses, weeks of gestation, and estimated date of delivery, among other factors (consensus, imperative).
  • RDNs should provide MNT with individual nutrition prescriptions and counseling to all women with a diagnosis of GDM (strong, imperative).
  • For optimal outcomes, RDNs should provide frequent and regular MNT visits to women with GDM (consensus, imperative). Visits should include:
    • An initial, 60-90 minute MNT visit
    • A second, 30-45-minute MNT visit within 1 week
    • A third, 15-45-minute MNT visit within 2 to 3 weeks
    • Additional MNT visits every 2 to 3 weeks or as needed for the duration of the pregnancy
  • Unless contraindicated, RDNs should encourage patients with GDM to engage in daily moderate physical activity lasting 30 minutes or more per day (strong, conditional).
  • After the nutrition intervention, RDNs should monitor and evaluate several components at each visit in order to track patients’ progress and compare with desired individual outcomes relevant to the diagnosis and intervention among women with GDM. This includes calorie intake, serving sizes, and meal and snack patterns, among other factors.


For the full executive summary of the guidelines, click here.

—Christina Vogt

Reference:
Gestational diabetes (GDM) guideline (2016). Evidence Analysis Library. Academy of Nutrition and Dietetics. https://www.andeal.org/topic.cfm?menu=5288&cat=5537. Accessed August 26, 2019.