Nutrition Intervention
GDM: Carbohydrate Prescription
➤ The RDN should individualize both the amount and type of CHO for women
with GDM based on nutrition assessment, treatment goals, blood glucose
response and patient needs. Limited evidence does not confirm an ideal
amount (grams or percent of total calories) of CHO for all women with
GDM, but suggests an interaction between the amount and type of CHO.
Several studies showed positive effects on glycemic control and neonatal/
fetal and maternal outcomes in women with GDM, when evaluating
varying amounts and types of CHO:
• Low glycemic index (GI) (less than 55) or medium GI (55 to 69) diets, containing
a range of 36.7% to more than 60% CHO.
• Dietary Approaches to Stop Hypertension (DASH) diets (greater than 65% CHO).
However, when two studies evaluated the amount of CHO alone (without
specifying the type of CHO) mixed results were found:
• A CHO prescription of 202g CHO per day was more effective at reducing post-
prandial blood glucose (PPBG), compared to >270g CHO per day.
• A 23% incidence of large-for-gestational-age (LGA) infants was found with CHO
intake of less than 211g per day day, but no LGA when greater than 211g per
day. (Fair, Imperative)
GDM: Carbohydrate and Post Prandial Breakfast Glycemia
➤ The RDN should individualize both the amount and type of CHO at
breakfast based on nutrition assessment, treatment goals, blood glucose
response and patient needs. If the woman with GDM continues to
experience elevated PPBG after breakfast, the RDN may further modify the
amount or the type of CHO at breakfast to achieve blood glucose targets.
Limited evidence examining the impact of CHO on PPBG after breakfast
does not confirm an ideal amount (grams or percentage of total calories)
or type of CHO for all women with GDM to achieve PPBG targets after
breakfast, but suggests an interaction between the two.
• In women with GDM who followed low or medium GI diets containing 42-60%
total CHO (GI for breakfast meal <55; CHO range 15g to 60g or more) met PPBG
targets after breakfast.
• One study evaluating a 45% CHO diet overall (without specifying the type of
CHO), found improved PPBG after breakfast, compared to one that contained
60% CHO.
• No studies evaluated the effect of only restricting individual foods (e.g., fruit
or milk) at breakfast, although one study showed improved PPBG when fruit,
bread and milk were eaten in a low GI breakfast vs. a high GI breakfast with
CHOs from other sources. (Fair, Imperative)
