Academy of Nutrition and Dietetics Guidelines Bundle

Gestational Diabetes Mellitus

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Nutrition Monitoring and Evaluation GDM: Nutrition Monitoring and Evaluation ➤ Following the nutrition intervention of women with GDM, to check progress, the RDN should monitor and evaluate the following components at each visit and compare to desired individual outcomes relevant to the nutrition diagnosis and nutrition intervention. This may include, but is not limited to: > Food/Nutrition-Related History Outcomes • Daily food intake in relation to post-meal glucose readings • Food, beverage and nutrient intake including: ▶ Calorie intake; types and amount of carbohydrate (including fiber) fat, protein; with special attention to high calorie, low-nutrient dense foods such as desserts, candy, sugar-sweetened beverages ▶ Serving sizes ▶ Meal and snack patterns, including frequency and duration ▶ Recent changes to food choices and/or eating pattern ▶ Preferences, avoidance, intolerances, allergies including: » In relationship to gastrointestinal discomforts (e.g., nausea, vomiting, heartburn, constipation, ptyalism) » Reaction to or changes in food tastes/smells related to pregnancy » Cultural and religious considerations. ▶ Appetite and changes in appetite ▶ Frequency and intake of meals and snacks; meals eaten away from home ▶ Methods of food preparation; food safety ▶ Recommendation to add pharmacologic therapy (oral and/or insulin therapy) to maintain nutrient intake and achieve glycemic targets » Pharmacologic therapy – dose of diabetes medications: Oral glucose-lowering agent and insulin. ▶ Changes in substance use: alcohol, tobacco, caffeine, recreational drugs ▶ Knowledge, beliefs or attitudes: Motivation, readiness to change, self- efficacy; willingness and ability to make lifestyle changes; understanding of the treatment plan for GDM ▶ Physical activity and function: Exercise patterns, functionality for activities of daily living, sleep patterns. > Anthropometric Measurement Outcomes • Weight changes compared to previous obstetric visit or MNT visit. > Biochemical Data, Medical Tests, and Procedure Outcomes: • Self-monitoring blood glucose (SMBG) records, including meter downloads • Ketone testing records (if previously recommended because of weight loss or inadequate calorie intake) • Updated fetal and maternal testing or lab values. Nutrition monitoring and evaluation of these factors is needed to correctly/ effectively diagnose nutrition problems that should be the focus of further nutrition interventions. Inability to achieve optimal nutrient intake may contribute to poor outcomes or initiation of, or changes in, pharmacologic therapy. (Consensus, Imperative)

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