Nutrition Intervention
GDM: Medical Nutrition Therapy (MNT)
➤ The RDN should provide MNT that includes an individual nutrition
prescription and nutrition counseling for all women diagnosed with
GDM. Research indicates that MNT provided by an RDN (or international
equivalent) as part of a comprehensive nutrition intervention that includes
individualization of MNT is effective in improving blood glucose control and
neonatal and maternal outcomes in women with GDM. Improved outcomes
included lower birth weight and a reduction in the following: Incidence
of macrosomia (LGA), need for insulin therapy, hypertensive disorders
of pregnancy and maternal hospitalizations, neonatal intensive care unit
(NICU) admissions and neonatal deaths, premature births and rate of
shoulder dystocia, bone fracture and nerve palsy. (Strong, Imperative)
GDM: Frequency and Duration of MNT
➤ The RDN should provide regular and frequent MNT visits to women with
GDM to optimize outcomes. Visits should include an initial 60 to 90 minute
MNT visit, followed by a second MNT visit (30 to 45 minutes) within one
week, and a third MNT visit (15 to 45 minutes) within two to three weeks.
Additional MNT visits should be scheduled every two to three weeks or as
needed for the duration of the pregnancy. MNT assists the woman with
GDM in meeting her blood glucose and weight gain targets, contribute to
a well-balanced food intake and promote fetal and maternal well-being.
(Consensus, Imperative)
GDM: Calorie Prescription
➤ For women with GDM, the RDN should individualize the calorie prescription
based on a thorough nutrition assessment with guidance from relevant
references [Dietary Reference Intakes (DRI), Institute of Medicine (IOM)] and
encourage adequate caloric intake to promote fetal/neonatal and maternal
health, achieve glycemic goals, and promote appropriate gestational
weight gain (GWG). No definitive research suggests there is a specific
optimal calorie intake for women with GDM or if calorie needs are different
than pregnant women without GDM. Limited research in women with GDM
whose pre-pregnancy weights ranged from normal to obese showed no
significant differences in most fetal/neonatal and maternal outcomes with
various reported calorie intakes. In a study of obese women only, GWG
slowed after women with GDM reportedly consumed 30% below their
caloric requirements, without adverse effects. (Fair, Imperative)
GDM: Macronutrient Requirements
➤ In women with GDM, the RDN should provide adequate amounts of
macronutrients to support pregnancy, based on nutrition assessment, with
guidance from the DRI. The DRI for all pregnant women, including those with
GDM, recommends a minimum of 175g carbohydrate (CHO), a minimum of 71g
protein (or 1.1g per kg per day protein) and 28g fiber. (Consensus, Imperative)
