Gestational diabetes dietary therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
- Randomized controlled trials suggest that the risk of GDM may be reduced by diet, exercise, and lifestyle counseling.
Lifestyle Management
After diagnosis, treatment starts with medical nutrition therapy, physical activity, and weight management depending on pregestational weight.[1]
Target glucose control in gestational diabetes are:
- Fasting <95 mg/dL (5.3 mmol/L)
- One-hour postprandial <140 mg/dL (7.8 mmol/L)
- Two-hour postprandial <120 mg/dL (6.7 mmol/L)
It seems that, 70-85% of patients could reach the glycemic control with life style modification.[2]
Dietary Therapy
- Many randomized controlled trials suggest that the risk of GDM may be reduced by diet, exercise, and lifestyle counseling.[3][4]
- All women diagnosed with GDM require nutritional counseling for the appropriate amount of weight gain during pregnancy as well as dietary control. Women with a normal BMI [20-25], can consume about 30kcal/kg/d while those who are obese [BMI >25-34] should restrict their diet to 25 kcal/kg/d and those that have a BMI >34 should consume 20kcal/kg/d or less. These patients should restrict fat intake and substitute simple or refined sugars in their diet to more complex carbohydrates.
Moderate amount of non-weight bearing exercise is an important adjunct to dietary advice. It is recommended that pregnant women exercise for about 20-30 minutes everyday or at least most days of the week. It is a critical point in time for changing the lifestyles of these women since they are at a high risk for development of type 2 diabetes.
Specific treatment will be determined by the physician(s) based on:
- age, overall health, and medical history
- extent of the disease
- tolerance for specific medications, procedures, or therapies
- expectations for the course of the disease
- opinion or preference [5]
Treatment for gestational diabetes focuses on keeping blood glucose levels in the normal range. Treatment may include:
- special diet
- exercise
- daily blood glucose monitoring
- insulin injections
- there is evidence that certain oral glycemic agents such as glyburide are safe in pregnancy, or at least, are significantly less dangerous to the developing fetus than poorly controlled diabetes. However, few studies have been performed as of this time.
References
- ↑ Metzger BE, Buchanan TA, Coustan DR, de Leiva A, Dunger DB, Hadden DR, Hod M, Kitzmiller JL, Kjos SL, Oats JN, Pettitt DJ, Sacks DA, Zoupas C (2007). "Summary and recommendations of the Fifth International Workshop-Conference on Gestational Diabetes Mellitus". Diabetes Care. 30 Suppl 2: S251–60. doi:10.2337/dc07-s225. PMID 17596481.
- ↑ Mayo K, Melamed N, Vandenberghe H, Berger H (2015). "The impact of adoption of the international association of diabetes in pregnancy study group criteria for the screening and diagnosis of gestational diabetes". Am. J. Obstet. Gynecol. 212 (2): 224.e1–9. doi:10.1016/j.ajog.2014.08.027. PMID 25173183.
- ↑ Bain E, Crane M, Tieu J, Han S, Crowther CA, Middleton P (2015). "Diet and exercise interventions for preventing gestational diabetes mellitus". Cochrane Database Syst Rev (4): CD010443. doi:10.1002/14651858.CD010443.pub2. PMID 25864059.
- ↑ Koivusalo SB, Rönö K, Stach-Lempinen B, Eriksson JG (2016). "Response to Comment on Koivusalo et al. Gestational Diabetes Mellitus Can Be Prevented by Lifestyle Intervention: The Finnish Gestational Diabetes Prevention Study (RADIEL): A Randomized Controlled Trial. Diabetes Care 2016;39:24-30". Diabetes Care. 39 (8): e126–7. doi:10.2337/dci16-0014. PMID 27457642.
- ↑ "Gestational Diabetes". An overview of gestational diabetes, including risk factors and treatment. University of Maryland Medicine. 2003. Retrieved 2006-11-29. Unknown parameter
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