GDM: Monitor and Evaluate MNT Effectiveness 2006
Click here to see the explanation of recommendation ratings (Strong, Fair, Weak, Consensus, Insufficient Evidence) and labels (Imperative or Conditional). To see more detail on the evidence from which the following recommendations were drawn, use the hyperlinks in the Supporting Evidence Section below.
GDM: Monitor and Evaluate MNT Effectiveness
The Registered Dietitian (RD) should monitor and evaluate blood glucose levels, weight change, food intake, physical activity and pharmacological therapy (if indicated) in women with gestational diabetes mellitus (GDM) at each visit. Research indicates that Medical Nutrition Therapy (MNT) results in improved maternal and neonatal outcomes.
Risks/Harms of Implementing This Recommendation
Conditions of Application
Recommended target blood glucose levels vary among organizations:
Fasting 1-hour 2-hour American Diabetes Association
American College of Obstetrics and Gynecology
<130 - 140 mg/dL
<7.2 - 7.8 mmol/L
Fifth International Workshop-Conference on GDM
90 - 99 mg/dL
5.0 - 5.5 mmol/L
<6.7 - 7.0 mmol/L
Potential Costs Associated with Application
- Although costs of MNT sessions and reimbursement vary, medical nutrition therapy sessions are essential for improved outcomes.
Six studies were evaluated to investigate the relationship between Medical Nutrition Therapy on pregnancy outcomes in women with gestational diabetes mellitus.
Medical Nutrition Therapy, initiated within one week of diagnosis and with a minimum of three nutrition visits, results in decreased hospital admissions and insulin use, improves likelihood of normal fetal and placental growth, and reduces risk of perinatal complications, especially when diagnosed and treated early(Svare et al, 2001; Taricco et al, 2003; Gabbe et al, 2004; Crowther et al, 2005; Reader et al, 2006; Sunsaneevithayakul et al, 2006).
American Diabetes Association Recommendation: MNT for GDM focuses on food choices for appropriate weight gain, normoglycemia, and absence of ketones (Grade E).
Recommendation Strength Rationale
- Conclusion Statement was given Grade II
- Risks/Harms of Implementing This Recommendation
The recommendations were created from the evidence analysis on the following questions. To see detail of the evidence analysis, click the blue hyperlinks below (recommendations rated consensus will not have supporting evidence linked).
What is the evidence regarding Medical Nutrition Therapy on pregnancy outcomes (morbidity, birth weight, glucose control, pharmacological therapy, pre-term delivery, satisfaction with care) in women with gestational diabetes?
Crowther CA, Hiller JE, Moss JR, McPhee AJ, Jeffries WS, Robinson JS, for the Australian Carbohydrate Intolerance Study in Pregnant Women (ACHOIS) Trial Group. Effect of treatment of gestational diabetes mellitus on pregnancy outcomes. N Engl J Med 2005;352:2477-86.
Gabbe SG, Gregory RP, Power ML, Williams SB, Schulkin J. Management of diabetes mellitus by obstetrician-gynecologists. Obstet Gynecol 2004 Jun;103(6):1229-34.
Reader D, Splett P, Gunderson EP, for the Diabetes Care and Education Dietetic
Practice Group. Impact of gestational diabetes mellitus nutrition practice guidelines
implemented by registered dietitians on pregnancy outcomes. J Am Diet Assoc 2006 Sep;106(9):1426-33.
Sunsaneevithayakul P, Kanokpongsakdi S, Sutanthavibul A, Ruangvutilert P, Boriboohirunsarn D, Keawprasit T, Tantawattana R. Result of ambulatory diet therapy in gestational diabetes mellitus. J Med Assoc Thai. 2006 Jan; 89(1): 8-12.
Svare JA, Hansen BB, Molsted-Pedersen L. Perinatal complications in women with gestational diabetes mellitus. Acta Obstet Gynecol Scand 2001;80(10):899-904.
Taricco E, Radaelli T, Nobile de Santis MS, Cetin I. Foetal and placental weights in relation to maternal characteristics in gestational diabetes. Placenta 2003 Apr;24(4):343-7.
References not graded in Academy of Nutrition and Dietetics Evidence Analysis Process
American Diabetes Association. Nutrition recommendations and interventions for diabetes: a position statement of the American Diabetes Association. Diabetes Care 2007;30 Suppl 1:S48-65.
Clinical Management Guidelines for Obstetrician-Gynecologists. ACOG Practice Guidelines Number 30, 2001;98(3):525-538.
Committee on Nutritional Status During Pregnancy and Lactation, Institute of Medicine. Nutrition During Pregnancy: Part I: Weight Gain, Part II: Nutrient Supplements. National Academy Press, Washington, DC, 1990.
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. Summary and recommendations of the Fifth International Workshop Conference on Gestational Diabetes Mellitus. Diabetes Care 2007;30 Suppl 2:S251-60.
Wylie-Rosett J, Albright AA, Apovian C, Clark NG, Delahanty L, Franz MJ, Hoogwerf B, Kulkarni K, Lichtenstein AH, Mayer-Davis E, Mooradian AD, Wheeler M. 2006-2007 American Diabetes Association Nutrition Recommendations: issues for practice translation. J Am Diet Assoc 2007;107(8):1296-304.