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Recommendations Summary

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.


  • Recommendation(s)

    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.

    Rating: Strong
    Imperative

    • Risks/Harms of Implementing This Recommendation

      None.

    • Conditions of Application

      Recommended target blood glucose levels vary among organizations: 

        Fasting 1-hour 2-hour
      American Diabetes Association

      <105 mg/dL

      <5.8 mmol/L

      <155 mg/dL

      <8.6 mmol/L

      <130 mg/dL

      <7.2 mmol/L

      American College of Obstetrics and Gynecology

      <95 mg/dL

      <5.3 mmol/L

      <130 - 140 mg/dL

      <7.2 - 7.8 mmol/L

      <120 mg/dL

      <6.7 mmol/L

      Fifth International Workshop-Conference on GDM

      90 - 99 mg/dL

      5.0 - 5.5 mmol/L

      <140 mg/dL

      <7.8 mmol/L

      <120-127 mg/dL

      <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.

    • Recommendation Narrative

      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

    • Minority Opinions

      Consensus reached.