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Recommendations Summary

GDM: Prevention of GDM Recurrence / Type 2 Diabetes 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: Weight Loss After Delivery

    For women with gestational diabetes mellitus (GDM) who are overweight/obese or with above recommended weight gain during pregnancy,  the Registered Dietitian (RD) should advise weight loss after delivery which includes a combination of diet modification and physical activity. Research indicates that the risks of recurrent gestational diabetes (GDM) or development of type 2 diabetes can be reduced with weight loss.

    Rating: Strong
    Conditional

    • Risks/Harms of Implementing This Recommendation

      None.

    • Conditions of Application

      This recommendation applies to women with gestational diabetes mellitus (GDM) who are overweight/obese or with above recommended weight gain during pregnancy. For further information on a comprehensive weight managment approach see ADA's Adult Weight Managment Evidence-based Nutrition Practice Guideline.

    • Potential Costs Associated with Application

      • Although costs of MNT sessions and reimbursement vary, medical nutrition therapy sessions are essential for improved outcomes.

    • Recommendation Narrative

      Five studies were evaluated to investigate the relationship between nutrition interventions and the recurrence of gestational diabetes mellitus in women with a history of GDM.  

      • In three studies reporting recurrence of GDM, prevalence ranged from 30% to 65% (Moses et al, 1996; MacNeill et al, 2001; Nohira et al, 2006).
      • Five studies evaluating modifiable risk factors for GDM recurrence include higher prepregnancy body mass index and weight gain between pregnancies (Philipson et al, 1989; Moses et al, 1996; Moses et al, 1997; MacNeill et al, 2001; Nohira et al, 2006).

      Seven studies were evaluated to investigate the relationship between nutrition interventions and the diagnosis of type 2 diabetes in women with a history of gestational diabetes.  

      • In four studies reporting development of type 2 diabetes, ranging from two to fifteen years in length, prevalence ranged from 15% to 40% (Dalfra et al, 2001; Linne et al, 2002; Lauenborg et al, 2004; Stage et al, 2004). 
      • All seven studies examining the association between history of GDM and type 2 diabetes mellitus reported that the risks of developing diabetes can be reduced with weight loss (Coustan et al, 1993; Dalfra et al, 2001; Linne et al, 2002; Schranz et al, 2002; Lauenborg et al, 2004; Stage et al, 2004; Smith et al, 2005). 
      • American Diabetes Association Recommendation:  Because GDM is a risk factor for subsequent type 2 diabetes, after delivery, lifestyle modifications aimed at reducing weight and increasing physical activity are recommended (Grade A). 

    • Recommendation Strength Rationale

      • Conclusion Statements were both given Grade I

    • Minority Opinions

      Consensus reached.