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.
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.
Risks/Harms of Implementing This Recommendation
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.
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
- 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 are the nutrition interventions that may prevent the diagnosis of type 2 diabetes in women with previous GDM?
What are the nutrition interventions that may prevent the recurrence of GDM in women with previous GDM?
Coustan DR, Carpenter MW, O'Sullivan PS, Carr SR. Gestational diabetes: predictors of subsequent disordered glucose metabolism. Am J Obstet Gynecol 1993; 168:1139-1145.
Dalfra MG, Lapolla A, Masin M, Giglia G, Dalla Barba B, Toniato R, Fedele D. Antepartum and early postpartum predictors of type 2 diabetes development in women with gestational diabetes mellitus. Diabetes Metab 2001 Dec;27(6):675-80.
Lauenborg J, Hansen T, Jensen DM, Vestergaard H, Molsted-Pedersen L, Hornnes
P, Locht H, Pedersen O, Damm P. Increasing incidence of diabetes after gestational diabetes: a long-term follow-up in a Danish population. Diabetes Care 2004;27(5):1194-9.
Linne Y, Barkeling B, Rossner S. Natural course of gestational diabetes mellitus: long term follow up of women in the SPAWN study. BJOG 2002 Nov;109(11):1227-31.
Schranz AG, Savona-Ventura C. Long-term significance of gestational carbohydrate intolerance: a longitudinal study. Exp Clin Endocrinol Diabetes 2002 Aug;110(5):219-22.
Smith BJ, Cheung NW, Bauman AE, Zehle K, McLean M. Postpartum physical activity and related psychosocial factors among women with recent gestational diabetes mellitus.
Diabetes Care 2005 Nov;28(11):2650-4.
Stage E, Ronneby H, Damm P. Lifestyle change after gestational diabetes. Diabetes Res Clin Pract 2004;63(1):67-72.
MacNeill S, Dodds L, Hamilton DC, Armson BA, VandenHof M. Rates and risk factors for recurrence of gestational diabetes. Diabetes Care 2001;24:659-662.
Moses RG. The recurrence rate of gestational diabetes in subsequent pregnancies. Diabetes Care 1996; 19:1348-1350.
Moses RG, Shand JL, Tapsell LC. The recurrence of gestational diabetes: could dietary differences in fat intake be an explanation? Diabetes Care 1997; 20:1647-1650.
Nohira T, Kim S, Nakai H, Okabe K, Nohira T, Yoneyama K. Recurrence of gestational diabetes mellitus: rates and risk factors from initial GDM and one abnormal GTT value.
Diabetes Res Clin Pract 2006 Jan;71(1):75-81.
Philipson EH, Super DM. Gestational diabetes mellitus: does it recur in subsequent pregnancy? Am J Obstet Gynecol 1989; 160:1324-1331.
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.
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.
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.