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Recommendations Summary

GDM: MNT for Pregnant Women with IGT or GDM 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: MNT for Women with GDM

    The Registered Dietitian (RD) should initiate Medical Nutrition Therapy (MNT) within one week after diagnosis of gestational diabetes mellitus (GDM), and include a minimum of three nutrition visits.  Research indicates that MNT results in improved maternal and neonatal outcomes, especially when diagnosed and treated early.

    Rating: Strong
    Imperative

    GDM: MNT for Pregnant Women with IGT

    For women with impaired glucose tolerance (IGT) during pregnancy, the Registered Dietitian (RD) should initiate the same recommendations of Medical Nutrition Therapy (MNT) as those for gestational diabetes mellitus (GDM).  Research indicates that impaired glucose tolerance (IGT) and gestational diabetes mellitus (GDM) carry similar risks of adverse outcomes.

    Rating: Strong
    Imperative

    • Risks/Harms of Implementing This Recommendation

      None.

    • Conditions of Application

      None.

    • 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).

      Twenty studies were evaluated to investigate the relationship between impaired glucose tolerance (definitions vary) during pregnancy and poor outcomes. 

      • Two studies demonstrate the metabolic similarities between impaired glucose tolerance and gestational diabetes mellitus (Ergin et al, 2002; Retnakaran et al, 2006). 
      • Twelve studies report increased risks of large for gestational age newborns and macrosomia in women with impaired glucose tolerance (Vambergue et al, 2000; Aberg et al, 2001; Jensen et al, 2001; Jimenez-Moleon et al, 2002; Gruendhammer et al, 2003; Ostlund et al, 2003; Parretti et al, 2003; Saldana et al, 2003; Schaefer-Graf et al, 2003; Bo et al, 2004; Bonomo et al, 2005; Nordin et al, 2006) . 
      • Additional research notes increased risks of preterm birth (Yang et al, 2002; Hedderson et al, 2003; Lao and Ho, 2003), perinatal morbidity (Lao and Ho, 2001; Lao and Wong, 2002) and neonatal hypoglycemia (Tuffnell et al, 2003). 

    • Recommendation Strength Rationale

      • Conclusion Statements were given a Grade I and II.

    • Minority Opinions

      Consensus reached.