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.
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.
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.
Risks/Harms of Implementing This Recommendation
Conditions of Application
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).
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.
- 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?
What is the relationship between impaired glucose tolerance and poor outcomes in pregnant women?
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.
Aberg A, Rydhstroem H, Frid A. Impaired glucose tolerance associated with adverse pregnancy outcome: A population-based study in southern Sweden. Am J Obstet Gynecol 2001;184:77-83.
Bo S, Menato G, Gallo M, Bardelli C, Lezo A, Signorile A, Gambino R, Cassader M, Massobrio M and Pagano G. Mild gestational hyperglycemia, the metabolic syndrome and adverse neonatal outcomes. Acta Obstet Gynecol Scand 2004; 83(4):335-40.
Bonomo M, Corica D, Mion E, Goncalves D, Motta G, Merati R, Ragusa A, Morabito A. Evaluating the therapeutic approach in pregnancies complicated by borderline glucose intolerance: a randomized clinical trial. Diabet Med 2005;22:1536-1541.
Ergin T, Lembet A, Duran H, Kuscu E, Bagis T, Saygili E, Batioglu S. Does insulin secretion in patients with one abnormal glucose tolerance test value mimic gestational diabetes mellitus? Am J Obstet Gynecol 2002; 186(2):204-209.
Gruendhammer M, Brezinka C, Lechleitner M. The number of abnormal plasma glucose values in the oral glucose tolerance test and the feto-maternal outcome of pregnancy. Eur J of Obstet and Gynecol Reproductive Biology 2003; 108(2):131-136.
Hedderson MM, Ferrara A, Sacks DA. Gestational Diabetes Mellitus and Lesser Degrees of Pregnancy Hyperglycemia: Association With Increased Risk of Spontaneous Birth. Obstetrics & Gynecology 2003;102:850-856.
Jensen DM, Damm P, Sorensen B, Molsted-Pedersen L, Westergaard JG, Klebe J, Beck-Nielsen H. Clinical impact of mild carbohydrate intolerance in pregnancy: A study of 2904 nondiabetic Danish women with risk factors for gestational diabetes mellitus. Am J Obstet Gynecol 2001;108(2):131-6.
Jiménez-Moleón JJ, Bueno-Cavanillas A, Luna-del-Castillo J, García Màrtín M, Lardelli-Claret P, Gálvez-Vargas R. Impact of different levels of carbohydrate intolerance on neonatal outcomes classically associated with gestational diabetes. Eur J Obstet Gynecol Reprod Biol 2002;102(1):36-41.
Lao TT, Ho LF. Perinatal Morbidity and Placental Size in Gestational Impaired Glucose Tolerance. J Soc Gynecol Investig 2001;8(6):347-350.
Lao TT, Ho LF. Does Maternal Glucose Intolerance Affect the Length of Gestation in Singleton Pregnancies? J Soc Gynecol Investig 2003;10(6):366-371.
Lao TT, Wong KY. Perinatal Outcome in Large-for-Gestational Infants: Is it influenced by gestational impaired glucose tolerance? The Journal of Reproductive Medicine 2002; 47(6):497-502.
Nordin NM, Wei JWH, Naing NN, Symonds EM. Comparison of maternal-fetal outcomes in gestational diabetes and lesser degrees of glucose intolerance. J Obstet Gynecol Res 2006; 32(1):107-114.
Ostlund I, Hanson U, Bjorklund A, Hjertberg R, Eva N, Nordlander E, Marja-Liisa S, Wager J. Maternal and Fetal Outcomes if Gestational Impaired Glucose Tolerance Is Not Treated. Diabetes Care 2003;26(7):2107-2111.
Parretti E, Carignani L, Cioni R, Bartoli E, Borri P, Torre PL, Mecacci F, Martini E, Scarselli G, Mello G. Sonographic Evaluation of Fetal Growth and Body Composition in Women With Different Degrees of Normal Glucose Metabolism. Diabetes Care 2003;26(10):2741-2748.
Retnakaran R, Zinman B, Connelly PW, Sermer M, Hanley AJG. Impaired Glucose Tolerance of Pregnancy Is a Heterogeneous Metabolic Disorder as Defined by the Glycemic Response to the Oral Glucose Tolerance Test. Diabetes Care 2006;29(1):57-62.
Saldana TM, Siega-Riz AM, Adair LS, Savitz DA and Thorp JM. The Association Between Impaired Glucose Tolerance and Birth Weight Among Black and White Women in Central North Carolina. Diabetes Care 2003;26(3):656-661.
Schaefer-Graf UM, Kjos SL, Kilavuz O, Plagemann A, Brauer M, Dudenhausen JW, Vetter K. Determinants of Fetal Growth at Different Periods of Pregnancies Complicated by Gestational Diabetes Mellitus or Impaired Glucose Tolerance. Diabetes Care 2003;26(1):193- 198.
Tuffnell DJ, West J, Walkinshaw SA. Treatments for gestational diabetes and impaired glucose tolerance in pregnancy. Cochrane Database Syst Rev 2003; (3):CD003395.
Vambergue A, Nuttens MC, Verier-Mine O, Dognin C, Cappoen JP and Fontaine P. Is mild gestational hyperglycemia associated with maternal and neonatal complications? The Diagest Study. British Diabetic Association. Diabetes Medicine 2000;17: 203-208.
Yang X, Hsu-Hage B, Zhang H, Zhang C, Zhang Y, Zhang C. Women With Impaired Glucose Tolerance During Pregnancy Have Significantly Poor Pregnancy Outcomes. Diabetes Care 2002; 25:1619-1624.