This Academy member benefit temporarily has been made public to allow all practitioners access to content that may assist in patient care during the national pandemic response. Click here for information on joining the Academy. 

Gestational Diabetes

GDM: Benefits and Risks/Harms of Implementation (2016)

Benefits and Risks/Harms of Implementing the Recommendations

Factors to consider when exploring treatment options include:

  • Patient’s age (advanced maternal age), gravida, socioeconomic status, cultural issues, psychosocial and mental health status, and other health history, and individual and health conditions 
  • Referral to a behavioral specialist if psychosocial issues are a concern [e.g., family and household strain, verbal/physical abuse, exposure to discrimination, major/catastrophic life events, and anxiety about the current pregnancy (Kaiser & Campbell, 2014)]
  • Referral to social services to assist individuals with financial arrangements, if economic issues are a concern [e.g., food insecurity, unemployment, low resources (Kaiser & Campbell, 2014)]
  • Women who are unwilling or unable to refrain from alcohol consumption during pregnancy (e.g., heavy drinker, alcohol dependency, binge drinker) should be referred for supportive services, such as counseling and possible treatment (O’Leary & Bower, 2012)
  • Use clinical judgment when evaluating patients with co-morbid conditions, such as hypertension, obesity, and eating disorders
  • Barriers that may hinder the application of these recommendations include health literacy and numeracy; barriers to attendance at MNT sessions may include inability to take time off work or school, lack of child care, and lack of transportation.
  • Healthcare provider consultation is warranted/required prior to beginning any exercise program (ACOG, 2015).

Potential Benefits

When implementing these recommendations, consider the following general benefits:

  • Improve the patient's ability to achieve optimal nutrition through healthful food choices and physically active lifestyle.
  • Achieve blood glucose targets
  • Achieve maternal weight gain targets
  • Achieve fetal growth/development targets
  • Prevent adverse maternal and fetal/neonatal outcomes.

Risk/Harm Considerations

Potential risks/harms to consider, when exploring treatment options include:

  • Physical Activity:
    • High-intensity or prolonged exercise in excess of 45 mins can lead to hypoglycemia (ACOG, 2015)
    • Pregnant women engaging in physical activity should be advised to ensure adequate caloric intake and to remain well hydrated (ACOG, 2015) 
    • Contact sports (ice hockey, boxing, soccer, basketball), activities with a high risk of falling (skiing surfing, off-road cycling, gymnastics, horseback riding), scuba diving, sky diving, and hot yoga or hot pilates should be avoided (ACOG, 2015).
  • High-Intensity Sweeteners:
    • In a 1985 review of saccharin, the American Medical Association suggested pregnant women should consider avoiding saccharin due to limited epidemiological studies in pregnant women and children (Council on Scientific Affairs, 1985). To date, more than 30 human studies have found that saccharin is safe for human consumption (FDA, 2015). Saccharin is approved for use as a non-nutritive high intensity sweetener by the FDA (FDA, 2015).  
  • Micronutrients:
    • Some individuals may not tolerate vitamin and/or mineral supplementation
    • In general, pregnant women should seek medical consultation before or while taking a non-prescribed over-the-counter (OTC) micronutrient supplement that exceeds the Tolerable Upper Limits (UL) for a particular vitamin or mineral (Kaiser & Campbell, 2014), or if taking herbal supplements.
References:

American College of Obstetricians and Gynecologists. Physical activity and exercise during pregnancy and the postpartum period. Committee Opinion No. 650. American College of Obstetricians and Gynecologists. Obstet Gynecol. 2015;126: e135-142. 

Council on Scientific Affairs, American Medical Association. Saccharin: Review of safety issues. JAMA 1985; 254(18): 2, 622-2, 624.

Food and Drug Administration. Additional Information about High-Intensity Sweeteners Permitted for use in Food in the United States. (2015, May 26). Retrieved September 12, 2016, from http://www.fda.gov/food/ingredientspackaginglabeling/foodadditivesingredients/ucm397716.htm

Kaiser LL, Campbell CG; Academy Positions Committee Workgroup. Practice paper of the Academy of Nutrition and Dietetics abstract: nutrition and lifestyle for a healthy pregnancy outcome. J Acad Nutr Diet. 2014 Sep; 114 (9): 1, 447. PMID: 25699300.

O'Leary CM, Bower C. Guidelines for pregnancy: what's an acceptable risk, and how is the evidence (finally) shaping up? Drug Alcohol Rev. 2012 Mar;31(2):170-183. doi: 10.1111/j.1465-3362.2011.00331.x. Epub 2011 Sep 29. Review. PMID: 21955332.