- Click here for explanation of classification scheme.

The purpose of this paper is to review the literature and current practices in the treatment of women with gestational diabetes in research centers across the United States.

Inclusion methods for studies not described.

Not mentioned.

Recruitment

Methods for study inclusion not described.

Design:

Narrative review

Blinding used (If applicable)

Not applicable.

Intervention (if applicable)

Not applicable

Statistical Analysis:

Not performed.

 

Timing of Measurements

Not applicable.

Dependent Variables:

Not applicable

Independent Variables:

Not applicable

Control Variables:

Not applicable.

Initial N:  91 references included 

Attrition (Final N):  91

Age:  not mentioned

Ethnicity:  not mentioned

Other relevant demographics:

Anthropometrics:

Location:  worldwide studies

Epidemiology:

6.4% perinatal mortality rate for pregnant women >25 yr of age with untreated gestational diabetes compared to 1.5% mortality in pregnant women with normal glucose tolerance test.

Neonatal complications of untreated GDM:

Macrosomia, hypoglycemia, hypocalcemia,

Polycythemia, ­ bilirubin, intrauterine fetal demise.

~40% of women with GDM develop overt diabetes within 20 years of the index pregnancy.

Pathophysiology:

The second half of pregnancy is considered diabetogenic because of ­ Increased gestational hormones and increased ­ maternal weight with an increased demand for insulin.

Possible mechanisms for gestational diabetes:

1.        mutation in glucokinase gene

2.        insulin resistance related to age, obesity, sedentary lifestyle, family history

3.        defect in adipocyte glucose transport system

 Screening:

1.        1-hr venous plasma glucose following 50-g oral glucose load given 24 to 28^th wk gestation.

2.        Plasma glucose >7.8 mmol/L requires full diagnostic glucose tolerance test.

 Diagnosis:

1.        Preparation phase: 3 days of unrestricted diet ( > 150 grams carbohydrate) and physical activity

2.        Fasting (8-14 hr) venous plasma glucose and 3-hr plasma glucose following 100-g oral glucose load.

3.        Diagnosis if 2 of the following are met or exceeded:

a.        fasting:  5.8 mmol/L

b.       1-hr:  10.6 mmol/L

c.        2-hr: 9.2 mmol/L

d.       3-hr: 8.1 mmol/L

 Nutrition Intervention:

1.        Meal plan should promote normal blood glucose levels and glucose self-monitoring is recommended.

2.        Weight gain should be appropriate for pregnancy based on prepregnancy weight.

3.        Monitor urine ketones daily to assure adequate carbohydrates and calories.

Energy Prescriptions:

Energy intake based on prepregnancy weight:

       Normal weight: 30 kcal/kg/d

        >120% DBW: 24 kcal/kg/d

        <90% DBW: 36 to 40 kcal/kg/d

Ketone Testing:

Daily or periodic testing of the 1st voided urine for ketones

Blood Glucose Monitoring and Daily Food Records:

Goal: Keep post-prandial blood glucose < 6.7 mmol/L

Exercise:

Regular sessions rather than sporatic exercise are effective in regulating blood glucose levels

Insulin Therapy:

Necessary if fasting plasma glucose >5.8 mmol/L and/or a 1-hr postprandial plasma glucose >7.2 mmol/L and/or 2 hour postprandial plasma glucose > 6.9 mmol/L.

Post partum care:

Breast feeding not contraindicated

6-10 weeks post partum, 75 gram carbohydrate 2 hour glucose tolerance test is recommended. Lactating women should repeat test after lactation is concluded.

Education is important re: increased future risk of Type II Diabetes. importance of maintaining desirable body weight and annual glucose tolerance screening

Nutrition Counseling Strategies:

Application of nutritional, medical, obstetric and behavioral knowledge

Emotional support essential

Initial instruction:

* Survival skills (3 meals and 2-3 snacks)

* Omission of concentrated sweets

*  Women on insulin  taught the signs and symptoms of hypoglycemia and importance of regular mealtimes

Follow-Up Visits:

* Portion sizes

* Label reading

* Eating out techniques

Important to document fully the woman's willingness to participate in the educational sessions

 

       

Continuous follow-up sessions for evaluation of the woman’s food diary, postprandial blood glucose levels, weight changes and urine ketones are necessary for making adjustments in the meal plan.

More nutrition research is needed to establish practice guidelines that define standardized management practices for women with Gestational diabetes mellitus. 

It is important to individualize dietary recommendations, study all resources available and communicate with the GDM specialists.

University/Hospital:

Long Beach Memorial Medical Center, Women's Hospital

Concise, well written paper. Factually stated with little controversial or conflicting data. Unclear what articles were omitted from the review.