Gestational Diabetes

GDM: Introduction (2008)

Guideline Overview

Guideline Title

Gestational Diabetes Mellitus (2008) Evidence-Based Nutrition Practice Guideline

Guideline Narrative Overview

The focus of this guideline is on medical nutrition therapy (MNT) for women with gestational diabetes mellitus.  The primary goals of MNT for women with gestational diabetes mellitus is to achieve and maintain normal blood glucose levels as safely as possible.

Guideline Development 

This guideline is intended for use by Registered Dietitians (RDs) involved in providing MNT for women with gestational diabetes mellitus. The guideline must be individualized, but it will assist the registered dietitian (RD) to successfully integrate MNT into the overall medical management of pregnant women with gestational diabetes mellitus. The recommendations in the guideline were based on a systematic review of the literature. Topics include: 
  • The provision of MNT for pregnant women with impaired glucose tolerance or gestational diabetes mellitus
  • Caloric intake
  • Macronutrient and micronutrient intake
  • Physical activity
  • Promotion of breastfeeding
  • Blood glucose monitoring and ketone testing
  • Indications for pharmacologic therapy
  • Monitoring and evaluation 
  • Prevention of gestational diabetes mellitus recurrence and type 2 diabetes  
The recommendations are based on the evidence published prior to August 2006 and reviewed by the ADA Gestational Diabetes Mellitus Evidence Analysis Work Group. The number of supporting documents for these topics is below: 
  • Recommendations:  15 
  • Conclusion Statements:  13   
  • Evidence Summaries:  13 
  • Article Worksheets:  164 
To view the guideline development and review process, click here.

Application of the Guideline

This guideline will be accompanied by a set of companion documents (i.e., a toolkit) to assist the practitioner in applying the guideline. The toolkit will contain materials such as the Medical Nutrition Therapy protocol, documentation forms, outcomes management tools, client education resources and case studies. The toolkit is currently under development and will undergo pilot-testing through the ADA's Dietetic Practice-Based Research Network prior to publication.

Revision

The literature search will be repeated for each guideline topic on an annual basis to identify new research that has been published since the previous search was completed. Based on the quantity and quality of new research, a determination will be made about whether the new information could change the published recommendation or rating.

If a revision is unwarranted, then the search is recorded, dated and saved until the next review and no further action is taken. If the determination is that there could be a change in the recommendation or rating, then the supporting evidence analysis question(s) will be re-analyzed following the standard ADA Evidence Analysis Process (see ADA Evidence Analysis Manual).

When the analysis is completed, the expert workgroup will approve and re-grade the conclusion statements and recommendations. The guideline will undergo a complete revision every three to five years.

Medical Nutrition Therapy and Gestational Diabetes Mellitus

Scientific evidence supports the effectiveness of medical nutrition therapy for gestational diabetes mellitus.  Topics included in this guideline are:

  • Medical nutrition therapy and dietitian intervention
  • Reduction of blood glucose levels
  • Reduction of risk factors for poor maternal and neonatal outcomes

The registered dietitian plays an integral role on the interdisciplinary healthcare team by making the optimal nutrition prescription and developing the nutrition intervention plan for patients undergoing gestational diabetes therapy.  Based on the client's treatment plan and comorbid conditions, other nutrition practice guidelines, such as diabetes, may be needed in order to provide optimal treatment.   

Populations to Whom This Guideline May Apply

This guideline applies to pregnant women with gestational diabetes mellitus.

Other Guideline Overview Material

For more details on the guideline components, click an item below:

  • Scope of Guideline
  • Statement of Intent and Patient Preference
  • Guideline Methods
  • Implementation of the Guideline
  • Benefits and Harms of Implementing the Recommendations.

Contraindications

Clinical judgment is crucial in the application of these guidelines.  Careful consideration should be given to the application of these guidelines for individuals with significant medical co-morbidities.