Gestational Diabetes

Individualization Is Key in Medical Nutrition Therapy for Gestational Diabetes

Author: Alyce Thomas, RDN
Nutrition Consultant, Department of Obstetrics and Gynecology, St. Joseph’s Regional Medical Center, Paterson, NJ

Citation: Thomas A. Individualization is key in medical nutrition therapy for gestational diabetes [Published online August 27, 2019]. Nutrition411.

 

The American Diabetes Association defines gestational diabetes mellitus (GDM) as diabetes diagnosed in the second or third trimester of pregnancy that was not clearly overt diabetes prior to gestation.1 GDM affects 2% to 10% of US pregnancies per year.2

Medical nutrition therapy (MNT) has always been the cornerstone and foundation of diabetes care, and GDM is no exception.3 The Academy of Nutrition and Dietetics’ 2016 nutrition guideline for women recommends that clinicians refer all women with GDM to a registered dietitian nutritionist (RDN), preferably one with experience in diabetes and pregnancy.3

Perhaps the most important component of MNT for GDM, as indicated in the 2016 guideline, is individualization.3 Dietary intervention for GDM cannot be lumped into a standard, “one-size-fits-all” approach. RDNs must take a number of factors and considerations into account when tailoring MNT to meet each patient’s unique needs, including:

  • Race/Ethnicity. According to the Centers for Disease Control and Prevention, the incidence and prevalence of GDM is higher in patients who are of African American, Hispanic/Latino American, American Indian, Alaska Native, Native Hawaiian, or Pacific Islander race/ethnicity.4
  • Cultural Background and Personal Preferences. Patients’ cultural practices, religion, etc. can play a key role in the types of foods they eat on a regular basis. It is important for RDNs to recommend foods that are familiar and compatible with a patient’s cultural background and sustainable for them throughout the duration of the pregnancy.
  • Lifestyle Factors. A patient’s physical activity level is an important consideration in MNT.
  • Family Factors. A patient’s family dynamic is important to consider when tailoring a meal plan to her needs. RDNs should note how many children the patient has and their ages, family meal times and customs, and what kinds of meals she is accustomed to cooking for her family, among other family life factors.
  • Access to Blood Glucose Monitoring. It is important for primary care providers to monitor a patient’s blood glucose level and for RDNs to have access to this information. Blood glucose level is a key component in tailoring MNT to each patient.
  • Health History and Comorbidities. Co-occurring conditions and risks, such as hypertension, thyroid diseases, and preeclampsia risk, need to be taken into account during MNT.


Because nutritional needs vary highly from patient to patient, calorie intake, carbohydrate needs, and other nutritional factors will need to be determined on an individual basis. Additionally, it is important to remember to not necessarily eliminate any particular foods or food groups but, instead, see what quantities of certain foods work for each patient in maintaining an appropriate blood glucose level.

For patients without dietary deficiencies, the guideline notes that obtaining nutrients primarily from dietary intake is best. However, some pregnant patients with dietary deficiencies may need supplementation.5 Supplementation may be warranted in the event of a teenage pregnancy, substance abuse, and/or multiple gestations, among other factors.5,6,7

Postpartum Testing

All women with a diagnosis of GDM during pregnancy should receive follow-up testing at 6 weeks postpartum, via either hemoglobin A1c testing or 75-g oral glucose tolerance testing.8 These tests are important for a number of reasons. First, testing can help determine whether a patient’s condition was true GDM or undiagnosed type 2 diabetes. Second, it can elucidate the patient’s 10-year risk for developing type 2 diabetes. However, many women with GDM do not return for postpartum care and testing, so emphasizing the importance of testing with patients is key.

In addition, it is important that women with history of GDM receive oral glucose tolerance testing again every 1 to 3 years in order to rule out prediabetes, which could progress to type 2 diabetes.9

Take-Home Message

Individualization is the most important component of MNT for GDM. It is not a “one-size-fits-all” approach. Instead, it is important for RDNs to help uncover what foods and quantities of foods suit each patient based on blood glucose level, cultural background, and unique needs.

In my own practice, I have found that the US Department of Agriculture’s MyPlate is a very useful reference point in helping tailor MNT to each of my patients. In addition, it is important for RDNs to review the Academy of Nutrition and Dietetics' 2016 guideline when tailoring MNT to patients with GDM.

References:

  1. American Diabetes Association. Classification and diagnosis of diabetes: Standards of Medical Care in Diabetes—2019. Diabetes Care. 2019;42(suppl 1):S13-S28. https://doi.org/10.2337/dc19-S002.
  2. Gestational diabetes. Diabetes. Centers for Disease Control and Prevention. https://www.cdc.gov/diabetes/basics/gestational.html. Last reviewed May 30, 2019. Accessed August 26, 2019.
  3. Gestational diabetes (GDM) guideline (2016). Evidence Analysis Library. Academy of Nutrition and Dietetics. https://www.andeal.org/topic.cfm?menu=5288&cat=5537. Accessed August 26, 2019.
  4. Gestational diabetes. Diabetes. Centers for Disease Control and Prevention. https://www.cdc.gov/diabetes/basics/gestational.html. Last reviewed May 30, 2019. Accessed August 26, 2019.
  5. Nutrients and vitamins for pregnancy. American Pregnancy Association. https://americanpregnancy.org/pregnancy-health/nutrients-vitamins-pregnancy/. Last updated July 16, 2019. Accessed August 26, 2019.
  6. Kominiarek MA, Rajan P. Nutrition recommendations in pregnancy and lactation. Med Clin North Am. 2016;100(6): 1199–1215. doi:10.1016/j.mcna.2016.06.004.
  7. Sebastiani G, Borrás-Novell C, Alsina Casanova M, et al. The effects of alcohol and drugs of abuse on maternal nutritional profile during pregnancy. Nutrients. 2018;10(8):1008. doi:10.3390/nu10081008.
  8. Kitzmiller JL, Dang-Kilduff L, Taslimi MM. Gestational diabetes after delivery: short-term management and long-term risks. Diabetes Care. 2007;30(suppl 2):S225-S235. https://doi.org/10.2337/dc07-s221.
  9. American Diabetes Association. Gestational diabetes mellitus. Diabetes Care. 2003;26(suppl 1): s103-s105. https://doi.org/10.2337/diacare.26.2007.S103.