Medical Nutrition Therapy for Gestational Diabetes Mellitus
Manual of Clinical Nutrition Management C- 16 Copyright © 2 013 Compass Group, Inc.
diagnosis of GDM. The National Institutes of Health is currently planning a consensus development on these
two approaches (3). Likely registered dietitians will see the diagnosis of GDM using either one of the
approaches discussed in this section (3).
Clinical Monitoring
Maternal metabolic monitoring should be directed at detecting hyperglycemia severe enough to increase
risks to the fetus (4). Fasting hyperglycemia (>105 mg/dL) may be associated with an increased risk of
intrauterine fetal death during 4 to 8 weeks of gestation (5). For both GDM and preexisting diabetes, self-
monitoring of blood glucose levels is essential for the management of diabetes during pregnancy. Urine
should also be tested for ketones on a routine basis, and these test results can be used to detect insufficient
energy or carbohydrate intake in women treated with energy restriction (1-5). Monitoring the urine glucose
levels is not appropriate in GDM (3,5). The patient’s blood pressure and urine protein levels should be
monitored to detect hypertensive disorders (3,5). Monitoring schedules for patients with preexisting diabetes
have been developed by the American Diabetes Association (1,3,5). Initially it is suggested that women test
four times per day in a fasting state and one to two hours after each meal (1).
Nutrition Intervention for Gestational Diabetes Mellitus
All women with GDM should receive nutrition counseling by a registered dietitian, which is consistent with
the recommendations of the American Diabetes Association (1,4,5,6). Medical nutrition therapy for GDM
primarily involves a carbohydrate-controlled meal plan that promotes optimal nutrition for maternal and
fetal health with adequate energy for appropriate gestational weight gain, achievement and maintenance of
normoglycemia, and the absence of ketosis (3,4,6). Specific therapeutic goals are based on an individual
nutrition assessment and self-monitoring of blood glucose levels. Optimum neonatal outcomes occur more
frequently in women who gain the recommended amount of weight based on prepregnancy body mass index
(BMI) levels established by the Institute of Medicine (Grade I)* (6).
Overweight and obese women with GDM benefit from nutrition counseling by a dietitian to decrease the
rate of weight gain, decrease the levels of fasting and postpartum serum glucose, and normalize infant birth
weight (Grade I) (6). Weight loss is not recommended during pregnancy; however, modest energy and
carbohydrate restriction may be appropriate for overweight and obese women with GDM (4). Refer to Table
C-4 for the current weight gain guidelines and Section IA: Nutrition Management During Pregnancy and
Lactation (7-9).
Table C-4: Recommended Weight Gain for Pregnant Women Based on Prepregnancy BMIa
Prepregnancy Weight Classification BMI (kg/m^2 ) Recommended Total Gain (kg [lb])
Low BMI <18.5 12.5-18 (28-40)
Normal BMI 18.5-24.9 11.5-16 (25-35)
Overweight 25.0-29.9 7 - 11.5 (15-25)
Obese >30.0 5 - 9
For women carrying multiple fetuses, the following weight gain is appropriateb
Twin pregnancy
Normal BMI
Overweight
Obese
17.0-25.0 kg (37-54 lb)
14.0-23.0 kg (31-50 lb)
11.0-19.0 kg (25-42 lb)
Triplet pregnancy 20. 5 - 11.3 kg (45-55 lb) (9)
aSources: Institute of Medicine of the National Academies. Weight Gain During Pregnancy: Reexamining the Guidelines. Washington, DC:
The National Academies Press; 2009. Available at http://www.iom.edu/~/media/Files/Report%20Files/2009/Weight-Gain-During-
Pregnancy-Reexamining-the-Guidelines/Report%20Brief%20-%20Weight%20Gain%20During%20Pregnancy.pdf. Accessed January
23, 2013.
bBrown JE, Carlson M. Nutrition and multifetal pregnancy. J Am Diet Assoc. 2000;100:343-348.
Energy Requirements
The MNT should include adequate energy and nutrients to meet the needs of pregnancy and should be
consistent with the maternal blood glucose goals. Cohort studies show that energy requirements are highly
variable and can be met by increasing food intake, decreasing physical activity, or decreasing fat storage.
Therefore, recommendations for energy levels are best determined by monitoring weight gain, physical
activity, appetite, daily food intake, and glucose and ketone records (Grade I) (6). Refer to Table C-5 for the
suggested daily energy intake for pregnant diabetic women (5,10).