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Nutrition

Update

Gestational Diabetes Mellitus
CATHY FAGEN, MA, RD, CDE Perinatal Outreach Education Program Long Beach Memorial Medical Center

Long Beach, California
Treatment of gestational diabetes with insulin and/or diet is a topic still under research. There are many views of thought on the subject, consequently varying styles of treatment. No matter which approach yourinstitution or provider is using, the universal goal is control of blood glucose levels and prevention of macrosomia (infant weighing more than 9 lb or 4000 g). Since the data are not out yet, the most beneficial method of treatment is still to be determined. This paper will survey the issues and give one provider’s recommendation.

stricted activity and diet (ie, a miniof 1500 calories per day).The 300-g carbohydrate load diet is not necessary. On the morning of the test, the woman’s fasting blood glucose level is determined. She then ingests the 100-g glucola and her blood is taken at 1-hour, 2-hour, and 3-hour intervals. The diagnosis of gestational diabetes is made when two or more of the glucose measurements meet the following criteria:
mum

Screening and Diagnosis
Manyinstitutions or providers are screening all pregnant women for gestational diabetes (GDM) between 24 and 28 weeks’ gestation. The American Diabetes Association recommends this universal screening since 50% of women with GDM exhibit no risk factors. The correct procedure for screening is to challenge the woman’s metabolism with a 50-g glucola load. This test is administered at any time of the day withoutany dietary preparation or restrictions. If the 1-hour venous plasma glucose result is greater than or equal to 140 mg/dL (7.8 mmol/L), the woman should be given the 3-hour oral glucose tolerance test (OGTT) of 100 g glucola. The OGTT is considered the diagnostic test. Diagnosis cannot be made from the 50-g oral glucose screening test, a blood glucose meter, a glycosylated hemoglobin test, or urineglucose testing. The OGTT requires an overnight fast of 8 to 14 hours.’ The test should be preceded by 3 days of unreto Cathy Fagen, MA, RD, CDE, Perinatal Outreach Education Program, Long Beach Memorial Medical Center, 2801 Atlantic Avenue, Long Beach, CA 90801.

Fasting 105 mg/dL(~ 5.8 mmol/L) 1 hour 190 mg/dL (~ 10.5 mmol/L) 2 hour: > 165 mg/dL (> 9.2 mmol/L) 3 hour: ~145 mg/dL (~ 8.0 mmol/L)If only one value is elevated, it is recommended that the OGTT be repeated at 32 weeks’ ge station.2
Education
is made, the pregneeds to be educated about gestational diabetes and what it means to her and her baby. Risks that are often associated with a GDM pregnancy are depicted in Table 1.; Diet, psychosocial assessment, blood glucose monitoring, and an explanation of any other obstetricaltesting that may be needed are all components of the education sessions. Control of blood glucose levels requires a team approach, with the patient being the most important member of the team. Once the

diagnosis

nant woman

Diet Education Dietary management is
of all diabetes

a

cornerstone

therapy. The person most qualified to explain the dietary rationale and develop anindividualized meal
plan is the registered dietitian. The Nutrition During Pregnancy report of the
Institute of Medicine of the National Academy of Sciences (NAS) recommends assessing, counseling, and monitoring pregnant women for both weight gain and diet quality, while stressing the importance of individualizing guidelines as circumstances warran t. Gestational diabetes mellitus is a circumstancerequiring individualized meal plans. Before setting up the individualized meal plan, the registered dietitian determines the woman’s weight gain goal and calorie level for the diet. Table 2 depicts how a recommended kilocalorie level is determined. The NAS weight gain recommendations for pregnancy and the use of the body mass index (BMI) have been incorporated. The diet is not meant for weight reduc-...