Gestational Diabetes is defined as carbohydrate intolerance of variable severity during pregnancy. Gestational Diabetes is a serious complication of pregnancy that requires Medical Nutrition Therapy intervention. People with GDM have a sixty per cent chance of developing NIDDM later in life.

Risk Factors

• age => 25 yrs

• overweight before pregnancy

• family history of diabetes

• previous history of high blood sugar

• previous delivery of an infant > 9 lb

• history of stillbirth for unknown reasons

• ethnicity: higher rates of GDM occur in Latino, Native American, Asian, or African-American women

• history of GDM in a previous pregnancy

Diagnosis

GDM is usually tested in the 24-28^th week of pregnancy and is diagnosed with a

3 hour Oral Glucose Tolerance Test (OGTT). A diagnosis of GDM is made if 2 plasma glucose (blood glucose) values equal or exceed the following:

*Ranges suggested by the Fourth International Conference on Gestational Diabetes.

If the 3 hour OGTT cannot be tolerated by the person, the physician may recommend a nutrition plan as a precaution based on a 1 hour, 50 gram Carbohydrate Oral Load Screen. If the one hour glucose level is between 140 mg/dL and 200 mg/dL a 3 hour OGTT should be performed.

Complications of Unmanaged GDM

• Increased risk of cesarean section

• Macrosomia, an obese type of premature development of fetus

• Fetal hypoglycemia at birth

• Stillbirth

Medical Nutrition Therapy

To provide adequate amount and types of carbohydrate, fat, protein, fiber, sodium, and micronutrients (especially iron, calcium, vitamin A, vitamin, C, folacin and other B vitamins) to support pregnancy. To provide adequate intake of calories to achieve a recommended pattern of weight gain for pregnancy based on prepregnancy weight. Small frequent meals with a balance of high fiber and low glycemic sources of carbohydrate foods, moderate amounts healthy fats, high quality protein foods, and adequate water intake are beneficial methods of regulating blood glucose levels with GDM. (See the glycemic list of foods in the article on The PMS Nutrition Solution.)

To maintain normal blood glucose levels for pregnancy by balancing food intake, activity, and insulin if needed.

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