General Dietary Recommendations For

A dogmatic approach to the dietary advice for GDM should be avoided as only four randomised trials of primary dietary management of GDM against no treatment were considered to be of sufficient standard to include in a recent Cochrane systematic review (57). This pooled data analysis of 612 women failed to show any benefit of dietary intervention on final birthweight, risk of LGA infants and/or Caesarean deliveries (57). However, ignoring all clinical and observational nutritional studies that have no non-intervention arm is probably unwise, and until definitively controlled studies are done each available study should be considered on its own merit.

The objectives in the dietary management of GDM include glycaemic control, balancing adequate nourishment for the mother and foetus, while limiting excessive weight gain, and establishing healthy eating habits that will continue beyond the pregnancy. Lifestyle changes encompassing diet and exercise should be started during the pregnancy itself, when access to a qualified dietitian is likely to be greater than at any future time.

It is important that women with gestational diabetes understand why dietary intervention during the pregnancy is so important to obstetric care. It is worth stressing that adherence to a diet in pregnancy can in most women improve glycaemic control. Understanding that a diet will reduce her risk of having a very large baby and the need for insulin therapy in pregnancy will help compliance. The importance of avoiding unnecessary weight gain needs to be emphasised, and women need to know that too much weight gain increases the risk of delivering an LGA infant and increased obesity post partum (58). Unnecessary weight gain will also increase the future risk of developing GDM in a subsequent pregnancy (59), and diabetes in later life (60).

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