There remains a lack of good randomised studies on the dietary management of diabetic pregnancies. Such studies are required for both short-term pregnancy outcomes and long-term outcomes for the mother and her child. One of the main difficulties in conducting such studies is the control arm; even when no dietary advice is given, women once diagnosed with GDM make lifestyle changes based on family beliefs or information gathered from a variety of sources. Also if the health care providers are aware of the diagnosis they too unintentionally are likely to influence lifestyle factors. The need to blind both the women and the health care staff to the diagnosis is difficult and often considered unethical, as GDM if ignored can carry a risk to the pregnancy (99). It is hoped that the HAPO Study (Hyperglycaemia Adverse Pregnancy Outcome Study) currently underway, looking at pregnancy outcomes in 25 000 pregnant women in whom lesser degrees of glucose intolerance will go untreated, will help to answer some of these questions.
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