Change is an excellent word to describe what is happening in the gestational diabetes mellitus (GDM) field. A major change is the expected number of women who will be diagnosed with GDM. Previously about 1 in 15 or ~7% of pregnant women were diagnosed with GDM. However, the increase in obesity has resulted in more women of childbearing age being diagnosed with type 2 diabetes (T2D), an increase in the number of women with undiagnosed T2D, as well as an increase in GDM during pregnancy. This will have a major impact on Registered Dietitian Nutritionists (RDNs) as medical nutrition therapy (MNT) is, and will continue to be, the first line of therapy for GDM. Thus, the increase in women with GDM who are predicted to be referred to RDNs for MNT is why it is important for RDNs to be up to date on the management of GDM. 

Research has reported the risk of adverse outcomes for the mother and infant increase at glycemic levels previously thought to be normal during pregnancy. Glycemic goals for GDM are reviewed in chapter 3. As a result, it is likely RDNs will find more health care providers using either metformin or insulin combined with MNT if glucose goals are not met with MNT alone. Perhaps the most important change that will result from the changes in therapy will be an increase in healthier infants and mothers! 

Several major research studies have supported the role of MNT in the management of GDM. The Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study, a large-scale multinational epidemiologic study, reported that previous glucose recommendations for diagnosis and therapy were too high. The frequency of adverse outcomes increased with increasing maternal glucose levels that were previously considered to be normal (HAPO Study Cooperative Research Group, 2008). Evidence supports the effectiveness of MNT as first-line therapy for GDM (Crowther, 2005, Reader, 2006, and Landon, 2009; Duarte, 2018; Kapur, 2020).  

The Academy of Nutrition and Dietetics (Academy) nutrition practice guideline (NPG) for gestational diabetes (Duarte, 2018) based on a systematic review of evidence, outlines optimal nutrition therapy and desired clinical outcomes. The emphasis is on individualizing the nutrition prescription based on nutrition assessment, treatment goals, a caloric intake for fetal and maternal health, amount and type of carbohydrate based on blood glucose responses, and the women’s unique cultural and socioeconomic needs.  

This continuing professional education (CPE) program is written to assist nutrition professionals (RDNs; nutrition and dietetic technicians, registered [NDTR]; and others) to become familiar with the changes in the GDM field and how they impact on their practice. Chapter 1 reviews screening and the controversy over how to diagnose GDM. Chapter 2 reviews the pathophysiology and maternal and fetal risks of GDM. Management goals, glucose monitoring, self-management education, physical activity, surveillance during pregnancy, and delivery and post-delivery postpartum care are covered in Chapter 3. Chapter 4 summarizes MNT for GDM based on the Academy’s NPG. Medical therapies for GDM, including glucose-lowering medications and insulin, are reviewed in Chapter 5. Chapter 6 covers the important role that nutrition professionals, and lifestyle changes, can make in preventing future diabetes in women diagnosed with GDM during their pregnancies.