80-90% of all cases of mild gestational
diabetes can be treated with lifestyle changes.
This table shows the results of the
study, the “Effect of Treatment of Gestational Diabetes
Mellitus on Pregnancy Outcome”. This was the first large
trial to show a reduction in perinatal complications
with intervention, as compared to routine obstetric
care.
|
Routine
Care |
Intervention
|
Adjusted
P
Value |
Any
serious
perinatal complication |
4% |
1% |
.01 |
Macrosomia |
21% |
10% |
<.001 |
Shoulder dystocia |
3% |
1% |
.08 |
C-section |
32% |
31% |
.73 |
Medical Nutrition Therapy guidelines as
set forth by the American Diabetes Association and the
Academy for Nutrition and Dietetics strongly recommend
that women evaluate the lifestyles before conception.
This includes things like any medical conditions or risk
factors which could interfere with the baby’s
development, achieving a healthy body weight before
conception, and stopping smoking, among others.
•Identify
medical conditions that need treatment
•Evaluate
risk factors, history, medications, & dietary &
exercise habits
•Establish
a meal & exercise plan to achieve healthy body
weight
•Initiate
folic acid therapy
•Smoking
cessation
•Minimize
exposure to lead, mercury, & other toxins
IOM’s
Guidelines for Gestational Weight Gain
Excessive maternal weight gain is associated
with an increased risk of neonatal hypoglycemia, macrosomia,
low Apgar scores, seizures, and polycythemia. These may
increase the infant’s risk of obesity later in life. Keeping
gestational weight gain within certain parameters also helps
to prevent postpartum weight retention. Additionally, a
total gestational weight gain of < 69% of the recommended
ranges have been associated with an increased risk of
preterm birth & low birth weight.
It should be noted that weight gain during
the 2nd
half of pregnancy is strongly associated with fetal growth.
The chart below helps to illustrate these parameters.
IOM’s Guidelines for Gestational Weight Gain
BMI |
Recommend Weight Gain |
< 18.5 |
28-40 lbs |
18.5-24.96 |
25-35 lbs |
25-29.9 |
15-25 lbs |
> 30 |
11-20 lbs |
Rate of weight gain appears to be as
important to the infant’s health
as amount of weight gain
1st
Trimester……….3-5 lbs
2nd
& 3rd
Trimester………..3-4 lbs per month