The first line of treatment for control of gestational diabetes – GDM (Diabetes in Pregnancy) is lifestyle management.
- Medical nutrition therapy
- Weight management depending on prepregnancy weight.
Studies suggest that upto 70-85% of women with GDM can control GDM with lifestyle changes alone.
Medical nutrition therapy (MNT)
Medical nutrition therapy is nothing but an individualized food plan supervised by a registered dietician.
- It should provide adequate nutrients for a healthy pregnancy and proper weight gain and should achieve and maintain normal glucose levels.
- It should take into account calorie intake, carbohydrate content in meals, and distribution of meals throughout the day.
- A typical meal plan includes three small to moderately sized meals and 2-3 snacks.
- In general, you should avoid simple sugars like sweets, starchy foods, potatoes, bread and baked products, and fatty foods.
- The source of carbohydrates you eat should be from peas, beans, whole grains, and vegetables.
Exercise like walking at a pace, arm exercises should be performed for 30 min daily for atleast five days in a week if there are no obstetric contraindications.
Excessive weight gain during pregnancy should be avoided as it hampers the benefit of glucose control in pregnancy.
Moderate restriction of calories (1/3rd reduction) is appropriate for overweight and obese GDM women.
- Self blood glucose monitoring should be done to evaluate the effectiveness of lifestyle management — Monitor glucose at fasting and 2hrs after meals.
- If glucose control is not achieved through lifestyle modification, medications should be added.
- Insulin is the drug of choice for treating high glucose levels in GDM as it does not cross the placenta.
- Metformin and glyburide should not be used as first-line agents, as both crosses the placenta to the fetus.
- American Diabetes Association - Diabetes Care 2020 Jan; 43 (Supplement 1): S183-S192. https://doi.org/10.2337/dc20-S014
- Ian Blumer, Eran Hadar, David R. Hadden, Lois Jovanovič, Jorge H. Mestman, M. Hassan Murad, Yariv Yogev, Diabetes and Pregnancy: An Endocrine Society Clinical Practice Guideline, The Journal of Clinical Endocrinology & Metabolism, Volume 98, Issue 11, 1 November 2013, Pages 4227–4249, https://doi.org/10.1210/jc.2013-2465