The controversy continues: Nutritional management of the pregnancy complicated by diabetes


Current controversies for medical nutrition therapy in pregnancies complicated by diabetes include the composition and amount of carbohydrates and fats as well as optimal gestational weight gain and energy restriction. Although carbohydrate is the macronutrient with the greatest effect on glycemic control, there is little evidence for a recommended amount and type of carbohydrate or its distribution. This lack of evidence prompts an issue of debate among practitioners over the type of carbohydrate and its percent distribution throughout the day. The best indicators at this time are the results of self-monitoring of blood glucose, ketone testing, food records, and weight gain. A review of the literature provides the most current information available for medical nutrition therapy during a pregnancy complicated by diabetes and reinforces the need for further research in the form of randomized controlled trials to answer questions regarding carbohydrate modification and distribution, energy needs, and weight gain.

This is a preview of subscription content, log in to check access.

References and Recommended Reading

  1. 1.

    American Diabetes Association: Nutrition recommendations and interventions for Diabetes. A position statement of the American Diabetes Association. Diabetes Care 2008, 31(Supp1):S61–S78.

    Article  Google Scholar 

  2. 2.

    Reader D, Splett P, Gunderson EP, et al.: Impact of gestational diabetes mellitus nutrition practice guidelines implemented by registered dietitians on pregnancy outcomes. J Am Diet Assoc 2006, 106:1426–1433.

    PubMed  Article  Google Scholar 

  3. 3.

    Gunderson EP: Gestational diabetes and nutritional recommendations. Curr Diab Rep 2004, 4:77–86.

    Article  Google Scholar 

  4. 4.

    Metzger BE, Buchanan TA, Coustan DR, et al.: Summary and Recommendations of the Fifth International Workshop-Conference on Gestational Diabetes Mellitus. Diabetes Care 2007, 30(Suppl 2):S251–S260.

    PubMed  Article  CAS  Google Scholar 

  5. 5.

    Food and Nutrition Board: Nutrition During Pregnancy. Part 1: Weight Gain. Part 2: Nutrient Supplements. Washington, DC: Institute of Medicine, National Academy of Sciences; 1990.

    Google Scholar 

  6. 6.

    Food and Nutrition Board, Institute of Medicine: U.S. Dietary Reference Intakes: Energy, Carbohydrates, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids. Washington, DC: National Academies Press; 2002.

    Google Scholar 

  7. 7.

    Setji TL, Brown AJ, Feinglos MN: Gestational diabetes mellitus. Clin Diabetes 2005, 23:17–24.

    Article  Google Scholar 

  8. 8.

    Franz MJ, Bantle JP, Beebe CA, et al.: Evidence-based nutrition principles and recommendations for the treatment and prevention of diabetes and related complications. Diabetes Care 2002, 25:148–198.

    PubMed  Article  Google Scholar 

  9. 9.

    American Dietetic Association: Evidence analysis library. Available at Accessed March 4, 2009.

  10. 10.

    Reader D, Sipe M: Key components of care for women with gestational diabetes. Diabetes Spectrum 2001, 14:188–191.

    Article  Google Scholar 

  11. 11.

    Kitzmiller JL, Block JM, Brown FM, et al.: Managing preexisting diabetes for pregnancy. Diabetes Care 2008, 31:1060–1079.

    PubMed  Article  CAS  Google Scholar 

  12. 12.

    Statement from the Diabetes Care and Education (DCE) Dietetic Practice Group of the American Dietetic Association: Preconception counseling for the women with diabetes. On the Cutting Edge 2007:, 23:9–15.

    Google Scholar 

  13. 13.

    Dornhorst A, Frost G: The principles of dietary management of gestational diabetes: reflection on current evidence. J Hum Nutr Dietetics 2002, 15:145–156.

    Article  CAS  Google Scholar 

  14. 14.

    Innis SM: Perinatal biochemistry and physiology of long-chain polyunsaturated fatty acids. J Pediatr 2003, 143(Suppl 4):S1–S8.

    PubMed  CAS  Google Scholar 

  15. 15.

    Makrides M: Outcomes for mothers and their babies: Do n-3 long-chain polyunsaturated fatty acids and seafoods make a difference? J Am Diet Assoc 2009, 108:1622–1626.

    Article  Google Scholar 

  16. 16.

    Moses RG, Luebcke M, Davis WS, et al.: Effect of a low-glycemic-index diet during pregnancy on obstetric outcomes. Am J Clin Nutr 2006, 84:807–812.

    PubMed  CAS  Google Scholar 

  17. 17.

    Scholl T, Chen X, Khoo C, et al.: The dietary glycemic index during pregnancy: influence on infant birth weight, fetal growth, and biomarkers of carbohydrate metabolism. Am J Epidemiol 2004, 159:467–474.

    PubMed  Article  Google Scholar 

  18. 18.

    Wheeler ML, Pi-Sunyer X: Carbohydrate issues: type and amount. J Am Diet Assoc 2008, 108(Suppl 1):S34–S39.

    PubMed  Article  CAS  Google Scholar 

  19. 19.

    Foster-Powell K, Holt SH, Brand-Miller JC: International table of glycemic index and glycemic load values: 2002. Am J Clin Nutr 2002, 76:5–56.

    PubMed  CAS  Google Scholar 

  20. 20.

    Reader DM: Medical nutrition therapy and lifestyle interventions. Diabetes Care 2007, 30(Suppl 2):S188–S193.

    PubMed  Article  CAS  Google Scholar 

  21. 21.

    Medical Nutrition Therapy, Evidence-Based Guides for Practice: Nutrition Practice Guidelines for Gestational Diabetes Mellitus. Chicago, IL: American Dietetic Association; 2001.

  22. 22.

    Reece EA, Hagay Z, Caseria D, et al.: Do fiber-enriched diabetic diets have glucose-lowering effects in pregnancy? (The Cochrane Controlled Trials Register (CCTR/CENTRAL). Am J Perinatol 1993, 10:272–274.

    PubMed  Article  CAS  Google Scholar 

  23. 23.

    Peterson CM, Jovanovic-Peterson L.: Percentage of carbohydrate and glycemic response to breakfast, lunch, and dinner in women with gestational diabetes. Diabetes 1991, 40(Suppl 2):172–174.

    PubMed  Google Scholar 

  24. 24.

    Gutierrez YM, Reader DM: American Dietetic Association Guide to Gestational Diabetes Mellitus. Chicago, IL: American Dietetic Association; 2005:45–64.

    Google Scholar 

  25. 25.

    Major CA, Henry MJ, De Veciana M, Morgan MA: The effects of carbohydrate restriction in patients with diet-controlled gestational diabetes. Obstet Gynecol 1998, 91:600–604.

    PubMed  Article  CAS  Google Scholar 

Download references

Author information



Corresponding author

Correspondence to Nadine Uplinger.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Uplinger, N. The controversy continues: Nutritional management of the pregnancy complicated by diabetes. Curr Diab Rep 9, 291–295 (2009).

Download citation


  • Gestational Diabetes Mellitus
  • Gestational Diabetes
  • Fruit Juice
  • Postprandial Glucose
  • Dietary Reference Intake