Dietary therapy is the cornerstone to the management of gestational diabetes mellitus. Medical Nutrition Therapy (MNT) is a therapeutic approach to deliver tailored dietary counselling to manage a disease or condition. The goals of MNT for GDM are to promote optimal foetal growth and maternal health by meeting nutritional needs in pregnancy and to promote normoglycemia, whilst avoiding ketonuria. Controversy remains over the most appropriate dietary prescription for the management of GDM. The aim of this presentation is to give an overview of the evidence in relation to aspects of medical nutrition therapy and defined dietary prescription for GDM including the amount and type of carbohydrate, nutritional adequacy, and gestational weight gain. Achieving a consistent, defined dietary prescription for women with GDM is unlikely to be achieved due to individual characteristics of glucose tolerance and glycaemic response, energy needs to promote healthy weight gain. An individualised approach is likely to achieve optimal pregnancy outcomes, however a renewed research focus on the process to engage women and deliver care is needed to ensure these positive health outcomes are realised.