Background: Medical nutrition therapy (MNT) is the first line treatment for women with Gestational Diabetes Mellitus (GDM). Dietetic input is essential to help women meet nutrient requirements, achieve glycaemic targets and meet weight gain recommendations. South Western Sydney has one of the highest prevalence of GDM in New South Wales. Prior to 2016 at Liverpool Hospital, MNT was delivered in a group setting at the time of diagnosis. Following that, the women were referred for an individual review by the dietitian on an “as-needed” basis. In 2016, additional funding for a dietitian was granted at our institution to facilitate individual dietetic reviews for women with GDM.
Aim: To assess the impact of dietetic enhancement on weight management for women with GDM.
Method: Weight gain data for women with GDM in the 12 months prior to the dietitian enhancement (2015) was compared to weight gain data in the 12 months post enhancement (2017).
Results: In 2015, 72% of women had an individual dietitian review, but in 2017 this was increased to 92%. There was a significant decrease in the mean total weight gain for women with GDM in the 2017 cohort compared to 2015 (10.6±5.7kg vs 12.0±8.3kg, p=0.024). The mean weight gain in the 2017 cohort was also more in line with the Institute of Medicine (IOM) weight-gain guidelines for women who were overweight: for body mass index (BMI) 25.0-29.9kg/m2 (10.5±5.3kg vs 12.9±6.6kg, p=0.013) and BMI >30.0kg/m2 (8.8±6.1kg vs 11.1±8.5kg, p=0.036). For women with a BMI of less than 18.5kg/m2 and BMI 18.5-25kg/m2, the mean weight gain for both cohorts remained within the recommended weight gain range. There was no difference in pregnancy outcomes between the 2 cohorts.
Conclusion: Enhanced dietetic services were associated with improved weight management for the women involved in this study. The findings support continuation of the service and demonstrate the potential benefit that enhanced dietetic services may provide for women treated for GDM in other settings.