[Physiopathology and nutritional care of patients with gestational diabetes]

Maternal risks include the development of diabetes after pregnancy, as well as having an infant with macrosomia, with elevated risk of developing obesity and diabetes in childhood. The main goal of treatment is to maintain an adequate glycemic control during pregnancy and guarantee the recommended weight gain. The first treatment strategy is diet therapy, however, some women need insulin therapy to achieve adequate glycemic control. The risk of diabetic fetopathy decreases when maintaining postprandial glycemic levels within normal ranges. These levels are directly associated with the amount and type of carbohydrates consumed during meals. So, nutrition therapy should be an integral part of gestational diabetes treatment. Nutrition therapy includes a complete nutrition assessment, an individual food plan that meets energy and protein requirements for pregnancy (in obese women never lesser than 1,700 kcal/day), in which lipids and carbohydrates may provide lesser than 40 and between 40 and 45% of total energy intake. Education about food groups that provide carbohydrates, portion sizes and how to achieve an equal carbohydrate distribution throughout the day should be provided. Orientation about eating healthy fats and increasing the consumption of high-fiber foods should also be included. This approach requires that treatment of women with gestational diabetes should be provided by a multidisciplinary team, including nutrition specialists.