Nutrition Therapy in Managing Pregnant Women With Gestational Diabetes Mellitus: A Literature Review

  • Neda Dolatkhah Mail Physical Medicine and Rehabilitation Research Center, Aging Research Institue, Tabriz University of Medical Sciences, Tabriz, Iran
  • Majid Hajifaraji National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  • Seyed Kazem Shakouri Physical Medicine and Rehabilitation Research Center, Aging Research Institue, Tabriz University of Medical Sciences, Tabriz, Iran
Pregnancy, Gestational Diabetes Mellitus, Medical Nutrition Therapy


Objective: Gestational diabetes mellitus is the most common metabolic and endocrine perinatal complication and is a growing health problem worldwide. Considering the fetal programming and its contribution as one of the evolutionary origins of human diseases, it is very important to improve the  glucose metabolism in pregnant women, determination of other nutrients, preventing excessive accumulation of fetal fats, emphasis on weight loss measures before pregnancy, dietary intake with low-fat healthy food and prevention of abundant weight loss. In this paper, we have provided a brief review on dietary intake and dietary interventions in GDM from the perspective of nutrition science attending the physiopathology and etiology of the disease.Materials and methods: Electronic search for English and Persian articles has been perform in databases, including Google Scholar, PubMed ,Scopus, Cochrane central ,Science direct, ISC, SID, Magiran, Iran Medex, and Med Libby key words: gestational diabetes, gestational diabetes mellitus, nutrition, macronutrient, micronutrient, Diabetes. All available articles (cross-sectional, descriptive-analytic, and clinical studies with desirable design and review quality studies were used. Reference books including Krause's Food and the Nutrition Care, The Williams Obstetrics editions of the 14th (2017) and the 24th edition (2014) were also reviewed.Results: Nutrition therapy and physical activity are the initial treatment of GDM. Proper and flexible methods of nutrition therapy that successfully regulate maternal glycaemia while improving expected fetal growth have extensive concepts. Meanwhile, dietary supplements with proven beneficial effects can play an important role in improving deficiencies and improving the metabolic profile of patients.Conclusion: Nutritional management is the main treatment for gestational diabetes mellitus and overweight/obesity is the principal contest in patient counseling and interventions during pregnancy. Despite extensive researches carried out, this field is an active research area and requires more clinical research to minimize maternal and fetal complications.  


Barbour LA, McCurdy CE, Hernandez TL, Kirwan JP, Catalano PM, Friedman JE. Cellular mechanisms for insulin resistance in normal pregnancy and gestational diabetes. Diabetes Care. 2007;30 Suppl 2:S112-9.

Cunningham F, Leveno K, Bloom S, Spong CY, Dashe J. Williams Obstetrics, 24e: Mcgraw-hill; 2014.

Gilmartin AB, Ural SH, Repke JT. Gestational diabetes mellitus. Rev Obstet Gynecol. 2008;1(3):129-34.

Ma RC, Chan JC. Pregnancy and diabetes scenario around the world: China. Int J Gynaecol Obstet. 2009;104 Suppl 1:S42-5.

Meetoo D, McGovern P, Safadi R. An epidemiological overview of diabetes across the world. Br J Nurs. 2007;16(16):1002-7.

Philipps LH, Santhakumaran S, Gale C, Prior E, Logan KM, Hyde MJ, et al. The diabetic pregnancy and offspring BMI in childhood: a systematic review and meta-analysis. Diabetologia. 2011;54(8):1957-66.

Catalano PM, Tyzbir ED, Wolfe RR, Calles J, Roman NM, Amini SB, et al. Carbohydrate metabolism during pregnancy in control subjects and women with gestational diabetes. Am J Physiol. 1993;264(1 Pt 1):E60-7.

Di Cianni G, Volpe L, Lencioni C, Miccoli R, Cuccuru I, Ghio A, et al. Prevalence and risk factors for gestational diabetes assessed by universal screening. Diabetes research and clinical practice. 2003;62(2):131-7.

Sayehmiri F, Bakhtiari S, Darvishi P, Sayehmiri K. Prevalence of Gestational Diabetes Mellitus in Iran: A Systematic Review and Meta-Analysis Study. The Iranian Journal of Obstetrics Gynecology and Infertility. 2013;15(40):16-23.

Manafi M, Khadem-Ansari M. Gestational diabetes mellitus in iranian women: A rising rate. ACTA ENDOCRINOLOGICA-BUCHAREST. 2013;9(1):71-8.

Zamanfar D, Farhadi R, Shahbaznejad L. Neonate of Diabetic Mother, Pathogenesis and Complications. Clinical Excellence. 2014;2(2):90-103.

Catalano PM, Huston L, Amini SB, Kalhan SC. Longitudinal changes in glucose metabolism during pregnancy in obese women with normal glucose tolerance and gestational diabetes mellitus. Am J Obstet Gynecol. 1999;180(4):903-16.

Buchanan TA, Xiang A, Kjos SL, Watanabe R. What Is Gestational Diabetes? Diabetes Care. 2007;30(Supplement 2):S105-S11.

Ategbo JM, Grissa O, Yessoufou A, Hichami A, Dramane KL, Moutairou K, et al. Modulation of adipokines and cytokines in gestational diabetes and macrosomia. J Clin Endocrinol Metab. 2006;91(10):4137-43.

Keely E, Barbour LA. Management of Diabetes in Pregnancy. 2000.

Kuhl C. Insulin secretion and insulin resistance in pregnancy and GDM. Implications for diagnosis and management. Diabetes. 1991;40 Suppl 2:18-24.

Ben-Haroush A, Yogev Y, Hod M. Epidemiology of gestational diabetes mellitus and its association with Type 2 diabetes. Diabet Med. 2004;21(2):103-13.

Association AD. Report of the expert committee on the diagnosis and classification of diabetes mellitus. Diabetes care. 2003;26(suppl 1):s5-s20.

Kim C, Newton KM, Knopp RH. Gestational diabetes and the incidence of type 2 diabetes: a systematic review. Diabetes Care. 2002;25(10):1862-8.

MacNeill S, Dodds L, Hamilton DC, Armson BA, VandenHof M. Rates and risk factors for recurrence of gestational diabetes. Diabetes Care. 2001;24(4):659-62.

Moses RG, Shand JL, Tapsell LC. The recurrence of gestational diabetes: could dietary differences in fat intake be an explanation? Diabetes Care. 1997;20(11):1647-50.

Larijani B, Hossein-nezhad A, Rizvi SW, Munir S, Vassigh AR. Cost analysis of different screening strategies for gestational diabetes mellitus. Endocr Pract. 2003;9(6):504-9.

O'Sullivan JB, Mahan CM. Criteria for the oral glucose tolerance test in pregnancy. Diabetes. 1964;13:278-85.

Metzger BE, Buchanan TA, Coustan DR, de Leiva A, Dunger DB, Hadden DR, et al. Summary and recommendations of the Fifth International Workshop-Conference on Gestational Diabetes Mellitus. Diabetes Care. 2007;30 Suppl 2:S251-60.

Association AD. Standards of medical care in diabetes—2014. Diabetes care. 2014;37(Supplement 1):S14-S80.

Association AD. Diagnosis and classification of diabetes mellitus

Diabetes Care. 2011;34 Suppl 1:S62-9.

Association AD. Standards of medical care in diabetes--2013. 2013/01/04 ed: Diabetes Care

p. S11-66.

Langer O. The Diabetes in Pregnancy Dilemma: Leading Change with Proven Solutions: University Press of America; 2006.

Hay WW, Jr. Care of the infant of the diabetic mother. Curr Diab Rep. 2012;12(1):4-15.

Hatfield L, Schwoebel A, Lynyak C. Caring for the infant of a diabetic mother. MCN Am J Matern Child Nurs. 2011;36(1):10-6.

Wei J, Gao J, Cheng J. Gestational diabetes mellitus and impaired glucose tolerance pregnant women. Pak J Med Sci. 2014;30(6):1203-8.

Kaufmann RC, Schleyhahn FT, Huffman DG, Amankwah KS. Gestational diabetes diagnostic criteria: long-term maternal follow-up. Am J Obstet Gynecol. 1995;172(2 Pt 1):621-5.

Khaw KT, Wareham N, Bingham S, Luben R, Welch A, Day N. Association of hemoglobin A1c with cardiovascular disease and mortality in adults: the European prospective investigation into cancer in Norfolk. Ann Intern Med. 2004;141(6):413-20.

ACOG practice bulletin. Diagnosis and management of preeclampsia and eclampsia. Number 33, January 2002. American College of Obstetricians and Gynecologists. Int J Gynaecol Obstet. 2002;77(1):67-75.

Seely EW, Solomon CG. Insulin resistance and its potential role in pregnancy-induced hypertension. J Clin Endocrinol Metab. 2003;88(6):2393-8.

Hillier TA, Pedula KL, Schmidt MM, Mullen JA, Charles MA, Pettitt DJ. Childhood obesity and metabolic imprinting: the ongoing effects of maternal hyperglycemia. Diabetes Care. 2007;30(9):2287-92.

Dabelea D. The predisposition to obesity and diabetes in offspring of diabetic mothers. Diabetes Care. 2007;30 Suppl 2:S169-74.

Di Benedetto A, Russo GT, Corrado F, Di Cesare E, Alessi E, Nicocia G, et al. Inflammatory markers in women with a recent history of gestational diabetes mellitus. J Endocrinol Invest. 2005;28(1):34-8.

Schmidt MI, Duncan BB, Sharrett AR, Lindberg G, Savage PJ, Offenbacher S, et al. Markers of inflammation and prediction of diabetes mellitus in adults (Atherosclerosis Risk in Communities study): a cohort study. Lancet. 1999;353(9165):1649-52.

Sell H, Dietze-Schroeder D, Kaiser U, Eckel J. Monocyte chemotactic protein-1 is a potential player in the negative cross-talk between adipose tissue and skeletal muscle. Endocrinology. 2006;147(5):2458-67.

Hotamisligil GS, Shargill NS, Spiegelman BM. Adipose expression of tumor necrosis factor-alpha: direct role in obesity-linked insulin resistance. Science. 1993;259(5091):87-91.

Hayaishi-Okano R, Yamasaki Y, Katakami N, Ohtoshi K, Gorogawa S, Kuroda A, et al. Elevated C-reactive protein associates with early-stage carotid atherosclerosis in young subjects with type 1 diabetes. Diabetes Care. 2002;25(8):1432-8.

Wang C, Guan Y, Yang J. Cytokines in the Progression of Pancreatic beta-Cell Dysfunction. Int J Endocrinol. 2010;2010:515136.

Badawi A, Klip A, Haddad P, Cole DE, Bailo BG, El-Sohemy A, et al. Type 2 diabetes mellitus and inflammation: Prospects for biomarkers of risk and nutritional intervention. Diabetes Metab Syndr Obes. 2010;3:173-86.

Matteucci E, Giampietro O. Oxidative stress in families of type 1 diabetic patients. Diabetes Care. 2000;23(8):1182-6.

Baynes JW, Thorpe SR. Role of oxidative stress in diabetic complications: a new perspective on an old paradigm. Diabetes. 1999;48(1):1-9.

Kinalski M, Sledziewski A, Telejko B, Zarzycki W, Kinalska I. Lipid peroxidation and scavenging enzyme activity in streptozotocin-induced diabetes. Acta Diabetol. 2000;37(4):179-83.

Dennery PA. Effects of oxidative stress on embryonic development. Birth Defects Res C Embryo Today. 2007;81(3):155-62.

Myatt L. Review: Reactive oxygen and nitrogen species and functional adaptation of the placenta. Placenta. 2010;31 Suppl:S66-9.

Ryan EA, Imes S, Liu D, McManus R, Finegood DT, Polonsky KS, et al. Defects in insulin secretion and action in women with a history of gestational diabetes. Diabetes. 1995;44(5):506-12.

Yessoufou A, Moutairou K. Maternal diabetes in pregnancy: early and long-term outcomes on the offspring and the concept of "metabolic memory". Exp Diabetes Res. 2011;2011:218598.

Yessoufou A, Soulaimann N, Merzouk SA, Moutairou K, Ahissou H, Prost J, et al. N-3 fatty acids modulate antioxidant status in diabetic rats and their macrosomic offspring. Int J Obes (Lond). 2006;30(5):739-50.

Young IS, Torney JJ, Trimble ER. The effect of ascorbate supplementation on oxidative stress in the streptozotocin diabetic rat. Free Radic Biol Med. 1992;13(1):41-6.

Yessoufou A, Ategbo JM, Girard A, Prost J, Dramane KL, Moutairou K, et al. Cassava-enriched diet is not diabetogenic rather it aggravates diabetes in rats. Fundam Clin Pharmacol. 2006;20(6):579-86.

Biri A, Onan A, Devrim E, Babacan F, Kavutcu M, Durak I. Oxidant status in maternal and cord plasma and placental tissue in gestational diabetes. Placenta. 2006;27(2-3):327-32.

Chen X, Scholl TO. Oxidative stress: changes in pregnancy and with gestational diabetes mellitus. Curr Diab Rep. 2005;5(4):282-8.

Lavie CJ, Milani RV, Ventura HO. Obesity and cardiovascular disease: risk factor, paradox, and impact of weight loss. J Am Coll Cardiol. 2009;53(21):1925-32.

Najmi M, Hajifaraji M, Abd Mishani M. The Effect of adipokines secreted from adipose tissue on immune function in obese subjects. Iranian Journal of Nutrition Sciences & Food Technology. 2013;7(5):887-96.

Lemieux I, Pascot A, Prud'homme D, Almeras N, Bogaty P, Nadeau A, et al. Elevated C-reactive protein: another component of the atherothrombotic profile of abdominal obesity. Arterioscler Thromb Vasc Biol. 2001;21(6):961-7.

Saijo Y, Kiyota N, Kawasaki Y, Miyazaki Y, Kashimura J, Fukuda M, et al. Relationship between C-reactive protein and visceral adipose tissue in healthy Japanese subjects. Diabetes Obes Metab. 2004;6(4):249-58.

Pannacciulli N, Cantatore FP, Minenna A, Bellacicco M, Giorgino R, De Pergola G. C-reactive protein is independently associated with total body fat, central fat, and insulin resistance in adult women. Int J Obes Relat Metab Disord. 2001;25(10):1416-20.

Park HS, Park JY, Yu R. Relationship of obesity and visceral adiposity with serum concentrations of CRP, TNF-alpha and IL-6. Diabetes research and clinical practice. 2005;69(1):29-35.

Mokdad AH, Ford ES, Bowman BA, Dietz WH, Vinicor F, Bales VS, et al. Prevalence of obesity, diabetes, and obesity-related health risk factors, 2001. JAMA. 2003;289(1):76-9.

Festa A, D'Agostino R, Jr., Tracy RP, Haffner SM. Elevated levels of acute-phase proteins and plasminogen activator inhibitor-1 predict the development of type 2 diabetes: the insulin resistance atherosclerosis study. Diabetes. 2002;51(4):1131-7.

Harris MM, Stevens J, Thomas N, Schreiner P, Folsom AR. Associations of fat distribution and obesity with hypertension in a bi-ethnic population: the ARIC study. Atherosclerosis Risk in Communities Study. Obes Res. 2000;8(7):516-24.

Wilson PW, D'Agostino RB, Sullivan L, Parise H, Kannel WB. Overweight and obesity as determinants of cardiovascular risk: the Framingham experience. Arch Intern Med. 2002;162(16):1867-72.

Mathieu P, Lemieux I, Despres JP. Obesity, inflammation, and cardiovascular risk. Clin Pharmacol Ther. 2010;87(4):407-16.

Rocha VZ, Libby P. Obesity, inflammation, and atherosclerosis. Nat Rev Cardiol. 2009;6(6):399-409.

Torloni MR, Betran AP, Horta BL, Nakamura MU, Atallah AN, Moron AF, et al. Prepregnancy BMI and the risk of gestational diabetes: a systematic review of the literature with meta-analysis. Obes Rev. 2009;10(2):194-203.

Endo S, Maeda K, Suto M, Kaji T, Morine M, Kinoshita T, et al. Differences in insulin sensitivity in pregnant women with overweight and gestational diabetes mellitus. Gynecol Endocrinol. 2006;22(6):343-9.

Chu SY, Callaghan WM, Kim SY, Schmid CH, Lau J, England LJ, et al. Maternal obesity and risk of gestational diabetes mellitus. Diabetes Care. 2007;30(8):2070-6.

Hedderson MM, Gunderson EP, Ferrara A. Gestational weight gain and risk of gestational diabetes mellitus. Obstet Gynecol. 2010;115(3):597-604.

Zhong C, Li X, Chen R, Zhou X, Liu C, Wu J, et al. Greater early and mid-pregnancy gestational weight gain are associated with increased risk of gestational diabetes mellitus: A prospective cohort study. Clinical nutrition ESPEN. 2017;22:48-53.

Truong YN, Yee LM, Caughey AB, Cheng YW. Weight gain in pregnancy: does the Institute of Medicine have it right? American Journal of Obstetrics & Gynecology. 2015;212(3):362. e1-. e8.

Weight gain during pregnancy: Reexamining the guidelines. Washington (DC): National Academies Press (US) National Academy of Sciences.

Ma D, Szeto IM, Yu K, Ning Y, Li W, Wang J, et al. Association between gestational weight gain according to prepregnancy body mass index and short postpartum weight retention in postpartum women. Clinical Nutrition. 2015;34(2):291-5.

Zilko CEM, Rehkopf D, Abrams B. Association of maternal gestational weight gain with short-and long-term maternal and child health outcomes. American Journal of Obstetrics & Gynecology. 2010;202(6):574. e1-. e8.

Crozier SR, Inskip HM, Godfrey KM, Cooper C, Harvey NC, Cole ZA, et al. Weight gain in pregnancy and childhood body composition: findings from the Southampton Women’s Survey–. The American journal of clinical nutrition. 2010;91(6):1745-51.

Brustman LE, Langer O, Bimson B, Scarpelli S, El Daouk M. Weight gain in gestational diabetes: the effect of treatment modality. The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstet. 2015:1-5.

Tanentsapf I, Heitmann BL, Adegboye AR. Systematic review of clinical trials on dietary interventions to prevent excessive weight gain during pregnancy among normal weight, overweight and obese women. BMC Pregnancy Childbirth. 2011;11:81.

Gardner B, Wardle J, Poston L, Croker H. Changing diet and physical activity to reduce gestational weight gain: a meta-analysis. Obes Rev. 2011;12(7):e602-20.

Herring SJ, Oken E, Rifas-Shiman SL, Rich-Edwards JW, Stuebe AM, Kleinman KP, et al. Weight gain in pregnancy and risk of maternal hyperglycemia. Am J Obstet Gynecol. 2009;201(1):61 e1-7.

Horosz E, Bomba-Opon DA, Szymanska M, Wielgos M. Maternal weight gain in women with gestational diabetes mellitus. J Perinat Med. 2013;41(5):523-8.

Drehmer M, Duncan BB, Kac G, Schmidt MI. Association of second and third trimester weight gain in pregnancy with maternal and fetal outcomes. PloS one. 2013;8(1):e54704.

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

Gunderson EP, Abrams B. Epidemiology of gestational weight gain and body weight changes after pregnancy. Epidemiol Rev. 2000;22(2):261-74.

Rasmussen KM, Catalano PM, Yaktine AL. New guidelines for weight gain during pregnancy: what obstetrician/gynecologists should know. Curr Opin Obstet Gynecol. 2009;21(6):521-6.

Chang N, Kim S, Kim Y. Physical and dietary characteristics in women with gestational diabetes mellitus. Korean J Nutr. 2001;34(2):158-64.

Ji SK, Jang HC, Choi H. A case-control study of food habits and diet intakes of women with gestational diabetes mellitus. Korean Journal of Nutrition. 2008;41(1):41-53.

Chen Z, Watanabe RM, Stram DO, Buchanan TA, Xiang AH. High calorie intake is associated with worsening insulin resistance and beta-cell function in Hispanic women after gestational diabetes mellitus. Diabetes Care. 2014;37(12):3294-300.

Kinnunen TI, Puhkala J, Raitanen J, Ahonen S, Aittasalo M, Virtanen SM, et al. Effects of dietary counselling on food habits and dietary intake of Finnish pregnant women at increased risk for gestational diabetes–a secondary analysis of a cluster‐randomized controlled trial. Maternal & child nutrition. 2014;10(2):184-97.

Guelinckx I, Devlieger R, Mullie P, Vansant G. Effect of lifestyle intervention on dietary habits, physical activity, and gestational weight gain in obese pregnant women: a randomized controlled trial–. The American journal of clinical nutrition. 2009;91(2):373-80.

Saldana TM, Siega-Riz AM, Adair LS. Effect of macronutrient intake on the development of glucose intolerance during pregnancy. Am J Clin Nutr. 2004;79(3):479-86.

Zhang C, Liu S, Solomon CG, Hu FB. Dietary fiber intake, dietary glycemic load, and the risk for gestational diabetes mellitus. Diabetes Care. 2006;29(10):2223-30.

He JR, Yuan MY, Chen NN, Lu JH, Hu CY, Mai WB, et al. Maternal dietary patterns and gestational diabetes mellitus: a large prospective cohort study in China. The British journal of nutrition. 2015;113(8):1292-300.

Georgoulis M, Kontogianni MD, Yiannakouris N. Mediterranean diet and diabetes: prevention and treatment. Nutrients. 2014;6(4):1406-23.

Karamanos B, Thanopoulou A, Anastasiou E, Assaad-Khalil S, Albache N, Bachaoui M, et al. Relation of the Mediterranean diet with the incidence of gestational diabetes. Eur J Clin Nutr. 2014;68(1):8-13.

Shen J, Obin MS, Zhao L. The gut microbiota, obesity and insulin resistance. Mol Aspects Med. 2013;34(1):39-58.

Duarte-Gardea MO, Gonzales-Pacheco DM, Reader DM, Thomas AM, Wang SR, Gregory RP, et al. Academy of Nutrition and Dietetics Gestational Diabetes Evidence-Based Nutrition Practice Guideline. J Acad Nutr Diet. 2018.

Tamime AY. Probiotics Dairy Products: Oxford: Blackwell publishing; 2005.

Mackie RI, Sghir A, Gaskins HR. Developmental microbial ecology of the neonatal gastrointestinal tract. Am J Clin Nutr. 1999;69(5):1035S-45S.

Dethlefsen L, Eckburg PB, Bik EM, Relman DA. Assembly of the human intestinal microbiota. Trends Ecol Evol. 2006;21(9):517-23.

Koren O, Goodrich JK, Cullender TC, Spor A, Laitinen K, Backhed HK, et al. Host remodeling of the gut microbiome and metabolic changes during pregnancy. Cell. 2012;150(3):470-80.

Turnbaugh PJ, Hamady M, Yatsunenko T, Cantarel BL, Duncan A, Ley RE, et al. A core gut microbiome in obese and lean twins. Nature. 2009;457(7228):480-4.

Collado MC, Isolauri E, Laitinen K, Salminen S. Distinct composition of gut microbiota during pregnancy in overweight and normal-weight women. Am J Clin Nutr. 2008;88(4):894-9.

Collado MC, Laitinen K, Salminen S, Isolauri E. Maternal weight and excessive weight gain during pregnancy modify the immunomodulatory potential of breast milk. Pediatr Res. 2012;72(1):77-85.

Santacruz A, Collado MC, Garcia-Valdes L, Segura MT, Martin-Lagos JA, Anjos T, et al. Gut microbiota composition is associated with body weight, weight gain and biochemical parameters in pregnant women. The British journal of nutrition. 2010;104(1):83-92.

Dolatkhah N, Hajifaraji M, Abbasalizadeh F, Aghamohammadzadeh N, Mehrabi Y, Abbasi MM. Probiotic Supplements in Gestational Diabetes Mellitus: Study Protocol for a Placebo-Controlled Randomized Clinical Trial. Journal of Clinical Research & Governance. 2015;4(2).

Agarwal MM, Dhatt GS, Punnose J, Koster G. Gestational diabetes: dilemma caused by multiple international diagnostic criteria. Diabet Med. 2005;22(12):1731-6.

Poolsup N, Suksomboon N, Amin M. Effect of treatment of gestational diabetes mellitus: a systematic review and meta-analysis. PloS one. 2014;9(3):e92485.

Marion D. Treatment and course of gestational diabetes mellitus: UpToDate Web site; [29 August]. Available from:

Gestational diabetes mellitus. Diabetes Care. 2003;26 Suppl 1:S103-5.

Aronovitz A, Metzger BE. IV gestational diabetes mellitus. ACP Medicine2006. p. 5-7.

Walker J. NICE guidance on diabetes in pregnancy: management of diabetes and its complications from preconception to the postnatal period. NICE clinical guideline 63. London, March 2008. Diabetic Medicine. 2008;25(9):1025-7.

Langer O, Conway DL, Berkus MD, Xenakis EM, Gonzales O. A comparison of glyburide and insulin in women with gestational diabetes mellitus. N Engl J Med. 2000;343(16):1134-8.

Lain KY, Garabedian MJ, Daftary A, Jeyabalan A. Neonatal adiposity following maternal treatment of gestational diabetes with glyburide compared with insulin. Am J Obstet Gynecol. 2009;200(5):501 e1-6.

Kalra B, Gupta Y, Singla R, Kalra S. Use of oral anti-diabetic agents in pregnancy: a pragmatic approach. N Am J Med Sci. 2015;7(1):6-12.

Rowan JA, Hague WM, Gao W, Battin MR, Moore MP. Metformin versus insulin for the treatment of gestational diabetes. N Engl J Med. 2008;358(19):2003-15.

Metzger BE, Coustan DR. Summary and recommendations of the Fourth International Workshop-Conference on Gestational Diabetes Mellitus. The Organizing Committee. Diabetes Care. 1998;21 Suppl 2:B161-7.

Association AD. Workshop-Conference on gestational diabetes:Summary and recommendations. Diabetes Care


Frenkel N. Summary and recommendations of the Second International Workshop- Conference on Gestational Diabetes

Diabetes. 1985;34(Suppl 2):S123–6.

Metzer B. Summary and recommendations of the Third International Workshop-Conference on Gestational Diabetes Mellitus. Diabetes. 1991;40(Suppl 2):S197–201.

Association AD. Medical Nutrition Therapy, Evidence-Based Guides for Practice: Nutrition Practice Guidelines for Gestational Diabetes Mellitus (CDROM)

Chicago, IL.2001.

Jovanovic-Peterson L, Peterson CM. Nutritional management of the obese gestational diabetic pregnant woman. J Am Coll Nutr. 1992;11(3):246-50.

Crowther CA, Hiller JE, Moss JR, McPhee AJ, Jeffries WS, Robinson JS. Effect of treatment of gestational diabetes mellitus on pregnancy outcomes. N Engl J Med. 2005;352(24):2477-86.

Perichart-Perera O, Balas-Nakash M, Parra-Covarrubias A, Rodriguez-Cano A, Ramirez-Torres A, Ortega-González C, et al. A medical nutrition therapy program improves perinatal outcomes in Mexican pregnant women with gestational diabetes and type 2 diabetes mellitus. The Diabetes educator. 2009;35(6):1004-13.

Reader D, Splett P, Gunderson E. Diabetes Care and Education Dietetic Practice Group. Impact of gestational diabetes mellitus nutrition practice guidelines implemented by registered dietitians on pregnancy outcomes. J Am Diet Assoc. 2006;106(9):1426-33.

Landon MB, Spong CY, Thom E, Carpenter MW, Ramin SM, Casey B, et al. A multicenter, randomized trial of treatment for mild gestational diabetes. New England Journal of Medicine. 2009;361(14):1339-48.

Metzger BE, Freinkel N. Accelerated starvation in pregnancy: implications for dietary treatment of obesity and gestational diabetes mellitus. Biol Neonate. 1987;51(2):78-85.

Dornhorst A, Frost G. The principles of dietary management of gestational diabetes: reflection on current evidence. J Hum Nutr Diet. 2002;15(2):145-56; quiz 57-9.

Ho LF, Benzie IF, Lao TT. Relationship between caloric intake and pregnancy outcome in diet-treated gestational diabetes mellitus. Nurs Health Sci. 2005;7(1):15-20.

Conway R, Reddy S, Davies J. Dietary restraint and weight gain during pregnancy. Eur J Clin Nutr. 1999;53(11):849-53.

Cho AR, Kyeung KS, Park MA, Lee YM, Jeong EH. Risk factors of gestational diabetes mellitus. Korean Journal of Perinatology. 2007;18(4):329-37.

Reader D, Splett P, Gunderson EP. Impact of gestational diabetes mellitus nutrition practice guidelines implemented by registered dietitians on pregnancy outcomes. J Am Diet Assoc. 2006;106(9):1426-33.

Simpson SJ, Raubenheimer D. Obesity: the protein leverage hypothesis. Obes Rev. 2005;6(2):133-42.

Wolever TM, Katzman-Relle L, Jenkins AL, Vuksan V, Josse RG, Jenkins DJ. Glycaemic index of 102 complex carbohydrate foods in patients with diabetes. Nutrition Research. 1994;14(5):651-69.

Hoebler M-FD, A. Karinthi, C. Belleville, J.-L. Barry, C. Particle size of solid food after human mastication and in vitro simulation of oral breakdown. International journal of food sciences and nutrition. 2000;51(5):353-66.

Dona AC, Pages G, Gilbert RG, Kuchel PW. Digestion of starch: In vivo and in vitro kinetic models used to characterise oligosaccharide or glucose release. Carbohydrate Polymers. 2010;80(3):599-617.

Nematy M, Haghani M, Akhavan R, Babazadeh S, Safarian M, Abdi M. Determination of the Glycemic Index of the most popular Iranian rice-Tarom-in two cooking methods: Boiled and Steamed. International Journal of Health and Life Sciences. 2015;1(2):14-20.

Babazadeh S, Nematy M, Mobarhan M, Hajifaraji M. The Glycaemic Index Of 10 Popular Breads In Iran. Annals of Nutrition and Metabolism. 2009;55:590.

Hajifaraji M, Rezvani V, Yaghoobi A, Morteza H, Maddah M. Glycemic indices of three commonly consumed foods: a clinical trial in Iranian healthy adults. Mediterranean Journal of Nutrition and Metabolism. 2012;5(3):253-7.

Eleazu CO. The concept of low glycemic index and glycemic load foods as panacea for type 2 diabetes mellitus; prospects, challenges and solutions. African health sciences. 2016;16(2):468-79.

Faraji MH, Leeds A, Powell J, Frost G. The relationship between dietary Glycaemic Index and urinary chromium in British adults. Proceedings of the Nutrition Society. 2003;62(1):82A.

Wei J, Heng W, Gao J. Effects of Low Glycemic Index Diets on Gestational Diabetes Mellitus: A Meta-Analysis of Randomized Controlled Clinical Trials. Medicine. 2016;95(22).

Mahan LK, Raymond JL. Krause's Food & the Nutrition Care Process-E-Book: Elsevier Health Sciences; 2016.

Nikooyeh B, Hajifaraji M. Food supplements: opportunity or threat. Pajoohandeh Journal. 2014;19(2):60-5.

Tanaka Y, Seino Y, Ishida M, Yamaoka K, Yabuuchi H, Ishida H, et al. Effect of vitamin D3 on the pancreatic secretion of insulin and somatostatin. Acta Endocrinol (Copenh). 1984;105(4):528-33.

Kadowaki S, Norman AW. Dietary vitamin D is essential for normal insulin secretion from the perfused rat pancreas. The Journal of clinical investigation. 1984;73(3):759-66.

Gedik O, Akahn S. Effects of vitamin D deficiency and repletion on insulin and glucagon secretion in man. Diabetologia. 1986;29(3):142-5.

Kumar S, Davies M, Zakaria Y, Mawer E, Gordon C, Olukoga A, et al. Improvement in glucose tolerance and beta-cell function in a patient with vitamin D deficiency during treatment with vitamin D. Postgraduate medical journal. 1994;70(824):440-3.

Osati S, Homayounfar R, Hajifaraji M. Metabolic effects of vitamin D supplementation in vitamin D deficient patients (a double-blind clinical trial). Diabetes & Metabolic Syndrome: Clinical Research & Reviews. 2016;10(2):S7-S10.

Sun X, Cao Z-B, Tanisawa K, Ito T, Oshima S, Higuchi M. Vitamin D supplementation reduces insulin resistance in Japanese adults: a secondary analysis of a double-blind, randomized, placebo-controlled trial. Nutrition Research. 2016;36(10):1121-9.

Razzaghi R, Pourbagheri H, Momen-Heravi M, Bahmani F, Shadi J, Soleimani Z, et al. The effects of vitamin D supplementation on wound healing and metabolic status in patients with diabetic foot ulcer: a randomized, double-blind, placebo-controlled trial. Journal of Diabetes and its Complications. 2017;31(4):766-72.

Shahgheibi S, Farhadifar F, Pouya B. The effect of vitamin D supplementation on gestational diabetes in high-risk women: Results from a randomized placebo-controlled trial. Journal of research in medical sciences: the official journal of Isfahan University of Medical Sciences. 2016;21.

Zhang Q, Cheng Y, He M, Li T, Ma Z, Cheng H. Effect of various doses of vitamin D supplementation on pregnant women with gestational diabetes mellitus: A randomized controlled trial. Experimental and therapeutic medicine. 2016;12(3):1889-95.

Facchinetti F, Dante G, Petrella E, Neri I. Dietary interventions, lifestyle changes, and dietary supplements in preventing gestational diabetes mellitus: a literature review. Obstet Gynecol Surv. 2014;69(11):669-80.

D’Anna R, Scilipoti A, Giordano D, Caruso C, Cannata ML, Interdonato ML, et al. myo-Inositol supplementation and onset of gestational diabetes mellitus in pregnant women with a family history of type 2 diabetes: a prospective, randomized, placebo-controlled study. Diabetes care. 2013;36(4):854-7.

Corrado F, D’Anna R, Di Vieste G, Giordano D, Pintaudi B, Santamaria A, et al. The effect of myoinositol supplementation on insulin resistance in patients with gestational diabetes. Diabetic Medicine. 2011;28(8):972-5.

Jamilian M, Samimi M, Kolahdooz F, Khalaji F, Razavi M, Asemi Z. Omega-3 fatty acid supplementation affects pregnancy outcomes in gestational diabetes: a randomized, double-blind, placebo-controlled trial. The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstet. 2016;29(4):669-75.

Samimi M, Jamilian M, Asemi Z, Esmaillzadeh A. Effects of omega-3 fatty acid supplementation on insulin metabolism and lipid profiles in gestational diabetes: Randomized, double-blind, placebo-controlled trial. Clinical nutrition (Edinburgh, Scotland). 2015;34(3):388-93.

Anderson EJ, Thayne KA, Harris M, Shaikh SR, Darden TM, Lark DS, et al. Do fish oil omega-3 fatty acids enhance antioxidant capacity and mitochondrial fatty acid oxidation in human atrial myocardium via PPARgamma activation? Antioxidants & redox signaling. 2014;21(8):1156-63.

Oster RT, Tishinsky JM, Yuan Z, Robinson LE. Docosahexaenoic acid increases cellular adiponectin mRNA and secreted adiponectin protein, as well as PPARgamma mRNA, in 3T3-L1 adipocytes. Applied physiology, nutrition, and metabolism = Physiologie appliquee, nutrition et metabolisme. 2010;35(6):783-9.

Tishinsky JM, Ma DW, Robinson LE. Eicosapentaenoic acid and rosiglitazone increase adiponectin in an additive and PPARgamma-dependent manner in human adipocytes. Obesity (Silver Spring, Md). 2011;19(2):262-8.

Tian C, Fan C, Liu X, Xu F, Qi K. Brain histological changes in young mice submitted to diets with different ratios of n-6/n-3 polyunsaturated fatty acids during maternal pregnancy and lactation. Clinical nutrition (Edinburgh, Scotland). 2011;30(5):659-67.

Li H, Ruan XZ, Powis SH, Fernando R, Mon WY, Wheeler DC, et al. EPA and DHA reduce LPS-induced inflammation responses in HK-2 cells: evidence for a PPAR-gamma-dependent mechanism. Kidney international. 2005;67(3):867-74.

Lee BJ, Bak YT. Irritable bowel syndrome, gut microbiota and probiotics. J Neurogastroenterol Motil. 2011;17(3):252-66.

DuPont AW, DuPont HL. The intestinal microbiota and chronic disorders of the gut. Nat Rev Gastroenterol Hepatol. 2011;8(9):523-31.

Isolauri E, Rautava S, Collado M, Salminen S. Role of probiotics in reducing the risk of gestational diabetes. Diabetes, Obesity and Metabolism. 2015;17(8):713-9.

Laitinen K, Poussa T, Isolauri E. Probiotics and dietary counselling contribute to glucose regulation during and after pregnancy: a randomised controlled trial. The British journal of nutrition. 2009;101(11):1679-87.

Andreasen AS, Larsen N, Pedersen-Skovsgaard T, Berg RM, Moller K, Svendsen KD, et al. Effects of Lactobacillus acidophilus NCFM on insulin sensitivity and the systemic inflammatory response in human subjects. The British journal of nutrition. 2010;104(12):1831-8.

Dolatkhah N, Hajifaraji M, Abbasalizadeh F, Aghamohammadzadeh N, Mehrabi Y, Mesgari Abbasi M. Is there a value for probiotic supplements in gestational diabetes mellitus? A randomized clinical trial. J Health Popul Nutr. 2015;33(1):25.

Hajifaraji M, Jahanjou F, Abbasalizadeh F, Aghamohammadzadeh N, Abbasi MM, Dolatkhah N. Effect of probiotic supplements in women with gestational diabetes mellitus on inflammation and oxidative stress biomarkers: a randomized clinical trial. Asia Pacific journal of clinical nutrition. 2018;27(3):581.

Hajifaraji M, Jahanjou F, Abbasalizadeh F, Aghamohammadzadeh N, Abbasi MM, Dolatkhah N. Effect of Probiotic Supplementation on Blood Pressure of Females with Gestational Diabetes Mellitus: A Randomized Double Blind Controlled Clinical Trial. Iranian Red Crescent Medical Journal. 2017;19(6).

Roberfroid M. Prebiotics: the concept revisited. J Nutr. 2007;137(3 Suppl 2):830S-7S.

Meyer D, Stasse-Wolthuis M. The bifidogenic effect of inulin and oligofructose and its consequences for gut health. Eur J Clin Nutr. 2009;63(11):1277-89.

Cani PD, Lecourt E, Dewulf EM, Sohet FM, Pachikian BD, Naslain D, et al. Gut microbiota fermentation of prebiotics increases satietogenic and incretin gut peptide production with consequences for appetite sensation and glucose response after a meal. Am J Clin Nutr. 2009;90(5):1236-43.

Parnell JA, Reimer RA. Weight loss during oligofructose supplementation is associated with decreased ghrelin and increased peptide YY in overweight and obese adults. Am J Clin Nutr. 2009;89(6):1751-9.

Sasaki M, Ogasawara N, Funaki Y, Mizuno M, Iida A, Goto C, et al. Transglucosidase improves the gut microbiota profile of type 2 diabetes mellitus patients: a randomized double-blind, placebo-controlled study. BMC Gastroenterol. 2013;13:81.

Everard A, Lazarevic V, Derrien M, Girard M, Muccioli GG, Neyrinck AM, et al. Responses of gut microbiota and glucose and lipid metabolism to prebiotics in genetic obese and diet-induced leptin-resistant mice. Diabetes. 2011;60(11):2775-86.

Neyrinck AM, Possemiers S, Druart C, Van de Wiele T, De Backer F, Cani PD, et al. Prebiotic effects of wheat arabinoxylan related to the increase in bifidobacteria, Roseburia and Bacteroides/Prevotella in diet-induced obese mice. PloS one. 2011;6(6):e20944.

Cani PD, Possemiers S, Van de Wiele T, Guiot Y, Everard A, Rottier O, et al. Changes in gut microbiota control inflammation in obese mice through a mechanism involving GLP-2-driven improvement of gut permeability. Gut. 2009;58(8):1091-103.

Morrison DJ, Mackay WG, Edwards CA, Preston T, Dodson B, Weaver LT. Butyrate production from oligofructose fermentation by the human faecal flora: what is the contribution of extracellular acetate and lactate? The British journal of nutrition. 2006;96(3):570-7.

Kleessen B, Hartmann L, Blaut M. Oligofructose and long-chain inulin: influence on the gut microbial ecology of rats associated with a human faecal flora. The British journal of nutrition. 2001;86(2):291-300.

Silverman BL, Metzger BE, Cho NH, Loeb CA. Impaired glucose tolerance in adolescent offspring of diabetic mothers. Relationship to fetal hyperinsulinism. Diabetes Care. 1995;18(5):611-7.

Nehring I, Lehmann S, von Kries R. Gestational weight gain in accordance to the IOM/NRC criteria and the risk for childhood overweight: a meta-analysis. Pediatr Obes. 2013;8(3):218-24.

Poston L, Patel N. Dietary recommendations for obese pregnant women: current questions and controversies. Acta Obstet Gynecol Scand. 2014;93(11):1081-4.

How to Cite
Dolatkhah N, Hajifaraji M, Shakouri SK. Nutrition Therapy in Managing Pregnant Women With Gestational Diabetes Mellitus: A Literature Review. J Fam Reprod Health. 12(2):57-72.
Review Articles