Medical nutrition therapy in gestational diabetes: comparable pregnancy outcomes using a risk‑prioritised versus universal approach — ASN Events
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Medical nutrition therapy in gestational diabetes: comparable pregnancy outcomes using a risk‑prioritised versus universal approach (#123)

Roslyn A Smith 1 2 , Madeline Boaro 1 2 3 , Ka Hi Mak 2 4 , Vincent Wong 1 4
  1. Liverpool Hospital Diabetes and Endocrine Service, Liverpool, NSW
  2. Dietetics Department, Liverpool Hospital, South West Sydney, NSW
  3. Nutrition & Dietetics, School of Health and Society, University of Wollongong, NSW
  4. University of New South Wales, Sydney, NSW

Background: Medical nutrition therapy (MNT) involves personalised assessment and counselling, and is considered the ‘gold standard’ of dietary management. As such, MNT is inherently resource‑intensive, rendering it difficult to deliver to large numbers with gestational diabetes (GDM).

Objective: This study examined whether pregnancy outcomes differed when MNT was offered only to high-risk women with GDM following initial group education, compared with a model in which women were universally offered at least one MNT consultation post-group.

Methods: Observational data were analysed from three cohorts diagnosed with GDM using WHO 2013 criteria. Two cohorts received MNT on a risk-prioritised basis during the COVID19 pandemic in 2021 (RP1, n 369) and after in 2022 (RP2 n = 446). These were compared with a baseline cohort who were offered MNT under the universal model (UM) prior to the pandemic in 2019 (n = 649). The RP model relied predominantly on telehealth delivery, while the UM model was delivered in-person. Pregnancy and birth outcomes were compared across cohorts.

Results1: The RP approach substantially reduced dietetic workload, with MNT consultations decreasing by half (59 vs. 119 sessions per 100 diagnoses for RP2 vs. UM) and more than 20 hours of dietitian time saved per 100 diagnoses (95 vs. 73 hours for RP2 vs. UM). Across both RP cohorts, no significant increases were observed for any adverse pregnancy or neonatal outcomes compared with the UM cohort. This included maternal weight gain outside recommended targets; use of diabetes medications; early, induced and emergency caesarean deliveries; large‑ or small‑for‑gestational‑age infants; macrosomia; neonatal hypoglycaemia; and neonatal intensive care admission. The RP approach was associated with fewer small‑for‑gestational‑age infants, particularly in the post-pandemic cohort (6% for RP2 vs. 11% for UM; OR 0.55, 95% CI 0.34–0.89).

Conclusions: A risk‑prioritised MNT model delivered comparable clinical outcomes to universal MNT while using fewer dietetic resources, suggesting it may be a sustainable strategy for managing increasing GDM caseloads. Further research should explore consumer experiences, broader service implications, and longer‑term maternal and child health outcomes.

1 Previously published in Smith RA et al., Nutrients 2025;17:294. https://doi.org/10.3390/nu17020294