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A Medical Nutrition Therapy Program Improves Perinatal Outcomes in Mexican Pregnant Women With Gestational Diabetes and Type 2 Diabetes Mellitus

From the Public Health Research Branch-Research Direction (Ms Perichart-Perera, Ms Balas-Nakash, Ms Rodriguez-Cano), the Endocrinology Department (Dr Parra-Covarrubias, Dr Ramirez-Torres, Dr Ortega-González), and the Research Direction (Dr Vadillo-Ortega), Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City, Mexico.

Correspondence to Otilia Perichart-Perera, MS, RD, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Montes Urales 800, Lomas de Virreyes 11000, Mexico City, Mexico (o.perichart{at}servidor.inper.edu.mx).

Diabetes in pregnancy is a major public health problem in Mexico. Nutrition therapy is an important component of treatment. Intensive nutrition intervention has not been implemented for Mexican pregnant women with diabetes. Its effect on different types of diabetes mellitus has not been studied.

Purpose

The authors assessed the effect of a medical nutrition therapy (MNT) program on perinatal complications in Mexico City.

Methods

Quasi-experimental design with a historical control. Women were assigned to a MNT program (n = 88) and were followed up with every 2 weeks until delivery (2004-2007). The control group (n = 86) was selected from medical charts (2001-2003) and the same inclusion criteria were used. In each group, 55% of women had type 2 diabetes mellitus and 45% had gestational diabetes. The MNT program included a moderate intake of carbohydrate (40%-45% of total energy) and reduction in energy intake, capillary glucose self-monitoring, and education. The control group received usual hospital routine care. Statistical analysis included descriptive statistics, chi-square, and multivariate logistic regression (OR, 95% CI) as indicated.

Results

Women in the MNT program had a lower risk of preeclampsia, fewer maternal hospitalization, and neonatal deaths in both types of diabetes. Low birth weight was less frequent only in women with gestational diabetes receiving MNT, while neonatal intensive care unit admissions were lower only in women with type 2 diabetes.

Conclusions

An intensive MNT program, including counseling, education, and capillary glucose self-monitoring, has a positive effect over preeclampsia, maternal hospitalization, and neonatal death in women with diabetes in pregnancy. MNT guidelines should be implemented in Mexican health care facilities treating diabetes in pregnancy.

This version was published on November 1, 2009

The Diabetes Educator, Vol. 35, No. 6, 1004-1013 (2009)
DOI: 10.1177/0145721709343125


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