Nutritional Management of Pregnancy Complicated by Diabetes: Historical Perspective

The important role of diet in the management of pregnancies complicated by diabetes has been recognized since the nineteenth century. In this historical review we have traced the evolution of the diabetic diet from the pre-insulin era, when diabetic pregnancies were not only rare, but accompanied by high maternal mortality and fetal loss to 1981, when the nutritional management of carbohydrate intolerance during gestation is again raising provocative questions. Our recent understanding of diabetes as a heterogeneous syndrome, the 1979 dietary guidelines of the American Diabetes Association (ADA), and the 1980 revised Recommended Dietary Allowances (RDA) for pregnant and lactating women are summarized as representative of the current approach to the nutritional management of diabetic pregnancies. Many questions remain unanswered. These include the hundred-year-old debate concerning the optimal amount of carbohydrate in the diabetic diet, the possible beneficial role of large amounts of dietary fiber, and the nagging concern about total caloric intake in type I insulin-dependent diabetes mellitus (IDDM) versus type II non-insulin-dependent diabetes mellitus (NIDDM) pregnant diabetic women. We suggest that nutritional counseling during gestation in the future may need to be more highly individualized as metabolic distinctions between different types of patients with carbohydrate intolerance are more clearly delineated.