Calorie Restriction for Treatment of Gestational Diabetes

Birth weights of infants of 35 gestational diabetic mothers treated with calorie restriction alone (1200–1800 kcal) were compared with those of infants of 2337 nondiabetic women, including two control groups (A and B) matched for race, body mass index, age, and parity. All women were screened for gestational diabetes with the O'Sullivan screening method, and a 3-h oral glucose tolerance test was performed on all abnormal results. Control group A mothers had a normal screen, and control group B mothers had an abnormal screen with a normal glucose tolerance test. Pregnancy weight gain was significantly less for the gestational diabetic mothers (mean ± SD 4.6 ± 4.9 kg) than for the general prenatal population (9.3 ± 5.3 kg), group A control subjects (9.7 ± 5.3 kg), and group B control subjects (9.7 ± 5.4 kg; P < 0.0005). No infant of a gestational diabetic mother was below the 10th percentile for weight, and birth weights were similar to those of the control groups even though weight gain after the 28th wk of gestation was only 1.7 ± 1.6 kg. The frequency of macrosomia (birth weight ≥ 4000 g) was similar among the gestational diabetic mothers (9.3%), the general prenatal population (7.4%), and group A mothers (11.6%) but significantly higher for the group B control subjects (20.9%; χ² = 8.57, P < 0.005). This study demonstrated that gestational diabetic mothers who are calorie restricted have infants with normal birth weights and a frequency of macrosomia less than that of screen-positive nondiabetic women with similar macrosomic risk factors.