Poster Presentation Australasian Diabetes in Pregnancy Society and Society of Obstetric Medicine Australia and New Zealand Joint Scientific Meeting 2021

Medical nutrition therapy for gestational diabetes mellitus in Australia: What has changed in 10 years and how does current practice compare with best practice?   (#86)

Robyn A Barnes 1 2 , Melinda Morrison 3 4 , Jeff R Flack 2 5 6 , Glynis P Ross 2 7 , Carmel E Smart 1 8 , Clare E Collins 1 9 , Lesley MacDonald-Wicks 1 9
  1. School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, Newcastle , NSW, Australia
  2. Diabetes Centre, Bankstown-Lidcombe Hospital, Bankstown, NSW, Australia
  3. Diabetes NSW & ACT, Glebe, NSW, Australia
  4. Diabetes Australia, Canberra, ACT, Australia
  5. Faculty of Medicine, University of NSW, Sydney, NSW, Australia
  6. School of Medicine, Western Sydney University, Sydney, NSW, Australia
  7. Faculty of Medicine, University of Sydney, Sydney, NSW, Australia
  8. Department of Paediatric Endocrinology and Diabetes, John Hunter Children’s Hospital, Newcastle, NSW, Australia
  9. Priority Research Centre in Physical Activity and Nutrition, University of Newcastle, Callaghan, Newcastle, NSW, Australia

Aims: To examine current Australian dietetic practice in the management of GDM by comparing findings to a 2009 survey1; and to the American Academy of Nutrition and Dietetics Nutrition Practice Guidelines2; and assess the need for Australian guidelines.

Methods: Cross-sectional surveys of dietitians providing Medical Nutrition Therapy (MNT) to women with GDM were conducted in 2009 and 2019. The current abstract compares responses to questions on MNT between surveys.

Results: A total of 220 and 149 dietitians met inclusion criteria in the 2009 and 2019 surveys respectively. Not all questions were answered by all respondents. The majority of respondents in both surveys (>60%) reported aiming for macronutrient targets consistent with a high carbohydrate (>45% energy), moderate protein (15-25% energy), moderate fat (15-30%) dietary intervention. Consistencies in key components of MNT found in 2009 continued in 2019 - such as topics covered. Inconsistencies in MNT found in 2009 also continued in 2019 including wide ranges in: target percentage of energy from carbohydrate (20-75% in 2009 versus 30-65% in 2019); and recommended minimum daily carbohydrate intake (60-300 grams in 2009 versus 40-220 grams in 2019). A minority of dietitians in both surveys (26% in 2009 versus 32% in 2019; NS) reported aiming for the recommended minimum carbohydrate intake (≥175 grams/day)2. Of note, significantly more dietitians in 2019 reported providing key components of MNT consistent with maternal weight gain recommendations2 including provision of weight gain advice (59% versus 40%; p<0.05), and routine weighing at clinic visits (74% versus 60%; p<0.05) versus 2009. Most respondents felt there was a need for Dietitians Australia (DA) endorsed guidelines (89% in 2019 and 86% in 2009; NS).

Conclusions: Although most dietitians provide MNT consistent with existing guidelines there is a need for greater implementation. These findings support the need for Dietitians Australia endorsed MNT guidelines for GDM.

1. Morrison MK, Collins CE and Lowe JM. Dietetic practice in the management of gestational diabetes Mellitus: A survey of Australian dietitians. Nutrition & Dietetics 2011;68:189-194.

2. Duarte-Gardea MO, Gonzales-Pacheco DM, Reader DM, Thomas AM, Wang SR, Gregory RP, Piemonte TA, Thompson KL, Moloney L. Academy of Nutrition and Dietetics Gestational Diabetes Evidence-Based Nutrition Practice Guideline. J Acad Nutr Diet 2018;118(9):1719-1742.