Ginekologia Polska

2019, vol. 90, no. 1, 46–49

Copyright © 2019 Via Medica
O R I G I N A L PA P ER / O BS TE TRICS ISSN 0017–0011

DOI: 10.5603/GP.2019.0007

Effects of nutritional nursing intervention based on

glycemic load in patients with gestational diabetes
mellitus
Shaofang Lv1*, Shanlan Yu2*, Rongxiang Chi3, Dongmei Wang4
1The Third Department of Obstetrics, Yantai Yuhuangding Hospital, Yantai City, China

2Endoscope Room, Yantai Hospital of Traditional Chinese Medicine, Yantai City, China

3Department of Nursing, Yantai Hospital of Traditional Chinese Medicine, Yantai City, China

4Department of Gynecology and Obstetrics, Yantai Hospital of Traditional Chinese Medicine, Yantai City, China

*These authors have contributed equally to this work

ABSTRACT
Objectives: To determine the effects of nutritional nursing intervention based on glycemic load (GL) for patients with
gestational diabetes mellitus.
Material and methods: One hundred thirty-four patients diagnosed with gestational diabetes mellitus at our hospital
were selected from March 2015 to March 2017 and randomly divided into the observation (n = 67) and control groups
(n = 67). All of the patients in the observation and control groups received conventional nutritional nursing. In addition,
the patients in the observation group received nutritional nursing intervention based on GL. The changes in blood glucose
levels and pregnancy outcomes were compared between the two groups after intervention.
Results: There were significant differences in fasting blood glucose (FBG) and the 2h postprandial glucose (2hPG) levels
between the two groups (P < 0.05). There was a lower incidence of premature delivery, fetal macrosomia, eclampsia, preg-
nancy hypertension syndrome, and fetal distress in the observation group.
Conclusions: Nutritional nursing intervention based on GL is more effective than traditional nutritional nursing for patients
with gestational diabetes, and can effectively control the blood glucose level, reduce the incidence of pregnant complica-
tions, and improve the pregnancy outcome. Thus, nutritional nursing intervention based on GL deserves to be popularized.
Key words: gestational diabetes mellitus; glycemic load; nutritional nursing; pregnancy outcome
Ginekologia Polska 2019; 90, 1: 46–49

INTRODUCTION exchange table after a meal, and cannot consider the impact
Gestational diabetes mellitus (GDM), defined as glucose in- of food processing and maturity on preparing food. The GL
tolerance with onset or first recognition during pregnancy [1], is a combination of the quality and quantity of carbohydrate
causes a heavy burden on patients, families, and society. intake to assess the overall glycemic effect of the diet. In
Nutrition nursing is an economic and effective means to the current study, a total of 134 GDM pregnant women
manage GDDM. Genetic studies have shown that food ex- were given nutritional nursing intervention based on the GL
change servings based on the glycemic load (GL) is more concept between March 2015 and March 2017 to determine
effective than traditional food exchange servings i for pa- the effect of blood glucose on pregnancy outcome.
tients with type 2 diabetes mellitus [2, 3]. The traditional
nutrition treatment strictly limits the role of nutrition nurs- MATERIALS AND METHODS
ing because there is a focus on moderation and spacing Clinical material
of carbohydrate intake. According to traditional nutrition, One hundred thirty-four women who were diagnosed
patients cannot distinguish the differences in response to with GDM based on the standards of medical care in dia-
the GL and insulin resulting from equivalent food in the food betes [4], were recruited between March 2015 and March

Corresponding author:
Dongmei Wang
Department of Gynecology and Obstetrics, Yantai Hospital of Traditional Chinese Medicine, No.39, Xingfu Road, Zhifu District, Yantai City, Shangdong Province, 264000, China
e-mail: dongmei_wang@aol.com

46
 Shaofang Lv et al., Nutritional nursing intervention based on GL

2017 for this study. The inclusion criteria were as follows: (1) tion recipes of the GL group adjusted the heat of food by
singleton gestation; (2) no metabolic disease, and no liver the GL, as follows: GL = glycemic index (GI)× carbohydrate
and kidney dysfunction; (3) no history of diabetes before content/100, where a GL > 20 indicates a high-GL food,
pregnancy; (4) junior high school diploma or above; (5) a GL10~20 indicates a moderate-GL food, and a GL < 10 in-
no diabetes health education from professional nutrition dicates a low-GL food. The pregnant women were instructed
physicians; and (6) no use of insulin. how to calculate calories in different activity states and
All of the selected patients signed informed consent pregnancy status to assure the amount of food that should
and were randomly divided into 2 groups by registration be eaten compared with the fixed diet.
order into a traditional food exchange group (control group Two groups of pregnant women were followed by the
[n = 67]) and the food exchange group based on the concept obstetric professional dietitian and physicians regularly
of GL (observation group [n = 67]). There was no statisti- (1 visit every 1~2 weeks). According to the current weight,
cally significant difference in maternal age, gestational age, gestational age, fetal size, and blood glucose level, the calo-
maternal height and weight, literacy, and family medical rie intake was calculated and adjusted as needed.
history between the two groups. The perinatal outcomes of The fasting blood glucose (FBG) and 2-h postprandial
the mother and offspring were followed through delivery blood glucose (2hPBG) levels were determined in pregnant
by the obstetric nutritionist and physicians. women after 2 weeks of intervention.

Diagnostic criteria Evaluation index

According to the diagnostic criteria recommended by The FBG and 2hPBG levels were measured before inter-
the International Association of Diabetes and Pregnancy vention and at 37 weeks gestation. At the same time, fetal
Study Group (IADPSG) [5] in 2010, the oral glucose tolerance heart tracing and maternal and infant outcomes, including
test (OGTT) using 75g glucose considered that any of the preterm delivery, fetal macrosomia, eclampsia , pregnancy
following thresholds should be met or exceeded: fasting hypertension syndrome, and fetal distress were recorded.
plasma glucose, 5.1 mmol/L; 1-hour plasma glucose, and
10.0 mmol/L; and 2-hour plasma glucose, 8.5 mmol/L. Statistical methods
Data are described as the mean ± SD for measurement
Intervention methods data or frequency [%] for enumeration data. The measure-
All pregnant women were given personalized diet guid- ment data were analyzed by independent sample t-tests
ance at the time of diagnosis. Based on the ideal weight, the between the two groups and the enumeration data by
actual weight gain, and eating habits of pregnant women, chi-square tests before and after intervention.
a reasonable diet plan, diet control, and proper exercise were
recommended. Patients were treated with insulin if an ideal RESULTS
blood glucose level was not achieved. All diet-guided preg- There was no statistical difference in the FBG level be-
nant women were advised to eat small meals 5 or 6 meals tween the two groups before intervention (P > 0.05), but
a day, to avoid overeating, and to engage in an appropriate there was a significant decrease in the FBG level after inter-
amount of exercise. vention. The FBG level was statistically significant lower in
The control group was counseled according to the tra- the GL group than the TFE (Traditional Food Exchange) group
ditional food exchange method and the observation group (P < 0.05). The same findings were observed with respect to
was counseled by the food exchange method based on the the 2hPBG level (Tab. 1).
concept of blood GL. According to nutritional equilibrium While not statistically significant (P > 0.05), differences in
theory and the food exchange principle, the fixed nutri- the rate of adverse pregnancy outcomes, such as preterm de-

Table 1. Comparison of blood glucose before and after intervention between the two groups(x– ± s)
FBG* 2h PG
Group cases
Before intervention After intervention Before intervention After intervention
TFE 67 6.68 ± 0.57 5.55 ± 0. 12 10.03 ± 0.64 7.98 ± 1.21
GL 67 6.71 ± 0.61 5.12 ± 0. 60 10.01 ± 0.64 7.41 ± 2.03
T -0.274 5.535 0.235 5.807
P 0.05 < 0.05 0.05 < 0.05
*fasting blood glucose; :2-hour postprandial glucose

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Ginekologia Polska 2019, vol. 90, no. 1

Table 2. Comparison of pregnancy outcome between two groups (N = 134)

Groups Cases Premature delivery Fetal macrosomia Eclampsia Pregnancy hypertension syndrome Fetal distress
TFE 67 13 (19.4) 2 (3.0) 1 (1.5) 2 (3.0) 3 (4.5)
GL 67 6 (9.0) 1 (1.5) 0 (0.0) 0 (0.0) 5 (7.5)

livery, fetal macrosomia, eclampsia, pregnancy hypertension to operate. In 1997, the concept of blood GL was suggested
syndrome, and fetal distress, existed between participants by Salmerón. GL is the product of the available amount of
between the two groups following the intervention (Tab. 2). carbohydrate and the blood glycemic index (GI) in food
[6]. GL reflects the response to blood glucose because the
DISCUSSION quality of carbohydrate in food and the effect of the total
GDM is one of the most common complications in ob- amount of carbohydrates on the response to blood glucose
stetrics departments. The pathogenesis is now considered is included [7]. Guo et al. [8] reported that most of the GL
to be due to placental hormones, such as estrogen, proges- in the diet is provided by cereal food based on the dietary
terone, and human placental lactogen (HPL), which lead to habits of Chinese people. Therefore, it is of great significance
insulin resistance and high blood glucose. Insulin resistance to introduce the concept of GL in the nutritional treatment
and hyperinsulinemia induce vascular changes, resulting in of patients with DM to improve the curative effect of nutri-
thickening of the basement membrane of the capillary wall tional therapy in China.
and aggravation of renal ischemia, which may promote the Dombrowski et al. [9] designed the International Scale of
occurrence of hypertension and other diseases in pregnancy. Glycemic Load on the basis of summing up the research of
A number of studies have shown that the hyperglycemic others in 2002. Because the food types and cooking meth-
state in pregnant women increases the proliferation of fetal ods in China are very different from foreign countries, these
islet cells, increases insulin secretion, promotes the synthesis data cannot be applied to pregnancies in Chinese patients
of fetal protein and fat, and inhibits the decomposition of as the basis for the choice of food for DM. This study mainly
glycogen, resulting in an increased incidence of macrosomia used the food exchange serving based on the GL concept to
and other adverse pregnancy outcomes. In addition, GDM be more consistent with Chinese physical attributes. It has
can cause a variety of diseases, such as polyuria. Indeed, been reported that this method of diet treatment, which
the hypertonic fluid environment can lead to high perme- lowers and stabilizes blood glucose in patients with DM,
ability diuresis. The glucose concentration in amniotic fluid is had a better effect than the traditional food exchange serv-
elevated, which can stimulate the amnion to increase secre- ing, but has not been determined for patients with GDM.
tion of amniotic fluid, which results in polyhydramnios. An The current study used food exchange servings based on
elevated insulin fetal environment reduces pulmonary sur- GL concept, which was professional, scientific, reasonable,
factant, which delays maturation of fetal lungs. Therefore, the and easy-to-operate; thus, suitable for housewives. Pregnant
blood glucose level should be controlled in the normal range women could receive nutrition knowledge in the process of
to reduce the incidence of complications among mothers food matching and production according to the fixed recipe,
and infants. A number of clinical studies have reported that which is conducive to self-management.
the blood glucose level of most patients with GDM can be The results of this study showed that the two groups
controlled in the normal range by diet, Therefore, nutrition of nutrition methods reduced the blood glucose level in
programs are receiving more and more attention by clini- gravidas with GDM. Food exchange serving based on GL
cians. Nutritional intervention depends on the success of yielded significant differences from the traditional method,
diet education. Some scholars have suggested that dietary thus indicating that the food exchange serving method is
education for patients with DM, letting the patient master more effective based on the GL, which could lead to better
the correct knowledge and skills of diet, is the primary means blood glucose level control, improved insulin resistance,
to promote a reasonable diet and healthy behavior, which is reduce the incidence of abnormal glucose metabolism dur-
the most economic and effective health care strategy. ing pregnancy, and improve perinatal outcome
The food exchange serving, which is the traditional
method, is used clinically to control the blood glucose level Acknowledgment
of patients with DM. The method does not include the ef- None.
fects of food cooking methods and the maturity of food on
blood glucose. Thus, changes in the blood glucose response Conflicts of Interest
cannot be truly reflected in application, although it is easy No conflict of interests to declare.

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 Shaofang Lv et al., Nutritional nursing intervention based on GL

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