Historical background

Before 1921, women with diabetes were advised to avoid pregnancy or to abort if they conceived because of adverse perinatal outcomes. If the pregnancies advanced to the stage of fetal viability, the infants were often stillborn or were born with major malformations. Medical nutrition therapy was the primary method of management for pregnant women with diabetes prior to 1921; however, the diets were often severely restricted or nutritionally unbalanced. These dietary approaches varied from high carbohydrate-low protein, or high protein-high fat, to brief periods of starvation [4, 5]. Alcohol was often included because of its calming effect on the mother [6].

Although insulin injections revolutionized diabetes management, nutrition therapy remained virtually unchanged in the early years after its discovery. In 1937, Priscilla White, a physician at the Joslin Diabetes Center in Boston, Mass., developed a new meal plan, which consisted of 30 kcal/kg body weight, 1 g protein/kg actual body weight, and 180-250 g carbohydrate with the remainder as fat [7]. Other researchers used similar meal plans to achieve maternal blood glucose control [8, 9].

During the 1950-1960s, health care providers were concerned with the risk of macrosomia and hypertension in pregnancy. Weight gain and sodium were restricted to less than 15 lb and 2 g, respectively, in all pregnant women. After the publication of Maternal Nutrition and the Course of Pregnancy in 1970 [10], weight gain recommendations were increased to 22-30 lb, and the sodium restriction was discontinued. This comprehensive literature review found no evidence to support the restriction of weight or sodium in pregnancy. However, weight gain and sodium restrictions for pregnant women with diabetes continued until 1970, when the American Diabetes Association recommended the same regimen for pregnant women with diabetes as for the general pregnant population [11]. Today, pregnant women with and without diabetes follow the same weight gain recommendations.

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