If the pregnant is overweight:

Overweight and obese women diagnosed with overt DM or GDM are at an increased risk for complications during pregnancy including preeclampsia, hypertension, stillbirth and increased risk for cesarean section. Though Institute of Medicine recommendantions for weight gain during pregnancy is not specifically written for women with overt or gestational diabetes, is nonetheless appropriate for women with these conditions.

R 4.2a Suggest that women either with overt DM or GDM gain weight according to Institute of Medicine revised guidelines. https://www.ncbi.nlm.nih.gov/books/NBK235235/ (ungraded) 

R 4.2b Suggest obese women reduce calorie intake by one third (compared with usual intake before pregnancy) while maintaining minimum intake of 1600-1800kcal. (2++)

R 4.3 Limit carbohydrate intake to 35-45% of total calories distributed to 3 meals and 2-4 snacks. (2++)

The measures mentioned above aim to:

• Limit maternal weight gain,
• maintain euglycemia
• avoid ketonuria and
• maintain an average birth weight of 3542g.