Low-carb Diet Linked To Insulin Resistance In Gestational Diabetes
Current dietary practice for women who have gestational diabetes is to focus on a low-carbohydrate diet, which often coincides with increased fat consumption. But low-carbohydrate, high-fat diets may increase maternal insulin resistance and infant adiposity, according to preliminary findings of a study presented by Teri L. Hernandez, PhD, RN, assistant professor of medicine and nursing at the University of Colorado. In the small trial, 11 pregnant women with gestational diabetes were randomized to either a low-carbohydrate, high-fat diet (LC/HF) or a high-carbohydrate, low-fat diet (HC/LF). The LC/HF was comprised of 40% carbohydrate, 45% fat, and 15% fat, while the HC/LF diet was comprised of 60% carbohydrate, 25% fat, and 15% protein. In both diets, 82% of the carbohydrates were complex. All meals were provided by the researchers. The researchers took blood samples at 30-32, and 37 weeks into the women’s pregnancies and biopsied the women’s adipose tissue at 37 weeks. At 37 weeks the women in the LC/HF group had higher fasting blood glucose (P = 0.007), insulin (P = 0.06), maternal insulin resistance (P = 0.02), and post-prandial free fatty acids (P = 0.037) than those in the HC/HF group. Mean adiposity was greater in infants born to mothers in the LC/HF group, at 14% compared to 11% in infants born to mothers in the HC/LF group. Overall, the higher fasting insulin and insulin resistance among women in the LC/HF group was associated with greater infant adiposity. In an interview with EndocrineWeb, Dr. Hernandez said that until now, most research involving women with gestational diabetes focused on maternal blood glucose. “That has been the only clinical metric we have, but our data implies that we can have an impact on these patients’ insulin resistance even i Continue reading >>
Real Food For Gestational Diabetes: What You Need To Know
Note From Mommypotamus: When I wrote about natural alternatives to the glucola test, many of you asked what to do if gestational diabetes is diagnosed and confirmed. Today I am so excited to welcome Lily Nichols, RDN, CDE, CLT, a registered nutritionist and gestational diabetes educator, who will be filling us in on how to take a real food approach to GD. Lily is the author of Real Food for Gestational Diabetes, a thoroughly researched guide filled with practical guidance and easy-to-follow instructions. It is, hands down, the best resource on the subject that I have found so far. If you or someone you know is looking for information on managing GD with real food, I highly recommend it! Gestational diabetes is never part of any mom’s plan . . . But it is the most common complication of pregnancy, affecting up to 18% of pregnant women. Yet there are many misconceptions about this diagnosis, both in conventional health care and the integrative medicine world. As a registered dietician/nutritionist and certified diabetes educator who specializes in gestational diabetes, I’m going to clear up some of the confusion for you today. Whether or not you have gestational diabetes, this post will help you understand how it develops and why it’s important to maintain normal blood sugar (for all pregnant women, really). I’ll also be sharing why the typical gestational diabetes diet fails and why a real food, nutrient-dense, lower carbohydrate approach is ideal for managing gestational diabetes. What is Gestational Diabetes? Gestational diabetes is usually defined as diabetes that develops or is first diagnosed during pregnancy. However, it can also be defined as “insulin resistance” or “carbohydrate intolerance” during pregnancy. I prefer to rely on the latter descrip Continue reading >>
Gestational Diabetes Diet
Gestational diabetes, which causes higher-than-normal blood sugar levels to be present, occurs during pregnancy. Gestational diabetes testing usually occurs between 24 and 28 weeks of pregnancy. If you have risk factors for diabetes, your doctor may recommend testing earlier in the pregnancy. If you receive a gestational diabetes diagnosis, you’ll need testing 6 to 12 weeks after giving birth to see whether the diabetes is still present. Gestational diabetes usually resolves after you deliver, although you’re at higher risk for developing type 2 diabetes later in life. According to Johns Hopkins Medicine, gestational diabetes affects 3 to 8 percent of pregnant women in the United States. Gestational diabetes increases the risk of having a large baby, which may cause problems with delivery. It also increases the risk of having a baby born with hypoglycemia (low blood sugar). Respiratory distress, jaundice, and low calcium and magnesium levels are also more common in babies whose mothers have gestational diabetes. There’s a higher risk of your baby developing diabetes later in life as well. Changing your diet is generally the first method of treatment for gestational diabetes. The amount of calories you should consume each day depends on a number of factors, such as your weight and activity level. Pregnant women should generally increase their calorie consumption by 300 calories per day from their prepregnancy diet. Doctors recommend three meals and two to three snacks per day. Eating smaller meals more frequently can help you keep your blood sugar levels stable. Your doctor will likely recommend that you monitor your blood sugar levels to help manage gestational diabetes. Testing your blood sugar after meals tells you how that meal affected your blood sugar. Your d Continue reading >>
Low Carb Diet Won't Help In Gestational Diabetes
Low Carb Diet Won't Help in Gestational Diabetes by Todd Neale Todd Neale, Senior Staff Writer, MedPage Today This article is a collaboration between MedPage Today® and: Note that this small randomized study demonstrated that a low carbohydrate diet was not superior to a control diet in reducing insulin use among women with gestational diabetes. Be aware that pregnancy outcomes were similar in both groups as well. Simply reducing dietary carbohydrate content was not an effective way to forestall the need for insulin among women with gestational diabetes, a randomized trial showed. The percentage of patients who were started on insulin was 54.7% both among those who ate a low-carbohydrate diet and among those who ate a diet with a normal level of carbohydrates (P=1.00), according to Didac Mauricio, MD, PhD, of the University of Lleida in Spain, and colleagues. Pregnancy and neonatal outcomes were similar in the two groups as well, the researchers reported online in Diabetes Care. "Therefore, the amount of carbohydrates [in] the diet may not be a key issue in future clinical recommendations on medical nutrition therapy of gestational diabetes," they wrote. "Additional randomized intervention studies that consider different populations and different strategies to modify glycemic load are warranted to assess the optimal [approach]," they wrote. Medical nutrition therapy has formed the basis of treatment for gestational diabetes, and has been centered on modifying the amount and distribution of carbohydrates to maintain glycemic control without ketosis, according to the researchers. In recent years, the therapy has been aimed primarily at modifying the glycemic index, but there is little evidence-based information on specific approaches to managing the condition. The curre Continue reading >>
Dietary Recommendations For Gestational Diabetes
Diabetes diagnosed during pregnancy is called gestational diabetes. Gestational diabetes occurs in about 7 percent of all pregnancies. It usually arises in the second half of pregnancy and goes away as soon as the baby is born. However, if gestational diabetes is not treated, you may experience complications. The first step in treating gestational diabetes is to modify your diet to help keep your blood sugar level in the normal range, while still eating a healthy diet. Most women with well-controlled blood sugar deliver healthy babies without any complications. One way of keeping your blood sugar levels in normal range is by monitoring the amount of carbohydrates in your diet. Carbohydrate foods digest and turn into blood glucose (a type of sugar). Glucose in the blood is necessary because it is the fuel for your body and nourishment your baby receives from you. However, it's important that glucose levels stay within target. Carbohydrates in Food Carbohydrates are found in the following foods: Milk and yogurt Fruits and juices Rice, grains, cereals and pasta Breads, tortillas, crackers, bagels and rolls Dried beans, split peas and lentils Potatoes, corn, yams, peas and winter squash Sweets and desserts, such as sugar, honey, syrups, pastries, cookies, soda and candy also typically have large amounts of carbohydrate. Carbohydrates in foods are measured in units called grams. You can count how many carbohydrates are in foods by reading food labels and learning the exchange lists. The two most important pieces of information on food labels for a carbohydrate-controlled diet is the serving size and grams of total carbohydrate in each serving. Dietary Recommendations It is important to be meet with a registered dietitian to have your diet assessed. The dietitian will calcula Continue reading >>
Can A Ketogenic Diet Cure Gestational Diabetes? Here's What The Science Says
Higher risk of the child suffering other health conditions later in life (including obesity, heart disease, and yes, diabetes) Bigger babies, and tougher deliveries (e.g., shoulder dystocia) Plus, the test is cheap and doesnt harm anyone--the benefits greatly outweigh the costs. Should you get a glucose tolerance test if you already manage your diet well? Maybe not, but its good to play it safe. In an abundance of caution, its nice to know your status when it comes to blood sugar in the event you need to manage it better. (I know it helped me.) Most people in the general population can easily get caught up in the stress, dietary decisions, and lifestyle influences that can cause elevated blood glucose. Even healthy people are prone to higher blood sugar because they consume the excess carbs recommended in the Standard American Diet. So for the average pregnant woman, testing for GDM is a safe and reasonable idea--and even if you have a low-risk pregnancy, one morning of drinking sugar syrup isnt that terrible if theres even the slightest chance it would improve outcomes for your baby. When I got my GDM diagnosis, I had to schedule an appointment with a nutritionist to discuss the recommended dietary guidelines for the remainder of my pregnancy. Before I even met the nutritionist, I was furious. I feared they would force me to eat tons of carbs and try to shove a low-fat agenda down my throat. I mentally prepared to argue for a higher-fat, lower-carb diet, confess to my past dietary sins (forgive us our cheese puffs), and basically tell them no if they wanted me to do anything I wasnt comfortable with. I didnt want to follow the guidelines, mainly because theres heavy debate over their efficacy. Some reviews say that none of the existing guidelines help one way or the o Continue reading >>
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- The effect of a low-carbohydrate, ketogenic diet versus a low-glycemic index diet on glycemic control in type 2 diabetes mellitus
What Do We Know About Diet And Gestational Diabetes?
Why do some women develop diabetes during pregnancy? And if gestational diabetes is “just” a disease of pregnancy and goes away after birth, why do so many of those women go on to get Type 2 diabetes later in life? As it turns out, diabetes of pregnancy might be a red flag for pre-existing, long-term metabolic problems. It’s not an issue that suddenly appears out of the blue during pregnancy for no reason. And it’s one more reason for everyone to take care of their diet, even if they’re healthy right now. Gestational diabetes can affect the health of the woman long after her pregnancy is over, and it also affects the health of the baby (this is where men come in – if your mother had gestational diabetes, you’ll probably want to know about it). Here’s a look at where it comes from, and why a long-term game plan is so important. What Is Gestational Diabetes? Gestational diabetes is a type of diabetes triggered by pregnancy. Women with gestational diabetes didn’t have diabetes before they were pregnant (in that case it would just be regular old type 1 or type 2 diabetes). Typically, gestational diabetes also goes away after birth…at least temporarily. Like all other kinds of diabetes, gestational diabetes has been getting more and more common: the rate of gestational diabetes increased 122% between 1989 and 2004. Gestational diabetes is more common in older mothers, nonwhite women, women with a family history of diabetes, and women who were overweight before their pregnancy (although it also shows up in thin women, so just being thin is no guarantee of safety). If a woman has gestational diabetes during one pregnancy, she’s more likely to have it in future pregnancies. Women with gestational diabetes usually don’t get any symptoms, but they can some Continue reading >>
The Gestational Diabetes Diet: Taking Carbs From A Pregnant Lady
When I decided, at age 40, that I wanted to try to have a child, I knew I faced a few elevated risks over younger women: first and foremost, I might not be able to conceive at all. I mentally prepared myself—as much as I could, anyway—for that and other possibilities, including the higher risk of the baby having a genetic defect. So far I’ve been fortunate. The one risk I hadn’t given much thought to—the higher chance of developing gestational diabetes—is the only one that has been a factor in my pregnancy. I’m fairly healthy, I have no history of diabetes in my family, and I try to eat well—lots of fresh fruits and vegetables and few highly processed junk foods. But older pregnant women—and that means even women as young as in their late 20s, believe it or not—can have a harder time regulating insulin, leading to increased blood sugar levels. Gestational diabetes, if not controlled through diet and exercise, can cause high-birth-weight babies and potentially lead to delivery complications, as well as increasing the risk that the child will develop obesity and type 2 diabetes later in life. For the mother, there’s also the risk of high blood pressure and a higher likelihood of developing type 2 diabetes in the future. I haven’t been diagnosed with gestational diabetes so far. But because my blood sugar was a little high during my early glucose tolerance test (this is given to all pregnant women around 28 weeks, but women of my age are also sometimes tested earlier), I was advised to exercise more frequently and follow a low-carbohydrate diet, the same advice given to those with the diagnosis. The last thing a pasta-loving pregnant lady with a sweet tooth wants to hear is that she should cut out carbs. I have always been skeptical of the low-carb Continue reading >>
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Gestational Diabetes
Lives in Vancouver, BC, and has a doctorate in social work and education from McGill University Correspondence: Dr Carmen Lavoie, 512 W 21st, North Vancouver, BC V7M 1Z7; telephone 604 971-0966; e-mail moc.oohay@eioval_nemrac Copyright the College of Family Physicians of Canada Cet article est disponible en franais. Voyez " Diabte gestationnel ". For the first time in my life I had to watch what I ate. Results of a glucose tolerance test at 22 weeks of my first pregnancy revealed that I had gestational diabetes mellitus (GDM). Thereafter, I was caught up in an intense regimen of medical intervention, which included ketosis check 3 times per day (read: peeing on a stick), laboratory tests (read: peeing in a cup) on average once per week, nonstress tests twice a week toward the end of the pregnancy (still peeing in a cup), and of course, appointments for dietary counseling. I worked hard every day to control my blood glucose levels, faithfully following the schedule of poking, peeing, injecting, and exercising. I wanted to be a compliant patient: if I could not do what was necessary to ensure the health of my unborn child, what kind of mother would I be? With a diagnosis of GDM, my score as a good mom was on the line. What exactly were the target blood glucose levels? Interestingly, what seemed fine for one family doctor concerned another. Then there was the obstetrician who disagreed with both family doctors. I found different approaches to target blood glucose levels and different approaches to insulin dosing. The only topic I could be sure to get agreement on was diet. Canadas Food Guide versus low-carbohydrate diet Canadas Food Guide 1 seems to be the cornerstone of dietary counseling for patients with diabetesif I could just learn to follow the food guide then suppo Continue reading >>
- Women in India with Gestational Diabetes Mellitus Strategy (WINGS): Methodology and development of model of care for gestational diabetes mellitus (WINGS 4)
- Leeds diabetes clinical champion raises awareness of gestational diabetes for World Diabetes Day
- Gestational Diabetes: The Overlooked Form of Diabetes
Why I Went Paleo/primal For My Gestational Diabetes
Why I Went Paleo/Primal for My Gestational Diabetes Ive been interested in Paleolithic (or paleo) diets for ages, but it always seemed difficult to give up my favorite croissants and ciabatta bread and fully embrace the lifestyle. Plus, I have a wheat-addicted daughter and husband to deal with.Ive tried removing wheat from the house from time to time, but it usually results in some sort of mutiny and my dear hubby making panicked runs to Costco for massive packs of apple turnovers. I found him hiding some in his car last year and decided I may have been a wee bit extreme in my war on gluten. However, I got a wake up call last year when I was diagnosed with gestational diabetes (GD) fairly early on in my recent pregnancy with our twins. Gestational diabetes is much more common with twin pregnancies, but the diagnosis upset me. It seemed that getting a diagnosis of gestational diabetes triggered the five stages of grief! My first step was definitely denial: How could I possibly have gestational diabetes? I eat very healthy foods overall (well at least according to conventional holistic nutrition)plenty of healthy whole grains, beans, legumes, organic vegetables, fruit, grass-fed beef, and organic chicken. Oh, and wild salmon of courseI do live in the Pacific Northwest!I also love my dark chocolate , but Im more likely to make glucomannan pudding than cupcakes. (Okay, sometimes we have cupcakes.) I was tested for gestational diabetes earlier in my pregnancy than most because of my symptoms (hyperemesis gravidarum, constant thirst, and needing to pee even more than the average pregnant woman) and the high risk of GD with twins. My test results were marginal, and it was still early, so, convinced this was all a giant mistake, I started monitoring my blood sugars four times Continue reading >>
9 Gestational Diabetes Myths
As a specialist in gestational diabetes nutrition, I get a lot of questions about blood sugar and pregnancy. Gestational diabetes is controversial. Its complicated. And theres a lot of misinformation out there. I do my best to address the controversies in interviews and with participants in my online gestational diabetes course, but since Ive been receiving more and more inquiries in my inbox from fellow healthcare professionals, I wanted to dispel some gestational diabetes myths head-on right here on the blog. Ill also be attending some midwifery conferences this year (including one this weekend), and I figured this resource would be a helpful place to refer practitioners if they have questions. Given the medical interventions that are commonly pushed on women with gestational diabetes (believe me, Im also disheartened by the over-medicalization of pregnancy and birth), its important to understand the science behind high blood sugar and pregnancy. My goal is to help moms and practitioners make better decisions based on fact, not fear so they can have the healthiest pregnancy possible. Myth #1: Blood Sugar Levels are Naturally Higher In Pregnancy Theres a lot of misinformation floating around about blood sugar levels in pregnancy. Some think that gestational diabetes is a diagnosis looking for a disease. In other words, they believe that blood sugar levels naturally go up during pregnancy, so theres nothing to worry about. Some practitioners dont even test for gestational diabetes and just tell their patients to eat healthy under the assumption that any rise in blood sugar is just a normal phenomenon of pregnancy. Unfortunately, thats not true. Research has looked at blood sugar levels in normal, healthy pregnant women and found that blood sugar levels consistently tre Continue reading >>
Low-carbohydrate Diet For The Treatment Of Gestational Diabetes Mellitus
OBJECTIVE Medical nutrition therapy based on the control of the amount and distribution of carbohydrates (CHO) is the initial treatment for gestational diabetes mellitus (GDM), but there is a need for randomized controlled trials comparing different dietary strategies. The purpose of this study was to test the hypothesis that a low-CHO diet for the treatment of GDM would lead to a lower rate of insulin treatment with similar pregnancy outcomes compared with a control diet. RESEARCH DESIGN AND METHODS A total of 152 women with GDM were included in this open, randomized controlled trial and assigned to follow either a diet with low-CHO content (40% of the total diet energy content as CHO) or a control diet (55% of the total diet energy content as CHO). CHO intake was assessed by 3-day food records. The main pregnancy outcomes were also assessed. RESULTS The rate of women requiring insulin was not significantly different between the treatment groups (low CHO 54.7% vs. control 54.7%; P = 1). Daily food records confirmed a difference in the amount of CHO consumed between the groups (P = 0.0001). No differences were found in the obstetric and perinatal outcomes between the treatment groups. CONCLUSIONS Treatment of women with GDM using a low-CHO diet did not reduce the number of women needing insulin and produced similar pregnancy outcomes. In GDM, CHO amount (40 vs. 55% of calories) did not influence insulin need or pregnancy outcomes. Gestational diabetes mellitus (GDM) is defined as glucose intolerance with its onset or first recognition during pregnancy. The prevalence of GDM is ∼7% (from 1 to 14%), depending on the population and the diagnostic criteria used (1). In Spain, GDM has an estimated prevalence of 8.8% (2). GDM is associated with an increase in maternal and n Continue reading >>
- Women in India with Gestational Diabetes Mellitus Strategy (WINGS): Methodology and development of model of care for gestational diabetes mellitus (WINGS 4)
- The effect of a low-carbohydrate, ketogenic diet versus a low-glycemic index diet on glycemic control in type 2 diabetes mellitus
- Timing of Delivery in Gestational Diabetes Mellitus: Need for Person-Centered, Shared Decision-Making
Low-carbohydrate Diet For The Treatment Of Gestational Diabetes Mellitus
Low-Carbohydrate Diet for the Treatment of Gestational Diabetes Mellitus 1Department of Endocrinology and Nutrition, Hospital Universitari Arnau de Vilanova, Lleida, Spain 2Department of Medicine, University of Lleida, Lleida, Spain Find articles by Cristina Moreno-Castilla 1Department of Endocrinology and Nutrition, Hospital Universitari Arnau de Vilanova, Lleida, Spain 2Department of Medicine, University of Lleida, Lleida, Spain 3Institut de Recerca Biomedica de Lleida, Lleida, Spain 1Department of Endocrinology and Nutrition, Hospital Universitari Arnau de Vilanova, Lleida, Spain 2Department of Medicine, University of Lleida, Lleida, Spain 1Department of Endocrinology and Nutrition, Hospital Universitari Arnau de Vilanova, Lleida, Spain 3Institut de Recerca Biomedica de Lleida, Lleida, Spain 3Institut de Recerca Biomedica de Lleida, Lleida, Spain 4Department of Basic Medical Sciences, University of Lleida, Lleida, Spain Find articles by Montserrat Martinez-Alonso 1Department of Endocrinology and Nutrition, Hospital Universitari Arnau de Vilanova, Lleida, Spain 2Department of Medicine, University of Lleida, Lleida, Spain 3Institut de Recerca Biomedica de Lleida, Lleida, Spain 1Department of Endocrinology and Nutrition, Hospital Universitari Arnau de Vilanova, Lleida, Spain 3Institut de Recerca Biomedica de Lleida, Lleida, Spain 5Unitat de Salut Publica i Nutricio, Universitat Rovira i Virgili, Institut dInvestigaci Sanitria Pere Virgili, Reus, Spain 1Department of Endocrinology and Nutrition, Hospital Universitari Arnau de Vilanova, Lleida, Spain 2Department of Medicine, University of Lleida, Lleida, Spain 3Institut de Recerca Biomedica de Lleida, Lleida, Spain 1Department of Endocrinology and Nutrition, Hospital Universitari Arnau de Vilanova, Lleida, Spain 2Departm Continue reading >>
- Women in India with Gestational Diabetes Mellitus Strategy (WINGS): Methodology and development of model of care for gestational diabetes mellitus (WINGS 4)
- The effect of a low-carbohydrate, ketogenic diet versus a low-glycemic index diet on glycemic control in type 2 diabetes mellitus
- Timing of Delivery in Gestational Diabetes Mellitus: Need for Person-Centered, Shared Decision-Making
Is Low Carb And Keto Safe During Pregnancy?
When Carolina Cartier discovered she was pregnant with twins this past March, she never questioned whether she would continue eating a ketogenic diet. The 31-year-old Seattle area woman had been plagued by metabolic issues literally all her life: precocious puberty at age 3; polycystic ovarian syndrome (PCOS) by age 14; weight gain of 320 lbs (145 kg) on her 6 foot (183 cm) frame and pre-diabetes by her 20s. Her PCOS caused her ovaries to be enlarged and covered in cysts. She was told she was infertile and likely never able to have children. In August 2014, aged 28, her health was so poor that she went on medical disability from her job as a financial analyst. That first month off, however, she discovered and adopted the ketogenic diet. Between summer 2014 and February 2017, she lost 120 lbs (54 kg), experienced her first ever natural menstrual period that gradually established into a regular 28-day cycle; her blood sugar normalized and her ovaries reduced to 3.5 cm (< 1.5 inches) size. Her long-standing depression lifted. While she lost two early pregnancies at the start of 2016, likely because of poor egg quality, she knew she was getting healthier every day. Her positive pregnancy test in March 2017 was a happy surprise, as was the news soon after that she was carrying healthy twins. Except for a bout of extreme nausea and sea sickness for a week on a low-carb cruise early in this pregnancy, she has adhered to the ketogenic diet now through to 20 weeks of pregnancy and counting. She plans to continue this way of eating for the rest of her life. She feels great and looks wonderful; the twins in utero are thriving. “My life is transformed. Why would I even consider abandoning this way of eating when all of my positive health changes, and my pregnancy, I owe to this d Continue reading >>
What Is The Best Diet For Gestational Diabetes?
Gestational diabetes can cause a range of complications during pregnancy. Fortunately, a woman can help reduce complications by following a healthful diet. What foods should women eat and what foods should they avoid if they have gestational diabetes? Gestational diabetes occurs if a woman's body cannot produce enough insulin, during her pregnancy. This deficiency leads to high blood sugar. High blood sugar levels may cause problems for the woman and her baby if not managed properly. This article explains what type of diet a woman should follow during pregnancy if she has gestational diabetes. It also considers other treatment options for gestational diabetes and what complications may occur if the condition is not properly managed. Contents of this article: Understanding gestational diabetes Gestational diabetes is a type of diabetes that can develop during pregnancy. According to the Centers for Disease Control and Prevention (CDC), between 2 and 10 percent of pregnancies are affected by gestational diabetes each year in the United States. This type of diabetes occurs when a woman's body cannot make enough of the hormone insulin. Insulin is made by the pancreas and helps the body's cells to use sugar from the blood as energy. When a woman is pregnant, her body will produce more hormones, and she may put on weight. Both of these changes may mean that her body's cells may not use insulin as well as they used to. This is called insulin resistance. Becoming resistant to insulin means that the body needs more of it in order to use up the sugar in the blood. Sometimes a woman's body cannot produce enough insulin to keep up. This leads to a sugar buildup in the blood, resulting in high blood sugar levels. Symptoms of gestational diabetes may include: being unusually thirsty Continue reading >>
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- Women in India with Gestational Diabetes Mellitus Strategy (WINGS): Methodology and development of model of care for gestational diabetes mellitus (WINGS 4)
