I. Medical Nutrition Therapy (MNT) The purpose of treatment is to keep the blood sugar of pregnant women with diabetes in the normal range, to ensure a reasonable nutritional intake for the mother and the fetus, and to reduce the occurrence of complications for mother and child . Once diagnosed with gestational diabetes mellitus (GDM), pregnant women are immediately given MNT and exercise instruction, as well as education on how to perform blood glucose monitoring. After MNT and exercise management, monitoring fasting and 2 hours postprandial blood glucose of pregnant women, if the blood glucose is still abnormal, timely application of insulin is recommended. 1. Recommended nutritional intake The total daily energy intake should be based on the pre-pregnancy weight and the rate of weight gain during pregnancy. Although it is necessary to control the total daily energy intake of pregnant women with diabetes, excessive energy restriction (<1500kcal in early pregnancy and <1800kcal in late pregnancy) should be avoided. In particular, insufficient carbohydrate intake may lead to the development of ketosis, which may have adverse effects on both the mother and the fetus. Average weight gain in early pregnancy: 0.5-2Kg; average increase of about 200Kcal/d in middle and late pregnancy based on the above; for pregnant women of common height in China (150cm-175cm), we can refer to [height (cm)-105] as the ideal weight value. Pregnant women who are too short or too tall need to adjust their dietary energy recommendations according to the patient's condition. In the case of multiple pregnancies, the nutritional intake should be appropriately increased by 200 kcal per day on a singleton basis. 2. Carbohydrates The recommended intake should account for 50% to 60% of the total energy, with no less than 150g of carbohydrates per day, which is more appropriate for maintaining normal blood sugar during pregnancy. Refined sugars such as sucrose should be avoided as much as possible. Low glycemic index foods can be preferred when choosing equal carbohydrate foods. Monitoring carbohydrate intake is a key strategy to achieve glycemic control, whether by carbohydrate counting, food exchange portion method or empirical estimation. When only total carbohydrate is considered, using glycemic index and glycemic load may be more helpful for glycemic control. 3.Protein Recommended dietary protein accounts for 15%-20% of total energy is appropriate to meet the needs of maternal physiological regulation during pregnancy and fetal growth and development. 4.Fat The recommended dietary fat percentage of total energy is 25%-30%. However, foods with high saturated fatty acid content, such as animal fats, red meat, coconut milk and full-fat dairy products, should be appropriately restricted, and the intake of saturated fatty acids should not exceed 7% of the total energy intake for diabetic patients; while olive oil and camellia oil, which are rich in monounsaturated fatty acids, should account for more than 1/3 of the fat energy supply. Reducing the intake of trans fatty acids can lower LDL cholesterol and increase HDL cholesterol, so pregnant women with diabetes should reduce or avoid the intake of trans fatty acids. 5, dietary fiber Dietary fiber is a polysaccharide that does not produce energy. Pectin in fruits, kelp, algae gum in seaweed, guanidine gum in some beans and konjac flour have the effect of controlling the rise of blood sugar after meals, improving glucose tolerance and lowering blood cholesterol. Recommended daily intake of 25g-30g. can choose more dietary fiber-rich oatmeal, buckwheat noodles and other coarse grains, as well as fresh vegetables, fruits, algae food, etc. 6, supplemental vitamins and minerals The need for iron, folic acid, vitamin D doubled during pregnancy, calcium, phosphorus, thiamine, vitamin B6 increased by 33 to 50%, zinc, riboflavin increased by 20 to 25%, vitamin A, B12, C and energy, selenium, potassium, biotin, niacin increased by about 18%. Therefore, it is recommended to systematically increase foods rich in vitamin B6, calcium, potassium, iron, zinc and copper (such as lean meat, poultry, fish, shrimp and dairy products, fresh fruits and vegetables, etc.) during pregnancy. 7, the use of non-nutritive sweeteners ADA recommends that only FDA-approved non-nutritive sweeteners pregnant women can use, and moderately recommended, the current relevant research is very limited. The five FDA-approved non-nutritive sweeteners are: potassium acetyl sulfonate, aspartame, neotame, edible saccharin and sucralose. 8.Reasonable arrangement of meals Pregnant women with GDM should follow a small number of meals and eat regularly and quantitatively, which will play a very important role in their blood sugar control. The energy of breakfast, lunch and dinner should be controlled at 10-15%, 30% and 30%, and the energy of each additional meal before meals and bedtime can account for 5-10% of the total energy of the whole day, which can help prevent excessive hunger before meals and prevent the occurrence of hypoglycemia before meals and at night. Meal plans must be individualized, and reasonable meal arrangements and corresponding nutrition education should be made according to cultural background, lifestyle, economic conditions and education level. Second, exercise therapy for GDM 1, the role of exercise therapy exercise therapy can reduce the basic insulin resistance during pregnancy, is one of the comprehensive treatment measures for GDM, 30 minutes of moderate intensity exercise after each meal has no adverse effects on the mother and child . 2, exercise therapy method Select a low to moderate intensity aerobic exercise, or endurance exercise, mainly by the body in the large muscle groups to participate in continuous exercise, commonly used some simple available aerobic exercise such as walking. 3, the time of exercise exercise time can start from 10 min, gradually extended to 30 min, which can be interspersed with the necessary intervals, it is recommended to exercise after meals. 4, the frequency of GDM exercise is generally considered appropriate for the number of exercises 3 to 4 times / week. Precautions for GDM exercise therapy 1, EKG examination before exercise to exclude cardiac disorders, and screening for macrovascular and microvascular complications is required. 2, contraindications to GDM exercise therapy: with severe heart disease and chronic hypertension, placenta praevia, multiple pregnancies, cervical insufficiency, preterm labor or miscarriage, fetal growth restriction, hypertensive disorders during pregnancy, etc. 3.Prevent hypoglycemic reaction and delayed hypoglycemia: exercise after 30min of eating, control the duration of each exercise to 30~40 minutes, and rest for 30 minutes after exercise. Stop exercising if the blood sugar level is lower than 3.3mmol/L or higher than 13.9mmol/L. You should bring some cookies or candies with you when you exercise, so that you can eat in time when there are signs of low blood sugar. 4, the following conditions should be promptly sought medical attention during exercise: abdominal pain, vaginal bleeding, running water, breath-holding, dizziness, severe headache, chest pain, muscle weakness, etc. 5.Avoid exercising in the early morning on an empty stomach before insulin injection.