Gestational Diabetes Diet
Women with preexisting diabetes who become pregnant are at risk
for fetal complications along with risks to their own health if and when
complications of diabetes occur. About 4% of all pregnant women in the
United States will contract gestational diabetes during their pregnancy.
It is believed that the stress of pregnancy is one of the causes of
gestational diabetes because once the baby is born it goes away. Because
of the risks associated with pregnancy and diabetes it is important that
any woman diagnosed with diabetes during pregnancy follow a gestational
diabetes diet.
Whether the mother has preexisting diabetes or gestational diabetes
there is an increased risk of fetal abnormalities and mortality because
of the hyperglycemia caused by the insulin resistance. Any woman with
gestational diabetes should receive nutrition counseling by a registered
dietician and every effort should be made to control blood glucose
levels.
Changes that take place during pregnancy greatly affect diabetes control
and insulin use. Some hormones and enzymes produced by the placenta are
antagonistic to insulin reducing its effectiveness. Maternal insulin
does not cross the placenta but glucose does. This will cause the
fetus's pancreas to increase insulin production if blood glucose levels
are too high.
This increase in insulin levels causes the most typical characteristics
of babies born toe diabetic mothers; macrosomia which is a larger than
normal body size. New babies can also suffer from other conditions such
as respiratory difficulties, hypocalcemia, hypoglycemia, hypokalemia, or
jaundice.
Individualization of a gestational diabetes diet is contingent on
maternal weight and height. The diabetes diet plan should include
provision for adequate calories and nutrients to meet the needs of the
pregnancy and should be consistent with established maternal blood
glucose goals.
Self monitoring of blood glucose (SMBG) is an important part of any diet
plan because it gives vital information about the impact of food on
blood glucose levels. When blood glucose monitoring begins during a
pregnancy the minimal daily SMBG should be take place four times a day.
Blood glucose goals during a pregnancy are as follows.
Fasting – less than 95 mg/dl
1 hour after a meal – 140 mg/dl
2 hours after a meal – 120 mg/dl
The frequency of the self monitoring can be decreased once blood glucose
control is established. It is important to continue checking glucose
throughout the pregnancy though.
Desired weight gains and nutrient requirements are the same as for
established pregnancy guidelines: 2 to 4 pounds for the first trimester
and 1 pound per week for the second and third trimesters based on body
mass index before the pregnancy. Calorie adjustments for the first
trimester are not needed. During the second and third trimesters, an
increased energy intake of approximately 100 to 300 kcal/day is the
recommendation.
High quality protein should be increased by 10 g/day and can be easily
met with one or two extra glasses of low-fat or skim milk or 1 to 2 oz
of meat or meat substitute. All pregnant women should also take 400 ug/day
of folic acid to help prevent neural tube defects and other congenital
defects. As with any pregnancy drinking alcohol should be avoided.
Any restriction of calories should be approached with caution. In order
to prevent ketosis a minimum of 1700 to 1800 calories per day of
carefully selected foods must be eaten. Eating less then this amount is
not advised under any circumstances. Weight gain should still occur even
if the pregnant woman has had considerable weight gain before the onset
of their gestational diabetes. Every pregnant woman with gestational
diabetes should be individually evaluated by a registered dietician to
create a gestational diabetes diet that fits her specific needs.
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