Nutrition Management of Diabetes During Pregnancy

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Nutrition Management of Diabetes During
Pregnancy

• April Shaw, MPH, RD, CDE

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Goals of Nutrition Management

• Provide necessary nutrients for maternal/fetal
  health
• Maintain normal blood sugars
• (65-95 mg/dl before meals)
  (less than 120 mg/dl 2 hours after meals)
• Prevent ketosis
• Appropriate weight gain

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Assess Diet and Eating Habits

• Determine if intake of essential nutrients is
  adequate
• Determine if she is taking excessive amounts of
  sugar, salt, fat
• Any pregnancy related problems
• Food preferences, cravings, special diet, foods
  she avoids, use of fast foods, junk foods, picky
  eater
• Limit caffeine
• No Alcohol

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Recommended Weight Gain During Pregnancy

• Prepregnancy weight status
• Less than 90 ideal body weight Gain 28-40 lbs
• Desirable body weight Gain 25-35 lbs
• Greater than 120 ideal body weight Gain 15-25
  lbs
• Women may end up losing weight due to healthier
  eating habits

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Recommended Weight Gain During Pregnancy

• Prepregnancy weight status
• Low BMI (
• Normal BMI (19.8-26) Gain 25-35 lbs
• High BMI (26-29) Gain 15-25 lbs
• Obese (29) Gain 15 lbs
• Women with High BMI may end up losing weight due
  to healthier eating habits

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Nutrient Needs of Pregnancy

• Protein 60 grams/day
• Vit C 80-85 mg/day
• Vit B6 1.9 mg/day
• Folate 600 ug/day
• Calcium 1000-1300 mg/day
• Magnesium 350-400 mg/day
• Iron 27 mg/day
• Zinc 11-13 mg/day

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Nutrient Needs Cont

• Increased calorie needs in 2nd and 3rd Trimesters
  only, generally 300 extra calories a day.
• Some studies suggest calorie restriction in obese
  women with Gestational Diabetes-controversial
• If woman is taking a nutritionally adequate diet,
  blood sugar levels stay within normal range,
  maternal/fetal parameters appear normal, amount
  of weight gain isnt an issue.
• Pattern of weight gain most important

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Role of Nutrients

• Protein supports growth of new tissue both in
  mother and baby. Also helps to stabilize womans
  blood sugar levels, can help prevent low blood
  sugar
• Examples Meats, Fish, Eggs, Cheese, Cottage
  Cheese, Nuts, Peanut Butter

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Role of Nutrients Cont

• Fats provide a stored form of energy, help with
  absorption of fat-soluble vitamins. Fats also
  help to stabilize a womans blood sugar levels
  since fats take longer for the body to digest and
  absorb. They may prevent high peaks in blood
  sugar levels.

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Role of Nutrients Cont

• Carbohydrates (Carbs) provide energy for growth
  and all body functions for both mother and baby.
• Carbohydrates come from the food we eat. They
  are digested and broken down into smaller little
  packages of energy- which we call glucose or
  blood sugar.

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Carbohydrates Cont

• All foods can be changed into blood sugar when
  digested. Carbohydrates make the most blood
  sugar.
• Insulin is needed to get the sugar (glucose) from
  the blood into the cells to use.
• Since Carbs make the most blood sugar they must
  be watched closely in diabetes.
• Fiber may help stabilize blood sugars

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Carbohydrates Cont

• Examples Fruit, Milk, Desserts, Bread, Starchy
  Vegetables, Pasta, Rice, Crackers

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Meal Planning

• Recommended Distribution of Calories
• 40-50 Carbohydrates
• 20-25 Protein
• 30-40 Fat

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Meal Planning Guidelines

• Avoid high amounts of refined sugars
• Nutrasweet (Equal) and Sucralose (Splenda) safe
  to use
• Eat small frequent meals and snacks
• 3 meals plus 2-3 snacks per day
• Eat a small breakfast
• Space carbohydrates out throughout the day,
  complex carbs are the best choice they are higher
  in fiber

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Meal Planning Guidelines Cont

• Include source of protein in all meals and most
  snacks
• No fruit or fruit juice in the morning
• Always take bedtime snack to prevent blood sugar
  from dropping during the night
• Try to eat every 4-5 hours during the day and
  breakfast within 10 hours of bedtime snack

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Individualizing the Meal Plan

• Try to match diet pattern to mothers schedule as
  closely as possible.
• Provide fast food information
• Provide recipes
• Limited Resources
• Troubleshoot
• Be flexible

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Sample Meal Plan
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Creating a Sample Meal Plan
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Sample Meal Plan
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First Trimester Considerations

• Pregnancy with pre-existing diabetes
• Low Blood Sugar (Hypoglycemia)
• May be caused by hormonal changes of pregnancy
• May be caused by nausea and vomiting
• Symptoms of Hypoglycemia shaky, sweaty, weak,
  headache, dizzy, confused

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First Trimester

• Treatment ½ c. juice, ½ c. regular soda,
• 1 c. milk, 6-7 lifesavers, piece of fruit
• Follow with small meal or snack to keep blood
  sugars from dropping low again
• Treatment for nausea and vomiting
• eat every 2-3 hours, avoid fatty foods, eat
  crackers in bed before rising

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First Trimester

• If nausea/vomiting prevents eating or keeping
  food down
• Take easily tolerated foods and beverages in
  small amounts throughout the day
• ½ c. clear juice or regular caffeine-free soda,
  ½ c. regular jello, popsicles, yogurt, pudding,
  plenty of fluids.

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2nd and 3rd Trimester Considerations

• Increased calorie needs
• approximately 300 extra calories/day
• Increase in insulin requirements
• -woman with pre-existing diabetes using insulin
  may require more insulin (Insulin currently is
  glucose lowering medication approved for use,
  women using oral hypoglycemic agents must
  discontinue use and switch to insulin)
• GDM may be diagnosed.

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Screening for GDM

• For certain high risk populations, screen at
  first prenatal visit
• GTT test 1hour 130 mg/dl perform 3 hour test
• 3 hour GTT
• Fasting
• 1 hour
• 2 hours
• 3 hours
• If any 2 values are above limits, diagnosis of
  GDM

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Exercise

• Exercise lowers blood glucose levels and combined
  with diet- may be enough for some women with GDM
• Exercise helps to keep muscles strong- fewer back
  aches, more stamina for labor and delivery
• Helps to prevent excessive weight gain

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Exercise Cont

• Although good for most pregnant women, some women
  may not be able to exercise
• Diabetic Kidney, Eye or Nerve Disease
• Heart Disease, High Blood Pressure
• Hypoglycemia Unawareness (cant tell when low
  blood sugar is coming on)

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Exercise Cont

• Diabetes educator or exercise specialist can help
  prescribe exercise program
• Need doctors permission
• Test blood sugars before exercise
• Try light exercises like walking, swimming, water
  aerobics, cycling
• No exercise lying flat on the back after 1st
  trimester

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Exercise Cont

• During 3rd trimester avoid heavy exercise of the
  lower body which may cause fetal contractions,
  focus on upper body exercise
• Be careful of joints and straining muscles
• Use the sing/talk test
• Drink plenty of water, use suitable shoes
• Exercise 3 times/wk for 20-60 minutes

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Walk your Dog!
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Postpartum

• Blood Sugars usually return to normal immediately
  after delivery
• 50 of women with GDM are at risk of developing
  Type 2 diabetes within 5-10 years
• Continue to follow diet
• and exercise plan
• Lose weight

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Breastfeeding

• Helps to protect against diabetes
• Requires 500 extra calories/day so may help with
  controlling blood sugars in women with
  pre-existing diabetes
• May help to speed up weight loss

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What Can You Do to Help?

• Encourage regular prenatal care
• Encourage prenatal vitamins
• Encourage breastfeeding
• Make referrals if you feel patient is not
  following guidelines
• In between pregnancies encourage weight loss, if
  diabetic recommend they seek pre-conceptual
  counseling

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References

• Slocum, J. et al. Preconception to Postpartum
  Management of Pregnancy Complicated by Diabetes.
  The Diabetes Educator 2004 30 740-753.
• Trumbo, P. et al. Dietary Reference Intakes. J
  Am Diet Assoc.
• 2001 101 294-301.
• Carr, D.B., Gabbe, S. Gestational Diabetes
  Detection, Management, and Implications. Clinical
  Diabetes 1998 16 1 4-11.
• Publication of the American Diabetes
  Association. The Diabetes Advisor Get Fit, Keep
  Fit When Youre Pregnant.
• May/June 1999 10
• American Diabetes Association. Medical
  Management of Pregnancy Complicated by Diabetes
  p. 45-55 and p. 77-103. Alexandria VA, June 1993.