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chapters_4__5_nutrition_during_pregnancy.ppt
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Diabetes in Pregnancy

  • Diabetes: a leading complication in pregnancy
  • Forms of diabetes include:
  • Type 1 diabetes—Results from destruction of insulin-producing cells of pancreas
  • Type 2 diabetes—Due to body’s inability to use insulin normally, or produce enough insulin
  • Gestational—CHO intolerance with 1st onset during pregnancy

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Gestational Diabetes

  • In about 2-12% of pregnant women (increases with obesity)
  • Women developing gestational diabetes appear to be predisposed to insulin resistance, and have impaired insulin production
  • Related to metabolic changes favoring oxidative stress and elevated blood glucose

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Potential Consequences of Gestational Diabetes

  • Elevated glucose from mother – risk of adverse outcomes.
  • Spontaneous abortion, stillbirth, neonatal death
  • Congenital anomalies
  •  insulin   glucose uptake & triglyceride formation in fetus
  • Fetal changes  likelihood later in life:
  • Insulin resistance and/or Type 2 diabetes
  • High blood pressure
  • Obesity

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Adverse Outcomes Associated
with Gestational Diabetes

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Risk Factors for Gestational Diabetes

  • Linked to multiple inherited predisposition

  • Environmental triggers such as:
  • Excess body fat
  • Unhealthful diets
  • Low physical activity levels

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Risk Factors for Gestational Diabetes

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Diagnosis of Gestational Diabetes

All pregnant women should be screened at first prenatal visit for regular diabetes by the standard criteria used for those who are not pregnant.

  • One confirmed positive result for any of following would be the basis for diagnosis of diabetes:
  • Hemoglobin A1c (A1c) >6.5%
  • Fasting plasma glucose >126 mg/dL (7.0 mmol/L)
  • 2-hour glucose >200 mg/dL after 75 g oral load
  • Classic symptoms of hyperglycemia present
  • Random plasma glucose >200 mg/dL

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Diagnosis of Gestational Diabetes

  • All pregnant women without diabetes should be tested for GDM by a 75-gm oral glucose tolerance test at 24-28 weeks.
  • Diagnosis cutpoints: Women with one* of these elevated plasma glucose levels are diagnosed with GDM:
  • Fasting plasma glucose >92 mg/dL
  • 1-hr plasma glucose >180 mg/dL
  • 2-hr plasma glucose >153 mg/dL

*Note this difference from 4th edition of the textbook.

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Management of Gestational Diabetes

  • First approach is medical nutrition therapy to normalize blood glucose levels with diet & exercise
  • Blood glucose levels can be brought down with low calorie intake – avoid elevated ketones
  • Oral medication metformin (glyburide) used to decrease insulin resistance

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Exercise Benefits & Recommendations

  • Regular aerobic exercise decreases insulin resistance & blood glucose in gestational diabetes
  • Recumbent bicycle at moderate intensity 45 min 3 x week
  • Weight lifting with arms 20 min 3 x week
  • Brisk walking 30 minutes every day
  • Exercise to make women slightly sweaty but not overheated, dehydrated or exhausted

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Nutritional Management of Women with Gestational Diabetes

  • Assess dietary & exercise habits
  • Develop individualized diet & exercise plan
  • Monitor weight gain
  • Interpret blood glucose & urinary ketone results
  • Ensure follow-up during & after pregnancy

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THE DIET PLAN

  • Whole-grain breads & cereals, vegetables, fruits, & high-fiber foods
  • Limited intake of simple sugars
  • Low-GI foods, or carbohydrate foods that do not greatly raise glucose levels
  • Unsaturated fats
  • Three regular meals & snacks
  • Based around calculated level of calories

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Estimating Levels of Caloric Need in Women with Gestational Diabetes

  • Distribute calories among 3 meals & several snacks
  • Caloric levels & meal/snack plans are starting points and my need modifications.
  • See Table 5.11 for menu examples

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Consumption of Foods with Low
Glycemic Index

  • Low GI carbohydrate foods help sustain modest improvement in blood glucose levels
  • Blood glucose response with diabetes from meals of white bread or spaghetti is shown in graph

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Gestational Diabetes

  • Postpartum Follow-Up
  • 15% will remain glucose intolerant postpartum
  • 10-15% will develop Type 2 diabetes in 2-5 yrs
  • Prevention of Gestational Diabetes
  • Reduce excessive weight and obesity
  • Increase physical activity
  • Decrease insulin resistance prior to pregnancy

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