Nutrition Management of Diabetes During Pregnancy

8/2/2019 Nutrition Management of Diabetes During Pregnancy

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Al Azhar University- Gaza

Faculty of Pharmacy

Prepared by:Abed Al Hameed Al Blbeissi

Nutrition Management Of Diabetes DuringPregnancy:

Supervised by:

Dr. Jehad El-Hissi

Master Program of

Clinical Nutrition


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Diabetes Mellitus: Diabetes mellitus (DM) is a group of metabolic

diseases characterized by chronic hyperglycemiaresulting from defect in insulin secretion, insulinaction or both.


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Diabetes Mellitus (DM) Type 1 diabetes mellitus

Type 2 diabetes mellitus

WHO Diagnostic Criteria DM:

Fasting blood glucose > 126 mg/dl.

Random blood glucose > 200 mg/dl.


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More than 50% women that develop gestational DMare obese.

Both pregnancy and obesity tend to alter carbohydratemetabolism.

Placental hormones increase basal insulin secretion(human placental lactogen induces insulin resistance

of maternal tissues). Obesity can aggravate insulin resistance.


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Goals of nutrition management: Individualized assessment & advice by nutritionist &

endocrinologist are essential.

Careful monitoring of weight gain & glycaemic control. Pregnancy does not affect the basic principles of diet

of diabetic.

Provide necessary nutrients for maternal and fetal

health.


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Assess diet and eating habits: Nutritional management of DM should start with

nutritional assessment.

Determine if intake of essential nutrients is adequate. Determine if she is taking excessive amounts of

sugar salt fat, salt less than 5 gram per day.

Any pregnancy related problems. Food preferences cravings special diet foods she avoids

use of fast foods junk foods.

Limit caffeine.

No Alcohol.


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Management of diabetes: The management of diabetes mellitus during

pregnancy has four major components:

Nutrition Physical activity

Weight reduction

Medication


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Physical Activity: Improves blood glucose control and decreases insulin

resistance.

Improves BP and increases HDL. Enhances the sense of well-being.

Helps to achieve energy balance and to maintainhealthy weight.

Aerobic training of moderate intensity physicalactivity as walking.

for a minimum of 30 minutes 3 or 4 times per week.


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Weight reduction: Insulin resistance starts at BMI of 27.

High waist: hip ratios and high waist circumference

values indicate central obesity, which associated withan increased risk of CVD and DM.

The goal for weight reduction is a BMI of less than 25(better< 23).

Weight reduction should be gradual.Weight reduction improves glucose control and

decreases insulin resistance.


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Recommended Weight Gain During

Pregnancy: Poor weight gain is associated with poor fetal growth &

risk of preterm delivery.

A marked acceleration or deceleration of gain towardthe end of pregnancy was associated with lowergestational age & a risk of spontaneous pretermdelivery.


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Recommendations for weight gain in

pregnancy: Overweight women 0.3 kg/week

Well-nourished women 0.4 kg/week

Undernourished women 0.5 kg/week


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Nutrition and diabetes: Food for diabetic pregnant should be:

Adequate in starchy carbohydrates

High in NSP (fiber) Low in salt and sugar (not sugar free)

Low in fat (mainly saturated fat)


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Recommended intake of nutrients for

diabetics: CHO 50-60% of total calories

Protein 15%

Total fat 25-30%

Saturated fat


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Nutrient Needs of Pregnancy: Protein 48 - 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 30 mg/day Zinc 11-13 mg/day


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Nutrition and diabetes: Calories intake should be individualized to achieve or

maintain normal body weight (TEE= BMR * PAL).

Calories should be distributed over 3 meals and 2-3snacks. Snacks should contain CHO.

Proper attention to glucose level when exercising mayneed to eat a snack prior to exercising to prevent

hypoglycemia.


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High protein intake is not recommended as it can

impair the kidney function. Consume a variety of fruits, vegetables and wholegrain

cereals.

Consume fat-free or low-fat dairy products, legumes,

fish, poultry and lean meat. Limit foods with high content of saturated F.A.s, trans

F.A.s and cholesterol.

MUFA should be the main source of dietary fatbecause of its lower susceptibility to lipid oxidationand lower atherogenic potential.


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Sodium and diabetes: Diabetics pregnant are more sodium sensitive than

general population.

High salt (sodium) intake is associated with increasedblood pressure, thus increasing the risk ofPRE-ECLAMPSIA.

Diabetic pregnant should not consume more than 6

grams of salt daily (5 g of salt = 1-tsp = 2 g sodium).


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Sodium and diabetes cont. Do not add salt at table.

Decrease salt during cooking.

Limit the intake of salty foods (olives, pickles, chips,cheese, salted nuts, salted fishes and salted redpepper).

Decrease the intake of canned foods, stock cubes and

commercial biscuits.


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Nutrition and diabetes meal planning: Foods are grouped into 6 basic types: starches (CHO),

fruits, vegetables, milk (dairy products), meat and fat.

Each group contains various foods with the sameamount of calories, carbohydrates and other nutrients.

Pregnant can exchange foods within a group becausethey are similar in nutrient content and the manner in

which they affect blood sugar.


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Carbohydrates or Grains List: Carbohydrates are an important component of any

diabetic diet.

Approximately half of daily calorie intake should comefrom CHO.

The goal is to have an even CHO intake throughoutthe day.


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Carbohydrates or Grains List cont. Any of the following foods may be exchanged

depending on personal preference:

1 slice of bread (25-30 g)

1/2 pita bread

1 small potato

1/2cup of cooked rice or pastaAt least, half of your grains should be whole.


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Starchy foods and DM: Give moderate energy (4 kcal/g).

Induce satiety.

Often contains other nutrients (proteins, vitamins andminerals).

Starchy foods are digested slowly, so blood glucose willnot rise rapidly.


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Whole-grain Cereals: Prevent rapid rise of blood glucose

Decrease insulin resistance

Decrease total cholesterol Decrease LDL, Decrease BP

Decrease the risk of obesity

Decrease the risk of cancer

Rich in potassium, Rich in antioxidants

Rich in folate, magnesium, iron

Rich in NSP


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Sugars and DM: Human beings, including those with diabetes, have a

desire for sweetness in the diet that cannot be ignored.

Diabetics can take sucrose, which should not providemore than 10% of the total calories, provided thatsucrose is eaten in the context of a healthy meal.


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Fruits List: One fruit exchange includes: 1/2 cup fresh, frozen, or canned fruit

1 small fruit (apple, orange or banana) 1/2 cup fruit juice, 1/3 cup grape juice

1/4 cup dried fruit

Diabetic pregnant should eat fruits, according to their

needs. Fruits are very healthy food. Fruits provide water, vitamins, minerals, fibers,

phytochemicals.


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Vegetables List: Almost all vegetables may be included in the diabetic

food.

One exchange is about half a cup of cooked vegetablesor a cup of raw vegetables.


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MeatList: 30 g of cooked lean meat, fish or poultry

1 egg

cup of cooked legumes 1 oz (30 g) of nuts or seeds

Legumes (beans, peas and lentils) count as one starchexchange and one lean meat exchange.


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Milk List: 1 cup low-fat/ fat-free milk or yogurt 2 oz of low-fat processed cheese

2 oz = 60ml = 4 tbsp = 1/4 cup of cheeseAn ounce (oz) of cheese is like the size of your thumb,

although individual's thumbs are different.

1 oz of cheese = 1 oz of meat


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Menu plan for 2200 kcal:Food group:2 cupFruits

2.5 cupVegetables

6 cupCarbohydrates

5.5 ozMeat &legume

3 cupMilk

6 tspOils


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Nutrition Management of Diabetes During Pregnancy

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