Understanding The 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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