Diet in Gestational Diabetes - Coursework Example

Diet in Gestational Diabetes Introduction Variable degree of glucose intolerance with first recognition of onset during pregnancy is known as gestational diabetes or GDM (Moore, & Warshak, 2007). This condition is seen in 3-10% of all pregnancies and accounts for 90% of diabetes mellitus in pregnancy (Moore, & Warshak, 2007). About 3-5% of patients with GDM have underlying diabetes type- 1 or 2 (Moore, & Warshak, 2007) with pregnancy being the first opportunity to diagnose the disease. GDM merits importance because it causes significant morbidity and mortality in the mother and the new-born. In normal pregnancy, many hormonal interactions occur with each feeding to ensure adequate and non-excessive supply of glucose to both the mother and fetus. This is important because, fetus draws glucose from the maternal blood stream through placenta even between meals and sleep, and hence can cause significant hypoglycemia in the mother. Also, maternal blood levels of placental steroids and various other peptide hormones like progesterone, estrogens and chorionic somatomammotropin gradually increase through out the second and third trimesters. These hormones increase tissue insulin resistance and thus cause increase in insulin levels. Infact, the levels in third trimester can go upto 50% when compared to non-pregnant state. If such an increase in insulin secretion does not occur, it leads to maternal hyperglycemia which further leads to fetal hyperglycemia. High glucose levels in fetal blood causes increased insulin secretion by the fetal pancreas leading to hyperinsulinemia. Fetal hyperinsulinemia leads to excessive nutrient storage which in turn leads to macrosomia. This causes excessive energy expenditure and depletion in fetal oxygen levels. Intermittent fetal hypoxic episodes cause fetal hypertension, cardiac remodelling and hypertrophy, increased stimulation and production of erythropoietin. Raised levels of fetal erythropoietin leads to red cell hyperplasia and increased hematocrit known as polycythemia. Polycythemia in turn leads to sludging in the blood vessels, poor circulation and postnatal hyperbilirubinemia (Moore, & Warshak, 2007). In the baby, GDM can cause miscarriages, increased incidence of various birth defects involving cardiovascular and central nervous systems, macrosomia, growth acceleration, childhood metabolic syndrome, increased fetal mortality and birth injuries, polycythemia, hypoglycemic episodes, neonatal hypocalcemia, postnatal hyperbilirubinemia and neonatal respiratory distress syndrome. In the mother, this condition can contribute to and worsen diabetic retinopathy, chronic hypertension, renal dysfunction and preeclampsia (Moore, & Warshak, 2007). GDM can be diagnosed by routine screening of pregnant women in the second trimester. The diagnosis is established by glucose tolerance testing. Women who are at risk for developing this condition are those with advanced age, obesity and strong family history of diabetes. Management of gestational diabetes Since GDM can cause significant morbidity and mortality both in the mother and the baby, treatment has to be instituted immediately after diagnosis. The aim of treatment is to keep the blood glucose levels in normal ranges without compromising the calories and nutrients intake (American Diabetes Association, 2008). The treatment includes special meals, appropriate physical activity and also glucose monitoring and insulin injection if necessary. Diet in GDM in second trimester Before implementation of a dietary plan for GDM, it is important to know what are the recommended daily nutrients and calories intake for a normal pregnant women. In addition to the normal pre-pregnancy calorie requirements of 1500 to 2000 calories, a pregnant woman will need atleast 300 additional calories from second trimester and 500 additional calories during lactation. 10% of the calories must come from proteins like fish, eggs, pulses or meat; 35% must come from dairy products and 55% must come from carbohydrates like pasta, bread, potatoes, cereals and rice (American Pregnancy Association, 2008). Weight gain in pregnancy The amount of weight gain one must aim during pregnancy is dependent upon the pre-pregnancy weight. A pregnant woman must gain 25-37 pounds if she were of normal weight prior to pregnancy. She should aim for 28-40 pounds if she was previously underweight and her weight gain must be 15-25 pounds only if she was overweight prior to conception. In the first trimester, only 3- 5pounds of weight gain will occur. After that, approximately 1- 2pounds should be gained per week in the second and third trimesters (American Pregnancy Association, 2008). Detailed meal plans (sample) (Adopted from National Institute of Child health and Human Development, 2007) Breakfast: Hard boiled egg, toast, grapes, and milk: 1 egg, hard-boiled, 1 slice whole wheat bread, 1 tsp canola-based, trans-fat free margarine, 1/3 lb grapes (any kind) and 12 fluid ounces, non-fat skim milk. This yields 11g fat, 394 calories and 22 g protein. Mid- morning Half a peanut butter and jelly sandwich with milk: 1 slice whole wheat bread, one table spoon of peanut butter (smooth or chunky), one tablespoon of reduced-sugar jelly and 8 fluid ounces non-fat skim milk. This yields 9.7 g fat, 276 calories and 14.5 g protein. Lunch: Cheese, tomato, and black bean pita with milk: 1 pita, large, whole wheat, blend the following for inside the pita: 1/2 cup uncooked black beans, 1/2 fresh tomato (chopped), 1 ounce low-fat sharp cheddar cheese (shredded), 1 TBSP salsa, and 2 tsp olive oil and 8 fluid ounces non-fat skim milk. This yields 17.7 g fat, 547.7 calories and 29.2 gram protein. Mid- afternoon snack: Apple and peanut butter: 1 medium apple with peel, cored and sliced, 1 tablespoon peanut butter (smooth or chunky) and 12 fluid ounces, non-fat skim milk. This yields 9.2g fat, 295 calories and 15.8 g protein. Dinner: Grilled chicken with pineapple, rice, and green beans. This is done using 3 ounce chicken breast, boneless/skinless, raw 4 ounce pineapple rings, canned in juice 1 table spoon sesame seeds, toasted 1 table spoon sesame oil, dark 2 tsp soy sauce, low-sodium 1/2 cup green beans, cooked 1/4 cup instant rice, uncooked 1 tsp cornstarch, 1/4 lb fresh strawberries and 8 ounces water. This yields 16.2 g fat, 523.7 calories and 23 g protein. Foods to be avoided during pregnancy Uncooked seafood, undercooked beef or poultry, delimeats, certain types of fish, smoked sea food, raw shell fish, raw eggs, soft cheeses, unpasteurised milk, pate, caffeine, alcohol and unwashed vegetables and fruits should be avoided in pregnancy (American Pregnancy Association, 2008). In addition to these, a pregnant woman with GDM should avoid foods with direct cane sugar like chocolates, sweets and sugary drinks. References American Pregnancy Association. (2008). Eating for Two When Over/ or Under Weight. Retrieved on 4th Feb, 2009 from: http://www.americanpregnancy.org/pregnancyhealth/eatingfortwo.html Moore, T.R., & Warshak, C. (2007). Diabetes Mellitus and Pregnancy. Emedicine from WebMD. Retrieved on 4th Feb, 2009 from: http://emedicine.medscape.com/article/127547-overview American Diabetes Association. (2008). Gestational Diabetes. Retrieved on 4th Feb, 2009 from: http://www.diabetes.org/gestational-diabetes.jsp National Institute of Child health and Human Development. (2007). Sample Meal plan in Gestational Diabetes. Retrieved on 4th Feb, 2009 from: http://www.nichd.nih.gov/publications/pubs/gest_diabetes/sub15.cfm Read More