Nutritional Management of Gestational Diabetes - Case Study Example

Running Head: Nutritional Management of Gestational Diabetes Nutritional Management of Gestational Diabetes In APA Style Gestational diabetes mellitus (GDM) is one of the focuses of concern in terms of the period of pregnancy for the concern for the health of both the mother and the child. Due to the increasing cases of gestational diabetes through the recent years, the main objective of the study undertaken is to present the different methods to manage the said condition. Specifically, an emphasis on the nutritional management of gestational diabetes from recent researches is the target of study. One of the main concerns in terms of the health of the public is the occurrence of diabetes. During the period of pregnancy, a percentage of the mother can acquire a condition referred to as gestational diabetes mellitus (GDM). Gestational Diabetes Defined Gestational diabetes (GDM) is a condition that can be recognized by the carbohydrate intolerance that can arise during the period of pregnancy. Due to the change in the body chemistry, pregnant women undergo insulin resistance. This can be balanced through the increase of insulin secretion to compensate the said condition. The failure of the body to process the condition can lead to the development of gestational diabetes (Cheung, 2009). Specifically, hyperinsulinemia or the state of insulin resistance can lead to gestational diabetes due to the incapacity of the pancreas to achieve a balance in the pregnancy condition that can highly promote diabetes. The plasma glucose can be monitored along with other risks factors such as macrosomia history, diabetes history in the family and obesity (Gilmartin, Ural and Repke, 2008). The main concern regarding the development of gestational diabetes is the fact that it can be correlated to the development of maternal and perinatal complications (Crowther et al., 2005). Incidence and Prevalence The resolution that is needed to manage gestational diabetes mellitus can be related to the percentage of the population that can be affected. Based on the study by Gilmartin, Ural and Repke, two (2) to five (5) percent of pregnant women can acquire GDM (2008). On the other hand, the number of pregnant woman that can incur the condition, based on the majority of the studies in the field, can reach up to 8.8% to 9% (Cheung, 2009; Crowther et al., 2005). The parameters that can be monitored in the pregnant women include plasma glucose and body weight, cord blood serum C-peptide level and the risk factors that can be related to history of certain diseases and conditions in the family such as macrosomia, diabetes and obesity (Gilmartin, Ural and Repke, 2008). Other factors that can affect the development of GDM are old age, poor obstetric outcomes, ethnicity, polycystic ovary syndrome and hypertension (Cheung, 2009). Acute Complications of GDM The GDM can affect both the mother and the fetus, although on a different category and degree. Complications for the Mother Aside from the different dangers that can be related to pregnancy, acquiring gestation diabetes can be considered as a risk that can lead to pre-eclampsia and cesarean delivery (Turok, Ratcliffe and Baxley, 2003). Increased occurrence of urinary tract infections can also be observed in the women with GDM due to high amount of glucose in the urine that can increase the susceptibility to infection. Other risks include pyelonephritis and asymptomatic bacteriuria (Gilmartin, Ural and Repke, 2008). Complications for the Fetus There are different effects and conditions that can be incurred due to GDM. The worst effect of GDM to the fetus is the risk and the probability of perinatal morbidity and mortality (Giuffrida, Castro, Atallah and Dib, 2003). Other effects to the fetus include macrosomia, shoulder dystocia, birth injuries including bone fractures and nerve palsies, and hypoglycemia (Crowther et al., 2005). Chronic Complications of GDM Chronic Complications for the Mother Hypertension and diabetes are considered as chronic complications of GDM for the mother (Crowther et al., 2005). Specifically, type 2 diabetes can be acquired by the mother as an effect of the GDM (Turok, Ratcliffe and Baxley, 2003). Chronic Complications for the Fetus Included in the chronic effects of GDM are sustained impairment of glucose tolerance, obesity and impaired intellectual achievement (Crowther et al., 2005). Nutritional Implications of the Disease In the management of GDM there are different methods that can be undertaken that covers the different aspects needed by the patient and targeted to help both the mother and the fetus. The said methods include diabetes education, blood glucose self-monitoring, dietary therapy and physical activity and exercise (Cheung, 2009; Turok, Ratcliffe and Baxley, 2003). Among the said methods required in the management of GDM, the dietary and nutritional therapy is considered as the cornerstone in the management and treatment of GDM (Cheung, 2009; Reader, 2007). For that matter, it is important for the patient to be educated on the different aspects of the condition. One of the most important implications of GDM is the need for self-care and awareness of management methods and techniques. This will enable the capability to perform the different treatment methods such as blood glucose monitoring, dietary counseling and change of lifestyle (Cheung, 2009). Due to the fact that the gestational diabetes is a condition that can only present during pregnancy, a change in diet is one of the main methods. There is a need to have glycemic control, thus, the diet is monitored. One of the nutritional implications of GDM then is the control of carbohydrates intake to be able to control glucose levels (Reader, 2007). In relation to the control of glucose in the diet, there are different implications that are needed to be considered in cases of GDM. One is the fact that cases of GDM have different needs as compared to pregnant women without GDM, thus, they require a different and specifically more structured diet. This is important to be able to maintain the glucose level while simultaneously giving the needs of the developing fetus (Reader, 2007). Nutrition Therapy Nutritional Guidelines To be able to determine the ideal intake of the different nutrients, there are various nutritional guidelines used. One of the main bases of nutritional therapy is the BMI of the mother. If the BMI of the mother is 22 to 25, the recommended intake is 30 kcal/kg. As the BMI increases the caloric allotment decreases. For 26 to 29 BMI, a caloric allotment of 24 kcal/kg is recommended, and for above 30 BMI, a caloric allotment of 12 to 15 kcal/kg is allowed (Gilmartin, Ural and Repke, 2008). Meal planning In planning meals, it is important to consider that although there is needed control in terms of the intake of glucose of the mother, there is a need for the complete and healthy development of the child. In planning the meals, certain parameters are needed to be considered. For complex carbohydrates, the overall dietary ratio that is recommended is 33% to 40%. For fats it is 35% to 40% and for protein it is 20% (Gilmartin, Ural and Repke, 2008). In addition, foods with low glycemic index can help in achieving a healthy diet for the women with GDM (Reader, 2007). In terms of the meals, it is recommended to have 6 meals to where the dietary requirement can be distributed. Three meals and three snacks can be considered as a common suggestion. This will ensure the lower carbohydrate intake at a time (Cheung, 2009). Energy Intake vs. Expenditure Energy intake is one main focus of diet therapy. This can be related to the amount of energy giving foods that are in the diet. It is important to consider that the carbohydrates and glucose can be considered as energy giving foods, thus, the monitoring of such parameters can be related to the energy intake of the pregnant woman (Cheung, 2009; Reader, 2007). On the other hand, the monitoring of energy expenditure can be related to the physical activities and exercises undertaken. For women with GDM, exercise is required to increase energy expenditure to promote the removal of excess glucose. Based on the body mass, the energy expenditure can vary (Cheung, 2009; Gilmartin, Ural and Repke, 2008; Reader, 2007). Weight management Basically, the nutrition therapy is dependent on the weight of the pregnant woman. In addition it can also be related to the approximate weight of the fetus which can be measured through the change in the weight of the mother during and before pregnancy. Weight management is required to determine and monitor the possible presence of excess glucose which can be related to the increase in weight (Turok, Ratcliffe and Baxley, 2003). Conclusion In the study undertaken, the methods of management of gestational diabetes mellitus (GDM) are presented. The focus in nutritional therapy is the glycemic control that can ensure the monitoring of the condition if the mother and the fetus on the basis of the different parameters and precursors that can be related to GDM. References Cheung, N.W. (2009). The management of gestational diabetes. Vascular Heath and Risk Management, 5, 153-164. Crowther, C.A., Hiller, J.E., Moss, J.R., McPhee, A.J., Jeffries, W.S., Robinson, J.S. and Australian Carbohydrate Intolerance Study in Pregnant Women (ACHOIS) Trial Group (2005). Effect of treatment of gestational diabetes mellitus on pregnancy outcomes. New England Journal of Medicine, 352(24), 2477-86. Gilmartin, A.B., Ural, S.H. and Repke, J.T. (2008). Gestational diabetes mellitus. Rev Obstet Gynecol. 1(3), 129-134. Giuffrida, F.M.A, Castro, A.A., Atallah, A.N. and Dib, S.A. (2003). Diet plus insulin compared to diet alone in the treatment of gestational diabetes mellitus: a systematic review. Brazilian Journal of Medical and Biological Research, 36, 1297-1300. Reader, D.M. (2007). Medical nutrition therapy and lifestyle interventions. Diabetes Care, 30(Suppl 2), S188-93. Turok, D.K., Ratcliffe, S.D. and Baxley, E.G. (2003). Management of gestational Diabetes Mellitus. Am Fam Physician, 68, 1767-72, 1775-6. Read More