Page 620 - fbkCardioDiabetes_2017

596 “Medical Nutritional Therapy in Gestational Diabetes”

ning skills, barriers to dietary compliance, such as Guidelines for carbohydrate intake for
lack of family support, daily schedule or economic preexisting diabetes and GDM are discussed
issues, etc. Macronutrient (especially carbohydrate
and fiber) and micronutrient dietary intake. Vitamin below:
and mineral supplement use (prenatal and non-pre- The amount and distribution of calories and carbohy-
natal) or use of natural remedies, such as herbs or drates are individualized and based on the woman’s
alternative therapies. Food allergies or intolerances food preferences, blood glucose records, plasma
glucose responses, outcome measures and physical
Medications: Prescription (diabetes-related, non-dia- activity level.
betes-related); over the counter medications
MNT for GDM primarily involves a carbohydrate-con-
Use of alcohol, tobacco, caffeine or other substances trolled meal plan to achieve and maintain normo-
& Exercise pattern: Type, frequency, duration glycemia. Monitoring carbohydrate by choices, ex-
Screening for other nutrition risks (e.g., eating dis- changes, carbohydrate counting, glycemic index and
orders, pica, adolescence, low literacy, low income, glycemic load remains a key strategy in achieving
psychosocial issues), language, cultural background, glycemic control 5
ethnic or religious beliefs should be taken into con- CHO’s ideally to be distributed throughout the day
sideration in 3 small to moderate sized meals and 2-4 snacks.
Nutritional plan includes Calorie allotment, Single large meals with large percentage of simple
distribution & carbohydrate intake carbohydrates are not preferred.
The most difficult blood glucose level to manage is
The meal pattern should provide adequate calories the post breakfast value, because of the insulin resis-
and nutrients to meet the needs of pregnancy.Calorie tance associated with higher hormone levels seen in
requirement depends on age, activity, pre-pregnancy the early morning hours & may improve with splitting
weight and stage of pregnancy.
in two halves of equal portion & consuming at 2-hour
gap, peaking of plasma glucose is high with break-
GDM: Macronutrient Requirements fast (Dawn phenomenon) than with lunch and dinner.
For normal-weight and underweight women with An initial food plan would suggest the following car-
GDM, caloric intake is assessed by weight gain and bohydrate ranges for each meal and snack:An eating
avoidance of starvation ketosis. Unless a woman plan including foods with a low GI may improve post
begins pregnancy with depleted body reserves, en- meal glucose readings; however, the first nutrition
ergy needs do not increase in the first trimester. An therapy intervention is to control the total amount
additional 300 kcals/day are suggested during the and distribution of carbohydrate.
second and third trimester for increases in maternal
blood volume and increases in breast, uterus and * Breakfast - 10-15% of Total Energy Intake (TEI)
adipose tissue, placental growth, fetal growth, and * Mid-Morning snack - 5-10% of TEI
amniotic fluids.
* Lunch - 20-30% of TEI
First trimester- 30kcal/kg Ideal Body Weight(IBW).
*Evening Snack - 5-10% of TEI
Second & Third trimester- 30kcal/kg IBW + 300kcal/
day. * Dinner - 20-30% of TEI
TheDietary Reference Intakes for all pregnant wom- * Bed time Snack 5-10 % of TEI
en, including those with GDM, recommends a mini- On sick days associated with morning sickness, the
mum of 175g carbohydrate (CHO), a minimum of 71g diet restrictions need to be more flexible.
protein (or 1.1g per kg per day protein) and 28g fiber 3
Due to the continuous fetal draw of glucose from
Obese GDM the mother, maintaining consistency of times and
amounts of food eaten are important to avoidance
Weight loss diets are in general not recommended of hypoglycemia. Evening snack is a must to prevent
during a pregnancy.
nocturnal hypoglycemia accelerated starvation
If pre - pregnancy BMI >30kg/m -25kcal/kg Present If insulin therapy is added to MNT, maintaining carbo-
2
Body Weight (PBW)
hydrate consistency at meals and snacks becomes
a primary goal.

GCDC 2017