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598 “Medical Nutritional Therapy in Gestational Diabetes”

Energy First trimester- 30kcal/kg IBW. Second trimester- 30kcal/kgIBW+300kcal/day.
Obese – If pre-pregnancy BMI >30kg/m2 -25kcal/kg Present Body Weight& Re-
striction of CHO to 35-40% in Obese GDM.
Carbohydrates Minimum 175g/day is given to –prevent starvation ketosis. Carbohydrate percent-
age is individualized. Avoid hypo caloric diets to prevent IUGR
Sucrose and caloric USFDA approved sweeteners for pregnancy in moderation only.Avoid Saccharin.
sweeteners
Fiber 20-35g dietary fiber/day from a variety of food sources.
Protein +10g above RDA
Fat Percentage based on nutritional assessment and treatment goals
Sodium No benefit in alleviating gestational hypertension
Vitamins and minerals Ferrous iron-30mg/day, Folic acid – 400ug/day (to rule out Pernicious anemia
before supplementation), Calcium and magnesium requirement is increased. In
case of high risk pregnancies like low birth weight, Multiple Gestation and sub-
stance abuse, use of prenatal vitamins is necessary. Women with low gravid,Zinc
supplementation is essential.
Alcohol and caffeine Alcohol- not advisable. Caffeine- moderate usage is acceptable

References
1. Seshiah V, Balaji V, Balaji MS. Scope for prevention of diabetes ‘focus
intrauterinemilieu interieur’. J Assoc Physician India.2008;56:109-13
2. Morampudi S, Balasubramanian G, Gowda A, Zomorodi B and Patil AS,
TheChallenges and Recommendations for Gestational Diabetes Mellitus
Care in India: A Review. 2017, Front. Endocrinol. 8:56.
3. American Diabetes Association: Management of diabetes in pregnancy.
In Standards of Medical Care in Diabetes Diabetes Care, 2016; Volume
39 (Suppl.1): S94–S98.
4. American Diabetes Association: Nutrition Therapy Recommendations for
the Management of Adults with Diabetes, Diabetes Care,2013, Volume
36, S:3821-S3842
5. American Diabetes Association: Standards of medical care in diabetes:
2012. Diabetes Care, Volume 35 (suppl.1) S:11-S63
6. American Diabetes Association: Nutrition recommendation and interven-
tions for diabetes (Position Statement). Diabetes Care,2008, 31 (Supp
l): S61-S78,2008.

GCDC 2017