Pregnancy with diabetes: How to eat right

Pregnancy is a highly demanding period both physiologically and nutritionally. The mother’s diet and health during pregnancy has great influence on the foetus. Normalization of blood glucose levels during pregnancy is extremely important for women who have pre-existing diabetes (or) who develop Gestational Diabetes.

Medical Nutrition Therapy (MNT) is important not only to meet the increased nutrient needs of the mother and the developing foetus, but also to assist in optimizing blood glucose levels.

Increased demands of nutrients occur mainly in the third trimester as it is the period when the foetus achieves maximum growth.

Why are nutrient needs increased during pregnancy?
1.  To support the growth and development of the foetus.
2. To build up the mother’s tissues and fat stores.
3. To build up the baby’s stores of fat, iron and vitamin A.

Goals of medical nutrition therapy
1. To provide adequate nutrition for maternal and child health.
2. To provide adequate energy for appropriate weight gain.
3. To achieve the goal of maintaining optimal blood glucose levels.
4. To avoid hypoglycaemia and starvation ketosis.

Recommended weight gain during pregnancy

Weight gain during pregnancy varies with pre-pregnancy BMI.
Normal weight women 10-15 kg
Underweight women 12-18 kg
Obese women 6-11 kg

1.  Adequate energy intake for a desirable weight gain during pregnancy depends on pre-pregnancy BMI.
2. An additional 300 Kcals/day is recommended during II and III trimester.
3. A modest energy restriction in obese individuals (Not < 25Kcals/kg body wt/day) is recommended.

1. Requirements of protein during pregnancy are increased. 0.75 g/kg body weight + 10g/day.
2. Total protein intake should not be less than 60 g per day.
3. Rich sources of protein: Pulses, whole grams, milk and milk products, fish, egg, meat, nuts.

1. Fat intake should be < 30 % of total calories- SFA <10 %.
2. Avoid high fat foods.
3. Choose from poly and mono unsaturated fats. Avoid vanaspati, dalda and organ meat.
4. It may be necessary to supplement the diet with fish, green leafy vegetables, etc. which are good sources of omega-3 fatty acids.

Requirement of special nutrients
A pregnant woman requires more iron than a normal woman. She needs to maintain a daily intake of 38 mg of
iron throughout her child-bearing years. This amount not only replenishes her menstrual losses but also restores
her tissue reserves after pregnancy. The physician usually recommends intake of iron supplements in addition to
dietary sources to meet the iron requirement of pregnancy and for the development of foetal stores.
Sources: Cereals, especially bajra, ragi, pulses and green leafy vegetables.

Folate: 400 mg.
1. It is necessary to prevent some types of anaemia and to prevent fetal malformation.
2. Folic acid supplementation may be required to protect against megaloblastic anaemia.
Sources: Dark green leafy vegetables, oranges, Bananas, milk, mushrooms, beans and fortified cereals.

1. Daily requirement can be met from 3 or more servings of milk per day.
2. There is evidence that low calcium intake may be involved in development of high blood pressure in pregnancy.
Sources: Milk and milk products, dark green leafy vegetables.

Other vitamins and minerals that need special mention are Vitamin B6, A, C, D, E and K; zinc, copper, iodine, fluoride,
sodium, phosphorous and magnesium.

Please note that large doses of iron supplement can reduce zinc absorption.

1. Most women need 8-10 glasses of fluids per day during pregnancy.
2. In hot weather and in case of vomiting there can be dehydration if enough water is not consumed.

General problems during pregnancy
1. Nausea and vomiting
2. Morning sickness during the early month of pregnancy. This can be overcome by small, frequent meals.
3. Fairly dry and easily digested carbohydrate foods are more readily tolerated.
4. Liquids may best be taken between meals instead with food.

Fatty rich food, fried food, excessive seasoning, coffee in large amounts and strongly flavoured vegetables may be restricted in case of nausea, heart burn or gastric distress.

It could be caused by the physiological effects of pregnancy on gastric function, decreased physical activity and dietary changes.

What to do?
1. Increase fluid intake.
2. Natural laxative foods such as whole grains, dried fruits and other fruits, vegetables very rich in fibre should be included.
3. Fruits are better than fruit juices.
4. Laxatives should be avoided.
5. Regular habits of exercise and sleep are essential for proper elimination of wastes.

Guidelines for pregnancy with diabetes
Adequate calories and at least 60 g protein is necessary in the diet to be followed during pregnancy.

This has to be adequately supported with vitamin/ mineral supplements (especially iron, folic acid, and calcium).
1. The diet must include complex carbohydrates, low fat protein and low fat dairy products.
2. Small frequent feeds throughout the day (3 meals and 3-4 snacks) are better during pregnancy.
3. Regularity in meal times and insulin regimen should be stressed.
4. Avoid smoking and alcohol during pregnancy.
5. Monitoring blood glucose, HbA1c, lipids, blood pressure & integrate insulin with appropriate diet plan.
6. Weight gain should be monitored. The weight gain pattern would be similar to that of pregnant women without diabetes.
7. A regular daily walking regimen of 30 min/day should be followed.
8. Support and encouragement to patients and their relatives is also important.

Source: M. Malini. The author is Dietician, Department of Diet, M.V.Hospital for Diabetes & Prof. M.Viswanathan Diabetes Research Centre

Image: Getty Images