How to manage the gestational diabetes: Diet. Exercise. Treatment
Once diagnosed with gestational diabetes, the mother should monitor her blood glucose, to detect and prevent the glucose concentrations which are high enough to put at risk herself and the baby.
The blood glucose level can be kept at normal values, through a specific diet.
The Gestational Diabetes diet aims to provide adequate nutrition for both the mother and the child. The daily diet plan should include sufficient calories for appropriate maternal weight gain, while keeping the glycemia in normal range. The recommended daily caloric intake is 30 kcal/kg/day for women with a normal weight and for women with BMI > 30 kg/m2, the intake is 25 kcal/kg/day. Calories should be carefully planned in order to avoid ketosis, because ketonemia in mothers with diabetes during pregnancy has been associated with lower IQ levels and impaired psychomotor development in their babies.
The daily meal plan should include 3 small to moderate meals and 3 snacks. Each group of nutrients should be present in the nutritional plan:
- Carbohydrates should be distributed throughout the day. It is recommended to limit carbohydrates to 40% of the total daily caloric intake. Further limitation of carbohydrates at breakfast to 33% may be required to meet the desired postprandial glucose goals because insulin resistance is greatest in the morning. Restricting the carbohydrates consumption decreases the need for insulin therapy.
The healthier carbs are those provided by high-fiber, whole-grain cereals and vegetables (grains, beans, starchy vegetables). The future mothers with gestational diabetes can have each day 6 or more servings of these carbs: one serving means 1 slice bread, 1 ounce of cereals, 1/2 cup cooked rice or pasta. Other options- 1 serving of: starchy vegetables, such as potato, sweet potato, corn, legumes such as baked beans, red kidney beans and lentils, fruits, milk, yogurt and calcium fortified soy milk.
The daily intake of vegetables should be of 3 – 5 servings a day (example: 1 cup leafy, green vegetables; 1 cup cooked or chopped raw leafy vegetables; 3/4 cup vegetable juice etc).
Fruits: 2 – 4 servings a day: 1small to medium whole fruit; 1/2 cup chopped, frozen, cooked, or canned fruit; or 3/4 cup fruit juice.
Carbohydrates to be avoided are: soft drinks, fruit juices, lollies, cakes and biscuits.
- Proteins do not directly affect the blood glucose levels, but they are really important for the growth and maintenance of the body. Protein foods include lean meat, skinless chicken, fish, eggs, reduced fat cheese. Dairies and legumes are mixed sources of proteins and carbohydrates.
Mothers with GDM should eat 2 – 3 servings of proteins a day: one serving equals 2-3 oz. cooked meat, poultry, or fish; 1/2 cup cooked beans; 1 egg; or 2 tablespoons peanut butter. The meat should be fat free and it is recommended to bake it, roast it, broil, grill, or boil it instead of frying.
- Fats – Even if it is recommended to avoid fats as much as possible, the fats and oils from should not be removed completely from the diet, because they are an excellent source of long-term energy and the baby needs them for his brain development.
Scientists have proven that the mothers who exercise present an improved glycemic control. Women who follow the GDM diet and exercise, have a significant decrease in glycated hemoglobin levels and in both fasting and 1-hour plasma glucose levels during a glucose challenge test compared to the diet-alone group. Any obstetrician recommends for women with GDM to combine the diet with a program of moderate exercises.
Severe forms of gestational diabetes cannot be controlled with diet and exercise, so the insulin therapy is recommended. Using insulin as instructed by the physician decreases the rate of macrosomia, the risk of fetal metabolic complications, shoulder dystocia and respiratory complications. The optimal dose of insulin is determined taking into account each patient’s requirements.
Gestational Diabetes Mellitus, Tracy L. Setji, MD; Ann J. Brown, MD; and Mark N. Feinglos, MD, CM, Clinical Diabetes,2005 ;
The effects of carbohydrate restriction in patients with diet-controlled gestational diabetes, Major CA, Henry MJ, De Veciana M, Morgan MA, 1998;