General Health

How pivotal is nutrition in achieving normal pregnancy in GDM?

With the first confirmation of pregnancy, every mother-to-be develops a unique instinct to protect the little bundle of life which is growing inside her body. Mother takes the uttermost precaution and care during these miraculous 9 months. No matter how busy she is, her only focus always remains on her fetal baby. She lives with only one hope and wishes to have a healthy normal pregnancy and delivery with zero complications. In some cases, this desire does not come into reality and suddenly the mother gets diagnosed with a very common pregnancy complication which is gestational diabetes Mellitus (GDM).

GDM is a global health concern, and in India, the condition affects as many as 5 million women annually. Recent studies suggest that the incidence of GDM has increased in the past decade. GDM poses risks for both the mother and fetus. GDM is associated with an increased risk of obstetrical complications and adverse fetal outcomes. So prevention and preparation to manage GDM should start from the preconception period, especially in high-risk groups.

What is GDM?

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GDM is defined as any degree of glucose intolerance with onset or first recognition during pregnancy. It is characterized by impaired insulin secretion and action. It does not exclude the likelihood that unrecognized glucose intolerance may have preexisted or begun concurrently with the pregnancy. GDM is usually diagnosed at 24-28 weeks of pregnancy.  It is characterized by fasting hypoglycemia, postprandial hyperglycemia, carbohydrate intolerance, as well as insulin resistance with a compensatory increase in b -cell response and hyperinsulinemia. Insulin resistance usually begins in the second trimester and progresses throughout the remainder of the pregnancy due to an increase in placenta hormone secretion.

What is glucose intolerance? 

When carbohydrate foods are eaten, they are broken down by the body into glucose and released into the blood. When the glucose levels in the blood increase the body releases an increased amount of insulin. This insulin helps move the glucose out of the blood and into the body’s cells, which can be used for energy. With the hormone changes during pregnancy, sometimes insulin does not act as it should keep blood glucose levels in a normal range and they increase. If not treated, these high blood glucose levels in pregnancy can cause pregnancy complications.

Who are at GDM risk?

  • Older maternal age
  • Overweight or obesity
  • Short stature
  • Excessive central body fat deposition
  • Member of an ethnic/racial group with a high prevalence of diabetes
  • Having a family history of diabetes
  •  A history of poor pregnancy outcome
  • GDM in a previous pregnancy, preeclampsia, and hypertension in the current pregnancy

Consequences of GDM on mother 

  • Preeclampsia
  • Cesarean delivery
  • Antenatal depression addition
  • Increases the risk of having Type 2 diabetes within 5 to 10 years
  • Increases the risk of hypertension, dyslipidemia, and cardiovascular disease in the long term

Consequences of GDM on infant 

  • Macrosomia (birth weight of more than 4,000 g)
  • Large for gestational age
  • Premature birth
  • Birth injury
  • Shoulder dystocia
  • Stillbirth
  • Hypoglycemia
  • Hypocalcemia
  • Hyperbilirubinemia
  • Polycythemia
  • Respiratory distress syndrome
  • Increased risk of obesity, Type 2 diabetes, and cardiovascular diseases in later life

Nutritional management of GDM 

All pregnant women with GDM should get Medical Nutrition Therapy (MNT) as soon as the diagnosis is made. It is the first-line therapy in the treatment of women with GDM and has been shown to improve glycemic control.

Nutritional goals 

A carbohydrate-controlled balanced meal plan which promotes

  1. Optimal nutrition for maternal and fetal health
  2. Adequate energy for appropriate pregnancy weight gain
  3. Maintain maternal blood glucose concentrations, especially postprandial levels, within an acceptable range

It should start with an individualized nutrition assessment to allow an accurate appraisal of the nutritional status. BMI, pre-pregnancy weight and optimal weight gain during pregnancy should be well defined.

Select Carbohydrates Carefully

  • Carbohydrate foods are essential for a healthy diet for mother and baby
  • Once digested, they are broken down into glucose which goes into the bloodstream
  • The type, amount, and frequency of carbohydrate intake greatly influence blood sugar readings
  • Avoid eating large amounts of carbohydrate foods at one time as this can lead to high blood sugar levels
  • Spread carbohydrate foods throughout the day over 3 meals and 2 snacks
  • Choose complex carbohydrates like whole-grain cereals like oats, bajra, jowar, ragi, whole pulses, vegetables, and fruits with skins
  • Restrict simple carbohydrate foods like food with lots of added sugar or honey, or foods that are made from refined white flour

Understand Fat Intake 

  • Reduce saturated fat intake, foods like ghee, butter, coconut oil, palm oil, red meat, organ meat, and full cream milk.
  • Choose low-fat snacks like fresh fruit, salads, baked and steamed food items
  • Limit high-fat snacks such as cakes, biscuits, chocolates, pastries, samosas, pakoras, etc. Use lean meat in place of red meat

Protein 

  • Protein requirement in pregnancy is increased (an additional 23 g/day) to allow for fetal growth
  • Eat at least 3 servings of protein foods daily
  • Have foods like low-fat milk and milk products, egg, fish, chicken, pulses (dal) & nuts

Add fibre 

  • High fibre foods especially soluble fibre helps control blood sugar by delaying gastric emptying, retarding the entry of glucose into the bloodstream, and lessening the postprandial rise in blood sugar
  • The soluble fibre in flax seed, psyllium husk, oat bran, legumes (dried beans of all kinds, peas, and lentils), and pectin (from fruit, such as apples) forms in root vegetables (such as carrots)

Maintain healthy weight gain 

  • The amount of weight gain during pregnancy depends on pre-pregnancy weight
  • In the healthy weight range (BMI 19.8–26kg/m2), aim for a gain of 11.5–16kg weight gain
  • If underweight (BMI <19.8kg/m2) weight gain should be more than 12.5–18kg
  • If overweight (BMI 26–29kg/m2), limit weight gain to 7–11.5kg

Be aware of Low-Glycaemic Index Foods

  • The type and quality of carbohydrates is an important consideration in nutrition advice for people with diabetes, as not all carbohydrates have the same glycaemic response
  • The glycaemic index (GI) of foods is an important factor, as foods with a low GI reduce post-meal glycaemic excursions and flatten the glucose curve
  • Limit high-GI diets (>70) as they can increase postprandial glucose values
  • Eat low-GI diets to reduce haemoglobin A1C levels

Choose Non-Nutritive Sweeteners wisely 

  • Supportive studies are not available, to establish their safety and efficiency in GDM
  • Consult a doctor before planning to have any kind of artificial sweeter
  • Check and read food labels appropriately

Include Probiotics and prebiotics 

  • Improves digestion, metabolism of nutrients and helps in normal bowel movement
  • Promotes healthy gut health and immunity
  • Include foods like buttermilk, lassi, and curd in your daily diet

Healthy tips 

  • Identify the good eating habits and not-so-good eating habits in the current eating pattern
  • Understand the portion sizes for each food consumed
  • Don’t Follow any unauthentic fad diet and viral dietary tips
  • Eat diet as prescribed by the doctor
  • Drink adequate water throughout the day
  • Go for a 10-minute walk after meals
  • Be physically active to help lower blood glucose levels. Aim for 30-45 minutes of activity a day depending on doctors’ advice
  • Keep stress at bay, meditate, listen to music and read books
  • Relax and have good rest and healthy sleep daily
  • Maintain a food journal to refer to the same and add or delete foods that increase the blood sugar level
  • Keep a check on blood glucose regularly

Conclusion

GDM is one of the most common comorbidities of pregnancy. MNT, a healthy lifestyle and medication can maintain normal blood glucose levels and decrease maternal and fetal complications associated with GDM. With time-appropriate awareness and nutrition guidance during preconception, pregnancy and post-delivery to the GDM high-risk group, the possibility to attain a smooth 9-month maternity experience is attainable. Suitable medical support and guidance will make the GDM high-risk mothers well-fitted physically, mentally and emotionally to conquer GDM and associated complications. The depressed and pessimistic feelings of the mother-to-be should be replaced by hope and faith to provide a normal healthy life for her baby.

References

  1. JAMA Network Open. 2020;3(11):e2025074
  2. Nutrition & Food Science,2020;03:0034-6659. DOI 10.1108/NFS-03-2020-0095
  3. Diabetes Care Volume 41, July 2018
  4. Ann Nutr Metab 2020;76(suppl 3):17–29

Author

Aparna Das Parmar

Aparna Parmar has over 8.5 years of rich experience in the field of nutrition and healthcare and is currently a corporate nutritionist.

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