Diabetes which occurs for the first time during pregnancy is termed as Gestational Diabetes Mellitus (GDM). Lifestyle modification is an essential component in management of GDM. It is important to follow a healthy diet during pregnancy if one has GDM. Indeed dietary modifications have been shown to lower the risk for GDM. The diet plan should therefore provide adequate calorie intake to promote fetal/neonatal and maternal health, achieve glycemic goals, and promote appropriate gestational weight. The American Diabetes Association recommends that pregnant women should consume at least 175 g of carbohydrate, a minimum of 70 g of protein, and 28 g of fiber (1). In India carbohydrate intake is generally much higher than in other countries. Therefore, a dietitian’s role is very crucial in planning a proper well-balanced diet. It is very important to monitor carbohydrate consumption especially the type, amount and frequency of consumption of carbohydrates. This would help in a way to manage the blood glucose levels of the person. It is recommended to maintain a food diary for this purpose.
What is Carbohydrate counting?
This is a meal planning tool which helps in managing blood sugars. The amount of carbohydrates in foods is measured in grams. One has to measure the amount of carbohydrate present in food and add to calculate the total carbohydrate found in a meal. One should choose healthy carbohydrate such as whole grains, fruits and vegetables and avoid refined carbohydrates like white rice, white bread, added sugar, sweets etc.
What is a healthy plate?
The concept of healthy plate helps to control the portion sizes. Half of the plate should be filled with non starchy vegetables and leafy vegetables of different colours. A quarter of the plate is to be filled with protein such as whole pulses and legumes, milk and milk products, lean meats like poultry and fish. The last quarter of the plate is reserved for whole grains such as brown rice, whole wheat bread or chapatti etc.
GENERAL PRINCIPLES OF DIET FOR WOMEN WITH GDM
Foods to include
- Consistent and balanced meal and snack: four meal patterns and balanced meals are always recommended. Keep a healthy plate in mind while planning a meal and a snack. Choose from low glycemic index foods. Choose complex carbohydrate and combine with protein and fiber while planning a meal or a snack.
- Include more proteins: Protein helps in muscle repair and building. It gives a feeling of satiety when eaten with carbohydrates. Choose vegetable protein such as milk and milk product, whole pulses or legumes, or if non-vegetarian foods, lean parts of chicken, fish is taken.
- Add fiber with each meal: Fiber reduces the rapid absorption of glucose into the blood and controls the spike in blood sugar levels. eat plenty of colored vegetables and green leafy vegetables with each and every meal
- Ensure adequate hydration: Drink plenty of fluids and keep hydrated. Drink lots of fillers in between such as buttermilk, lemon juice without sugar, vegetable salads, soups as it controls the portion size for the next meal and also prevents hypoglycemia
Foods to avoid if one has GDM
- Sweets and Sugar: Some women develop craving for sugars and tend to add sugars, indulge in cakes and pastries, and fruits such as mango, pineapple etc. Instead, they can include fruits like apple, guava, pear, nuts, berries, milk products like paneer and cheese.
- Avoid drinks with added sugar: One should avoid proprietary drinks, healthy mixes. Fruit juices with sugar should be avoided and if possible, avoid fruit juice altogether. Whole fruit can be consumed instead.
- Reduce carbohydrates (carbs) but don’t stop(carbs) completely: It is not recommended that carbohydrates be avoided completely. A minimum amount of carbohydrates is essential for the body, to avoid ketone build-up. Fad diets such as “keto diets” should generally be avoided, especially during pregnancy.
- Avoid extra snacks and calories: Unnecessary snacking will only increase the amount of calories that are being consumed, and could lead to high blood sugars. Eating balanced meal is therefore very essential.
- Vitamin B12: It is necessary to include enough vitamin B12 in the diet to ensure a healthy baby. Green leafy vegetables can provide enough Vitamin B12. Please ensure you take these every day.
- A study conducted at Madras Diabetes Research Foundation showed that higher consumption of whole grains, dairy products and dietary fibre was associated with better neonatal outcomes. .(2)
OTHER CONSIDERATIONS FOR GDM
Exercise has been proven to be beneficial in improving pregnancy outcomes in women with GDM. But women tend to avoid exercise due to uncertain risk. It is recommended that women with GDM should do both aerobic and resistance exercise at a moderate intensity, a minimum of three times a week for 30-60 min each time under adequate supervision of a professional (3). The INDIAB study is one of the largest studies conducted in India by MDRF.
Findings from INDIAB study on physical activity of adults in India revealed that nearly half the population in 4 regions of India (Tamil Nadu, Maharashtra, Jharkand and Chandigarh), i.e, 392 million individuals were inactive (4). Another study conducted at MDRF among pregnant women with GDM showed that sedentary behavior (less physical activity) was associated with 4 times higher risk of poor neonatal outcomes, whereas recreational walking (moderate physical activity?) decreased the risk of poor outcomes by 70% (5).
Self-Monitoring of Blood Glucose
Self-monitoring of blood glucose (SMBG) is often recommended as a part of GDM management. It helps in insulin dosage adjustment and prevents the adverse outcomes of pregnancy. The first step towards a successful SMBG during pregnancy is patient education and an understanding of the importance of SMBG to reducing complications during and after pregnancy. GDM mothers should be taught on all aspects of meter use and its correlation with insulin dosage adjustment.
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- American Diabetes Association, ‘Management of Diabetes in Pregnancy: Standards of Medical Care in Diabetes—2020.’ Diabetes Care 2020 Jan; 43(Supplement 1): S183-S192..
- Ranjit Mohan Anjana, Parthasarathy Vijayalakshmi, Balaji Bhavadharini, Rajagopal Gayathri, Nagarajan Lakshmipriya, SubashchandraboseUthra, Ranjit Unnikrishnan, Ram Uma, Viswanathan Mohan, Vasudevan Sudha (2019).’Association of whole grains, dairy and dietary fibre with neonatal outcomes in women with gestational diabetes mellitus: The WINGS project (WINGS – 12)’. Journal of Diabetology. Vol.10:127-133.
- . Padayachee, C., & Coombes, J. S. (2015). Exercise guidelines for gestational diabetes mellitus. World journal of diabetes, 6(8), 1033–1044. https://doi.org/10.4239/wjd.v6.i8.1033
- Anjana, R.M., Pradeepa, R., Das, A.K. et al. Physical activity and inactivity patterns in India – results from the ICMR-INDIAB study (Phase-1) [ICMR-INDIAB-5]. Int J Behav Nutr Phys Act 11, 26 (2014).
- Anjana RM, Sudha V, Lakshmipriya N, Anitha C, Unnikrishnan R, Bhavadharini B, Mahalakshmi MM, Maheswari K, Kayal A, Ram U, Ranjani H, Ninov L, Deepa M, Pradeepa R, Pastakia SD, Malanda B, Belton A, Mohan V. Physical activity patterns and gestational diabetes outcomes – The wings project. Diabetes Res Clin Pract. 2016 Jun;116:253-62. doi: 10.1016/j.diabres.2016.04.041. Epub 2016 Apr 29. PMID: 27321343.