Diabetes in Pregnancy

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Diabetes in Pregnancy
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Preconceptional Counseling

• Getting the right information before becoming
  pregnant is very important for the woman with
  type 1 or type 2 diabetes who is of childbearing
  age.

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Preconceptional Counseling

• Achieving excellent blood sugar control with
  near-normal glycosylated hemoglobin can decrease
  the risk of problems for the baby

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Preconceptional Counseling

• Check blood pressure
• Have a dilated eye exam by an eye specialist who
  knows about diabetic eye disease
• Exam for heart and peripheral vascular disease
• Neurological exam

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Preconceptional Counseling

• Lab Exams
• A1C
• Protein tests for kidney function
• Thyroid tests
• Other tests as necessary

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Preconceptional Counseling

• Taking Folic Acid before you become pregnant can
  help prevent birth defects!

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Preconceptional Counseling

• Confirm pregnancy as soon as possible after
  conception and seek care immediately!

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Gestational Diabetes

• Gestational Diabetes is diabetes that happens
  during pregnancy, but goes away after the baby is
  born.

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Risk Factors for GDM

• If you are a woman who
• Has had a baby who weighed 9 lbs. or more
• Had gestational diabetes in earlier pregnancies
• Is overweight
• Has a family history of diabetes

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Screening for GDM

• Should occur between 24 and 28 weeks of pregnancy
• You will drink 50 grams of sugar solution and
  your blood sugar will be checked 1 hour later
• If the blood sugar is 140 mg/dl or higher,
  further testing is required

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Diagnosing GDM

• Requires an Oral Glucose Tolerance Test where you
  will be asked to drink a sugar solution
• Your blood glucose is checked each hour
• If 2 blood sugars are high, then you have
  Gestational Diabetes.

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Treatment for GDM

• The primary treatment is nutrition/diet
• Home blood glucose monitoring is recommended
• If blood sugar levels remain high, insulin shots
  may be needed.

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Blood Glucose Guidelines during pregnancy

• During Pregnancy, normal blood sugars run between
  60-120 mg/dl.
• Fasting Plasma Glucose less than or equal to 105
  mg/dl and whole blood glucose less than or equal
  to 95 mg/dl.
• 2 hours after eating less than or equal to 130
  mg/dl plasma glucose and whole blood glucose less
  than or equal to 120 mg/dl.

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Nutrition Guidelines for GDM

• Adjustment of carbohydrate intake to achieve
  improved blood glucose control
• Blood glucose monitoring and diet go hand in
  hand!
• Keep all appointments with your
  dietitian/certified diabetes educator.

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Goals of Nutrition Therapy in GDM

• Achieve and maintain normal blood sugars.
• Consume adequate calories to promote appropriate
  gestational weight gain and avoid maternal
  ketosis
• Consume food providing nutrients necessary for
  your health and your babys health

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Goals of Nutrition Therapy in GDM

• Decrease pregnancy related discomforts/complicatio
  ns such as hypoglycemia, nausea, vomiting,
  constipation, heartburn, etc.
• Discuss the benefits of breastfeeding
• Discuss the risks of developing type 2 diabetes
  and how to prevent development of diabetes.

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Nutrient Recommendations for GDM

• Sufficient calories to promote adequate weight
  gain and avoid ketones in the urine.
• Never eat less than 1800 calories per day so your
  baby continues to get the nutrients he/she needs!

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Nutrient Recommendations for GDM

• Carbohydrate is based on effect of intake on your
  blood glucose levels

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Nutrient Recommendations for GDM

• Carbohydrate should be distributed throughout the
  day with frequent feedings, and smaller portions.

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Nutrient Recommendations for GDM

• Limit the use of sucrose (sugar) and other
  caloric sweeteners. Include these based on
  ability to maintain blood glucose goals,
  nutritional adequacy of diet and contribution to
  total meal plan.

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Nutrition Recommendations for GDM

• Minimum of 60 grams of protein per day.

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Nutrition Recommendations for GDM

• Limit saturated fat.

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Nutrition Recommendations for GDM

• Sodium is not usually restricted.

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Nutrition Recommendations for GDM

• Fiber may be increased for relief of constipation.

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Nutrition Recommendations for GDM

• Non-nutritive sweeteners are generally safe in
  pregnancy. Moderation is advised.

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Nutrition Recommendations for GDM

• Only take vitamin and mineral supplementation if
  your doctor or health care provider recommends
  that you do so. However, most physicians
  recommend a prenatal vitamin.
• Supplement iron at 12 weeks.

Prenatal Vitamins
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Nutrition Recommendations for GDM

• Avoid Alcohol!

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Nutrition Recommendations for GDM

• Limit caffeine to less than 300 mg per day.
• For example, avoid colas, coffee, chocolate.

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Monitoring

• Blood glucose monitoring can help you better
  manage your diabetes and keep your blood sugar
  levels normal.
• Urine Ketone Monitoring can help you know if you
  are eating enough.

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Blood Glucose Monitoring

• Daily self monitoring of blood glucose is
  extremely important!!
• A blood glucose log book helps evaluate the CHO
  effect of meals and snacks.
• It also helps decide what changes may be needed
  in the diet.

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Urine Ketone Monitoring

• When you arent getting enough food to meet your
  needs and your babys needs, fat breaks down into
  acids or ketones.
• Check ketones each morning
• Check ketones if sick or unable to eat

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Complications of GDM Mom

• High Blood Pressure
• Increased need for a C-Section
• Increased risk of getting type 2 diabetes later
  in life

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Complications of GDM Baby

• Low Blood Sugar
• Jaundice
• Low Calcium
• BIG BABY!

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After the baby is born

• How are you going to feed your baby?
• Breastmilk
• Formula

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After the baby is born

• Have Moms blood sugar levels checked at 6-12
  weeks postpartum.
• If Moms blood sugar levels are back to normal,
  continue to check blood sugars yearly.

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After the baby is born

• Assess lifestyle behaviors to decrease the
  chances of getting diabetes in the future through
  healthy eating, weight control and routine
  activity.

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After baby is born

• Educate families about babys chances of getting
  diabetes in the future. Reducing the risk of
  obesity and diabetes is important for offspring
  of Moms who have had GDM.

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A healthy, happy pregnancy

• Keeping blood sugar levels in control through
  diet or medication (insulin) is the key to a
  healthy, happy pregnancy and a healthy baby!