Even for nondiabetic women maintaining glycemic control during pregrancy may be challenging. Due to hormonal changes, pregnancy increases insulin resistance and therefore the secretion of insulin. Especially obese women, who have developed insulin resistance before gestation, are in high risk of diabetes. As a result 7 percent of nondibetic women may develop gestational diabetes and require treatment during pregnancy. In addition glycemic control is necessary in order to avoid diabetes type 2 after pregnancy and for the children during adulthood.
Health risks during pregnancy.
Uncontrolled diabetes may lead to increased rate of:
- Birth defects & fetal deaths.
- Macrosomia (babies with abnormally large bodies)
- Need of cesarean section.
- Infants with respiratory dysfunctions.
- Infants with metabolic problems (hypoglycemia, jaundice, hypocalcemia)
Family history of diabetes.
Women who have family history of diabetes and are obese or have given birth to an infant over 4.5 kg are in high risk of gestational diabetes. Obese women, even with mild hyperglycemia may occur severe effects on the developing fetus and may lead to pregnancy complications. Therefore the gynecologist has to check all women for gestational diabetes between 24 and 28 weeks of gestation and prior or as soon as after conception in high risk women.
Women with type 1 or 2 diabetes.
Women with diabetes, who are planning to be pregnant, must achieve glycemic control and receive intensive care before conception. The first trimester of pregnancy is very critical to reduce the risk and to avoid spontaneous abortion. The glycemic control is very important during the 2nd and 3rd trimester of pregnancy, in order to minimize the risk of complications like macrosomin and morbidity in infants.
Nutritional treatment during pregnancy.
- Nutrient requirements are similar for women with or without diabetes.
- Overweight or obese woman may need to adjust their energy intakes and reduce them about 10 to 30 percent less than their energy needs. Further reduction is not suggested, because adequate energy intake is needed for normal fetal development.
- Adherence is very important, so the nutritional modifications for achieving glycemic control should be based on woman’s habits.
- Carbohydrates must be restricted to 40 – 50 percent of total energy intake. The total amount of carbohydrates should be ingested evenly throughout the day.
- At least 5 meals should be consumed every day, in order to avoid hypoglycemia. During pregnancy glucose is continuously supplied to the fetus, so it’s very likely hypoglycemia to occur.
- After the 1st trimester, regular aerobic activity is often recommended for better glycemic control.