Pregnancy & Diabetes

The nutritional needs of the pregnant woman with diabetes are similar to the pregnant woman who does not have diabetes. Taking into account weight, weight gain, appetite and blood glucose results, a dietitian can develop individualized meal guidelines with you. The goal of these meal planning guidelines is to help you maintain healthy blood glucose levels while providing adequate nutrition to both you and your baby. Pregnant women are encouraged to eat smaller and more frequent meals. This usually means 3 meals and 3 snacks for the woman with diabetes. The amount of food varies from woman to woman depending on her rate of weight gain. Pregnancy will affect your insulin treatment plan. During the months of pregnancy, your body's need for insulin will go up. This is especially true during the last three months of pregnancy. The need for more insulin is caused by hormones the placenta makes. The placenta makes hormones that help the baby grow. At the same time, these hormones block the action of the mother's insulin. As a result, your insulin needs will increase. A focus on the carbohydrate content of each meal and snack is important because of the effect it has on blood glucose. Timing of meals and snacks that contain carbohydrate is important to reduce the risk of hypoglycemia, which is a common problem in the first trimester. Your dietitian will keep track of your weight gain. If you start pregnancy at a normal weight, expect to add between 25 to 35 pounds. Women who start pregnancy too thin need to gain more. If you are obese at the start of your pregnancy, work with your dietitian to limit your weight gain to about 15-25 pounds. Some important facts:
  • Your calorie requirement will increase after the first trimester by about 300 calories a day over what you needed before you became pregnant.
  • You will need about 30 grams more of protein a day -- that's about the equivalent of one serving of meat or fish.
  • To maintain normal blood glucose levels, you'll have to be sure to get enough carbohydrates in the morning.
  • Snacks will be important, and should probably include a complex carbohydrate (such as whole-grain bread) and a protein (such as meat or cheese).
  • It's more important than ever not to skip meals or snacks, since that can lower blood glucose to dangerous levels. If you have trouble eating three large meals a day, split your daily food into six or eight smaller ones, regularly spaced and carefully planned.
  • Eat more starches such as bread, cereal, and starchy vegetables. Aim for six servings a day or more. For example, have cold cereal with nonfat milk or a bagel with a teaspoon of jelly for breakfast. Another starch-adding strategy is to add cooked black beans, corn or garbanzo beans to salads or casseroles.
  • Eat five fruits and vegetables every day. Have a piece of fruit or two as a snack, or add vegetables to chili, stir-fried dishes or stews. You can also pack raw vegetables for lunch or snacks.
  • Eat sugars and sweets in moderation. Include your favorite sweets in your diet once or twice a week at most. Split a dessert to satisfy your sweet tooth while reducing the sugar, fat and calories.

Healthy Snacks

  • 4 to 6 whole wheat crackers with a little low-fat cheese (<1 oz) or low-fat cottage cheese (1/4 cup)
  • 4 to 5 whole wheat crackers with a little peanut butter (< 2 tablespoons)
  • 3 cups of popcorn, air-popped, low-fat or no butter
  • 12 to 18 baked potato chips
  • one slice of whole wheat toast with melted low-fat cheese (< 1 oz)
  • 2 rice cakes
  • 1/2 whole wheat pita
  • 1/2 whole wheat English muffin
  • 1/2 cup fresh fruit
  • blended drink of 1/2 cup of low-fat milk and 1/4 cup of fresh fruit
  • 1/4 cup of regular pudding, or 1/2 cup of sugar-free pudding
  • 1/2 cup of regular or no-added-sugar ice cream
  • 1 cup of low-fat yogurt
  • 1/2 cup frozen yogurt, no sugar added
  • 1/4 cup sherbet or sorbet
  • 1 granola bar (Belly Bar, Larabar, Gnu Bar)
  • 3 cups of raw vegetables such as fresh broccoli, carrots, celery, or zucchini with 2 tablespoons of dip

Morning Sickness

How common is it? Up to 70 percent of expectant mothers have nausea, sometimes with vomiting, early in pregnancy. Queasiness may be most noticeable in the morning, but it can occur at any time. Even if you aren't nauseated, you may develop aversions to certain foods, such as coffee and meat, partly because of their odors. As long as you continue to eat a healthy diet and get all the nutrients you need, food aversions aren't a cause for concern. What causes it? The exact cause is unclear, but pregnancy hormones that relax the stomach may play a role. How long does it last? It generally improves by the 13th or 14th week of pregnancy, but some women continue to feel queasy from time to time well into the second trimester. How can you manage it? Munch a few crackers before getting up in the morning.   Eat several small meals a day so that your stomach is never empty. Avoid anything that causes nausea. Drink plenty of liquids, especially if you've been vomiting. Try crushed ice, fruit juice or frozen ice pops if water upsets your stomach.                                                                                                Try wearing a motion sickness band, which may relieve nausea by pressing on an acupressure point inside the wrist. Try ginger, which has proved effective in combating morning sickness. Some ways to consume the spice include ginger soda or tea, gingersnaps or ginger in capsule form.


How common is it? Constipation affects at least half of all pregnant women. What causes it? An increase in the hormone progesterone, which slows the digestive process, is partly to blame. In addition, your colon absorbs more water, which tends to make stools harder and bowel movements more difficult. How long does it last? Infrequent, difficult-to-pass stool can be a problem any time during pregnancy, but it may be worst in the first 13 to 14 weeks. How can you manage it?
  • Try to eat on a regular schedule.
  • Drink plenty of liquids — at least eight to 10 glasses a day.
  • Get some exercise every day.
  • Eat high-fiber fruits, vegetables and grains such as whole wheat and oatmeal.
  • Try fiber supplements, such as psyllium powder, Metamucil, Konsyl, Fiberall or Citrucel. Don't take any other laxative without discussing it with your doctor.


How common is it? Almost all women report increased fatigue and need for sleep in the first trimester. What causes it? To carry oxygen and nutrients to the fetus, your body produces extra blood and your heart works harder and faster. These early pregnancy changes make enormous demands on your circulatory system. During this time, you're also producing higher levels of progesterone, which tends to make you sleepy. These may be factors producing the fatigue of early pregnancy. How long does it last? Fatigue usually subsides by the second trimester, but may return in the third trimester when carrying the extra weight of the baby may be tiring. How can you manage it?
  • Rest. Take naps during the day or after work. If you need to go to bed at 7 p.m. to feel rested, do so. This is a symptom that has no solution other than sleep.
  • Avoid taking on extra responsibilities. Cut down on volunteer commitments and social events if they're wearing you out.
  • Ask for the support you need. Get your partner or children to help out as much as possible.
  • Exercise regularly. Moderate exercise, such as walking for 30 minutes a day, can help you feel more alert and energetic.
  • Eat foods rich in iron and protein. Skimping on these nutrients can aggravate your fatigue. Foods rich in both iron and protein include red meat, seafood, poultry and eggs. Other good sources of iron include whole-grain or iron-fortified cereals, breads and pastas. ‘
  • Avoid stimulants. Avoid caffeine, which may be harmful in high doses. Any product marketed for relieving fatigue and enhancing wakefulness is unsafe in pregnancy.


How common is it? More than half of all pregnant women get heartburn, an uncomfortable sensation caused by the backward flow of stomach acids into the esophagus, the tube that carries food from your mouth to your stomach. What causes it? Constipation, gas and heartburn are all effects of sluggish digestion, induced by pregnancy hormones. As pregnancy progresses, a second factor — the expansion of the uterus, which can push your stomach out of its normal position — also may contribute to heartburn. How long does it last? Heartburn can be a problem at any time during pregnancy, but may be most noticeable during the third trimester. How can you manage it?
  • Eat several small meals instead of two or three large ones. No matter how small the meal, eat slowly.
  • Avoid common heartburn triggers, such as fried foods, alcohol, chocolate, peppermint, garlic and onion.
  • Drink plenty of fluids, especially water.
  • Avoid coffee. Both regular and decaffeinated coffee may worsen heartburn.
  • Stay up for two to three hours after your evening meal. If your heartburn comes on when you recline, raise the head of your bed four to six inches.
  • Talk to your physician about using antacids or other medications that relieve heartburn. These products can be used safely in pregnancy, but your physician should know which ones you take and how often you take them.
Why is tight control of your blood sugar important? Blood sugar control is crucial not only to your health but to the health of your unborn child. If during the first six to eight weeks of your baby's development — when your baby's heart, lungs, kidneys and brain are being formed — your blood sugar is too high, your baby is at increased risk of birth defects. You could also have a miscarriage. A high level of acid in your blood (diabetic ketoacidosis) also can cause miscarriage. Later in pregnancy, uncontrolled blood sugar can lead to premature birth or stillbirth. Excess blood sugar can cause your baby to grow larger than normal and make delivery more complicated. And in contrast to your own condition, your baby may be born with low blood sugar. Another possible complication is a yellowish skin color (jaundice) from a buildup of old blood cells that aren't being cleared away fast enough by your baby's liver. Fortunately, these conditions are easily treatable. Your own risks from uncontrolled blood sugar during pregnancy include high blood pressure and a worsening of pre-existing diabetic complications, especially eye disease (retinopathy). First trimester During the first 10 to 12 weeks of your pregnancy, you'll meet with your obstetrician regularly, perhaps every one to two weeks. This is the time that your baby's organs are developing, so you want your blood sugar to be as close to normal as possible to prevent birth defects. Frequent blood sugar monitoring can help you do this. Because your body's need for insulin may drop slightly during this time, it's important to be alert to signs of low blood sugar. Second Trimester If you take insulin, expect your insulin requirements to rise gradually to about week 20 and then accelerate dramatically. Hormones made by the placenta to help your baby grow block the effect of your insulin, so you'll need significantly more to compensate. At this stage of your pregnancy, it's also important to see an eye specialist. Damage to the small blood vessels in your eyes can progress during pregnancy. Third trimester During the final three months of your pregnancy, your doctor will monitor you carefully. He or she will check for complications that can occur during the late stage of any pregnancy, such as high blood pressure, swollen ankles from fluid buildup and kidney problems. Your doctor may also recommend that you have your eyes examined again to check for eye damage. If you're on insulin, you'll need to take a few precautio:
  • Be aware of the risk of hypoglycemia, and take a high-sugar snack along with you.
  • It may be necessary to eat small snacks between meals.
  • If you exercise right after a meal, have a snack after the exercise.
  • If you exercise two hours or more after a meal, eat the snack before the exercise.
  • One serving of fruit will maintain blood sugar for most short-term activities (about 30 minutes).
  • One serving of fruit plus a serving of starch will be enough for activities that last longer (an hour or more).
  • Don't inject insulin into a part of the body that will be exercised; for example, if you'll be walking, avoid injecting into your leg.
How will my diabetes affect my baby? A common problem among diabetic women who are pregnant is a condition called "macrosomia," which means "large body." In other words, babies of diabetic women are apt to be considerably larger than others. The reason for this lies in the interchange of the mother's blood with the fetus. If the mother's blood has too much glucose, the baby's pancreas will sense that and produce more insulin in an attempt to use the glucose. The baby then converts the extra glucose to fat. The combination of high blood glucose levels from the mother and high insulin levels in the baby results in large deposits of fat, causing the baby to grow excessively large. Sometimes the baby gets too big to be delivered vaginally, and a cesarean delivery becomes necessary. Your doctor will be closely watching the size of your baby and planning the safest delivery for you and the baby. Sometimes the baby of a diabetic mother will have very low blood sugar immediately after delivery. This occurs if the mother's blood glucose levels have been high throughout the pregnancy, and especially if they were high in the 24 hours prior to delivery, causing the baby to have a high level of insulin in its circulation. After delivery the baby continues to have a high insulin level, but it no longer has the high level of sugar from its mother, so its glucose level drops quickly. Your baby's levels will be checked after birth and it may be necessary to give the baby glucose intravenously. Infants of mothers with diabetes may also have other chemical imbalances such as low serum calcium or magnesium levels. Your baby should receive special examinations and tests right after birth.


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