Nutritional Management

Nutritional management strategies include the use of optimizing diet and exercise habits, developing individualized plans to meet these goals, careful maternal monitoring including blood glucose, and following through with this plan postpartum.

Components of nutritional management:

Estimating Caloric Needs

It’s important for pregnant mothers to get enough to eat, but it’s also important that they don’t overdo it. While there is no research to support the caloric needs during pregnancy, the information given below gives some good guidelines for meeting the nutritional needs of non-pregnant women. Those would be women of normal weight, meaning a body mass index, or BMI, of between 18.5-24.9 need 30-34 calories per kilogram body weight.

It should be noted that some obese women will not gain much weight in spite of a good nutritional intake, and fetal growth is usually normal.

EER = 354 – (6.91 X A) + PA  x (9.36 x Wt + 726 x Ht)

1st trimester  = Adult EER + 0

2nd trimester = Adult EER + 340

3rd trimester = Adult EER + 452

Obese Women = Adult EER using ABW + 150-300

  Physical Activity (PA) Coefficients:  Sedentary 1.0;  Low activity 1.1.2;

  Active 1.27; Very Active 1.45

  A= age, Wt = kg, Ht = meters, ABW = adjusted body weight

  To determine ABW [ (Actual wt – IBW) x 0.25}] + IBW

Macronutrients should be divided as in a normal diet. This means protein intake should comprise no more than 20% of calories, carbohydrates 40-45%, and fat about 35-40%.

Protein does not significantly affect blood-glucose excursions. And note that no more than 7-10% of total fat intake should come from saturated and trans fats.

 

Carbohydrates: 40-45% Protein: 20% Fat: 35-40% Case Study: mother’s caloric requirements are 2000 kcal …  200-225 grams carbohydrates 100 grams protein 78-89 grams fat

 

Distribution of Carbohydrates

Decreased carbohydrates at breakfast affect the production of hormones in the morning that promote insulin resistance, which in turn affects blood glucose levels.

In addition to controlling the amount of carbohydrates, their type and distribution also influence blood glucose levels. By decreasing processed carbohydrates and increasing high-fiber foods a woman can improve her glycemic control.

The amount of carbohydrates consumed (to allow for fetal growth and brain development) should be at least 175 gm/day.

Carbohydrates are distributed throughout the day into 3 meals & 2-4 snacks

Carbohydrate intake is limited to 15-30 grams at breakfast

A consistent carbohydrate intake at meals & snacks will result in better glucose control & facilitate insulin adjustments

 

The Diet Plan

Whole grain breads & cereals, vegetables, fruits, & high-fiber foods Limited intake of simple sugars High-fiber carbohydrate foods that do not greatly raise BG levels •Unsaturated fats •Three regular meals & snacks daily

 

It may be useful for patients to learn how to count carbohydrates. It will make more sense to the pregnant mother with gestational diabetes if they follow the dietary guidelines as laid out by the Academy of Nutrition and Dietetics. These suggest eating whole grains and higher fiber foods (around 28g per day), limiting the intake of simple sugars, eating higher carbohydrate foods that do not raise blood glucose levels by a significant amount, and eating three regular meals not high in saturated fats.