Your Eating Plan Is Important

At 30 years old, Lisa Schooner wasn't concerned about developing diabetes any time soon. There was no family history, she didn't smoke, she had no chronic illnesses that weakened her immune system, her cholesterol and blood pressure were normal, and, even at 200 pounds, she still managed to eat relatively healthfully.
Barbara L. Vergetis Lundin

When Schooner learned she was pregnant, she read voraciously to learn everything she could about the right foods to eat and all the best things to do for the baby growing inside her. She read about the risks of developing gestational diabetes and the complications it could pose to a developing baby, but, again she wasn't too concerned. Her older sister had had three children and never developed gestational diabetes.

The luck of the draw
Unfortunately, Schooner wasn't so lucky. She became one of about 135,000 cases of gestational diabetes in the United States every year. Doctors aren't sure exactly why some women develop gestational diabetes and others don't, but there are some ideas.

According to the American Diabetes Association (ADA), the placenta supports the baby as it grows and supplies hormones that help the baby develop. These hormones are part of the problem. They block the action of the mother's insulin in her body producing a condition called insulin resistance in which it is difficult for the mother's body to use insulin. An expectant mother with this condition could need up to three times as much insulin.

Schooner was diagnosed by a routine fasting blood glucose test called a Glucose Tolerance Test. The test revealed that her blood glucose levels were 164 after three hours, above the normal 140 mg/dl for pregnant women. Fasting sugar levels in someone without diabetes are generally between 70 to 110 mg/dl.

Concerns for Mom and Baby
Gestational diabetes affects the mother in late pregnancy, after the baby's body has been formed, but while the baby is busy growing. Because of this, gestational diabetes does not cause the kinds of birth defects sometimes seen in babies whose mothers had diabetes before pregnancy, according to the ADA. But Schooner knew she still had cause to be concerned.

Untreated or poorly-controlled gestational diabetes can hurt a baby. The extra blood glucose of a mother with diabetes goes through the placenta, giving the baby high blood glucose levels. This causes the baby's pancreas to make extra insulin to get rid of the blood glucose. According to ADA, since the baby is getting more energy than it needs to grow and develop, the extra energy is stored as fat that can lead to a "fat" baby. This condition is called macrosomia, which can cause damage to a baby's shoulders during birth. Because of the extra insulin made by the baby's pancreas, newborns may have very low blood glucose levels at birth and are at higher risk for breathing problems, as well as obesity and type 2 diabetes later in life.

After giving birth, women with gestational diabetes have a 5 to 10 percent chance of developing type 2 diabetes right away. If they don't, there is a 20 to 50 percent chance they will develop diabetes in the next five to 10 years.

Taking care of Mom and Baby
Because gestational diabetes can hurt Mom and Baby, treatment must be started quickly. The main goal of treatment is to keep blood glucose levels equal to those of pregnant women who don't have gestational diabetes. Treatment for gestational diabetes includes special meal plans, scheduled exercise, blood glucose testing and, often, insulin injections.

According to the ADA, losing even a few pounds postpartum can lower the risk of developing type 2 diabetes. However, while you are pregnant is not the time to worry about this or start dieting.

Instead, exercise regularly to help the body burn extra glucose, and make healthy food choices by eating a variety of foods including fresh fruits and vegetables, limiting fat intake to 30 percent or less of daily calories as advised by ADA, and watching portion sizes.

Learn to recognize the difference between good, complex (whole grain, all natural, high fiber) carbohydrates and bad, or refined, (highly processed, sugar sweetened) carbohydrates. It is important during this time that complex carbohydrates not be limited.

Karmeen Kulkarni, MS, a registered dietician and co-author of the American Diabetes Association's Complete Guide to Carb Counting, encourages eating three meals a day and keeping carbohydrate counts consistent at each meal.

During pregnancy, counting carbohydrates can be more art than science, so it can be difficult to predict exactly how many complex carbohydrates an expectant mom with gestational diabetes should consume.

"Two-thousand calories for the day can be broken down in different ways for grams of carbs, protein and fat. It will depend on what percentage of carbohydrate, protein and fat a person with diabetes and the registered dietician mutually agree upon. And, therefore, it cannot be calculated generically," says Kulkarni.

She also suggests using a blood glucose meter to monitor blood glucose levels: fasting blood glucose in the morning upon waking, before lunch, two hours after lunch, before dinner, and two hours after dinner. Write all of the results down every day, as well as the foods consumed and amount of insulin taken. This information will be critical for meetings with your diabetic educator and endocrinologist.

As always, check with your doctor regarding any changes you would like to make to your eating plan.

Staying on track with healthy eating as part of your gestational diabetes treatment plan will only improve your chances of a healthy pregnancy and baby, and may help your baby avoid future health issues.


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