By Dr Seema Khanna
During pregnancy, women can become more resistant to insulin and hence need to have foods with a low glycemic index, which represents the relative risk in the blood glucose levels two hours after consuming that food.
The hypoglycemia adverse pregnancy outcome trial recently defined Gestational Diabetes Mellitus (GDM) as having one positive glucose reading after a 75 gm glucose challenge. Glucose intolerance may be associated with obesity.
Women with recurrent preterm births are often treated with 17 alpha hydroxeprogesterone caproate, which increases insulin resistance and the rate of GDM. Women diagnosed with GDM are at risk of future type-2 diabetes mellitus and cardiovascular disease. Foetuses of mothers with typer-1 diabetes mellitus are at risk for cardiac defects such as transportation of great vessels and double outlet of the right ventricle.
Foetuses are at risk of hypoglycemia at the time of birth and may have lower levels of potassium, zinc, manganese and chromium. During pregnancy, extra glucose from the mother crosses the foetal placenta and the foetus’s pancreas responds by releasing extra insulin to cope with excess glucose. The excess glucose is converted to fat, which results in macrosomnia (foetus too large) for normal birth, resulting in a cesarean delivery.
To reduce the coincidence of GDM, include providing women with supplemental probiotics before and during pregnancy. Probiotics appear to alter maternal microbiota, change the immune response and support better glucose tolerance and lower body weight. After the delivery, nearly 90 per cent of women with GDM become normoglycemic but are at increased risk of developing GDM earlier in subsequent pregnancies. These women have 40-60 per cent chances of developing diabetes in next five to 10 years. Lifestyle modification aimed at reducing or preventing weight gain and increasing physical activities after pregnancy may reduce the risk of subsequent diabetes.
Women during this period, should eat healthy foods whenever they feel hungry.
Here are some tips to follow
· Increase your protein intake to at least 70-80 gm for an average weighed individual. Increase the consumption of A-quality proteins rather than B quality proteins. A-quality protein implies egg, chicken fish, milk, paneer (cottage cheese).
· Intake of fruits should be around 150-200 gm with a combination of watery and less sweetened fruits.
· Include raw veggies in the form of salads.
· Keep your meals short and frequent to avoid overeating.
· Include a combination of healthy fat and protein as they slow the absorption of carbohydrate in your blood.
· Eat walnuts and almonds.
· Consume whole grains like bran or wheat mixed with black gram in the ration 4:1. You can also include ragi, quinoa and eggs or cottage cheese in the diet.
· Include vegetable oils like soybean, mustard or olive oil, but in restricted amounts of approximately 20-25 gm per day. This is visible fat. Other than this, invisible fat can also be consumed but the combination of both fats should not exceed 35 gm per day.
Diet precautions for gestational diabetes
· It is important to restrict the salt intake to 5-6 gm per day.
· Avoid cookies, biscuits and namkeens.
· Tea or coffee is safe during GDM but should be without sugar and in restricted amounts. These beverages should be avoided before and after meals and in cases where gastritis is persisting.
· 400 gm of folic acid should be consumed per day. This can be achieved by consuming green leafy vegetables and egg yolk.
· Sugar and artificial sweeteners should be avoided.
· The in-between snacks should consist of protein and fiber, avoiding visible fat.
Diet patterns can be adjusted with body types and other problems (if any). You can consult your nutritionist for any assistance in a critical scenario.
(The writer is a consultant nutritionist.)