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NAVIGATING DIABETES IN PREGNANCY

NAVIGATING DIABETES IN PREGNANCY

The diagnosis of Diabetes in pregnancy can be both frightening and overwhelming for the pregnant mum.  So, let’s break it down into an easier to understand format.


Diagnosing Gestational Diabetes Mellitus

According to the IADPSG (International Association of the Diabetes and Pregnancy Study Groups) guidelines, used by SEMDSA (Society for Endocrinology, Metabolism & Diabetes of SA, 2017), Gestational Diabetes Mellitus (GDM) refers to the onset of a new and mild high glucose state, with blood glucose (BG) before meals between 5.1 – 6.9 and 2-hours post-meal levels of 8.9 – 11mmol/l.  This typically presents at any time during pregnancy but is not present at the time of conception.  All women should be screened during pregnancy, especially at 24-28 weeks gestation (Diabetes Care, 2010).  If you are a high-risk individual (family history of DM or overweight at onset of pregnancy), then you should also undergo a fasting BG and Glycosylated Haemoglobin (HbA1c) at your first ante-natal visit with your gynae.  This should be retested at 24 weeks if the initial screening is normal. GDM is associated with an increased risk and prevalence of hypertension (high blood pressure) in the mother, large babies at birth, as well as potential long-term metabolic effects on the babies, but with careful attention, this condition can be well managed.  


Pregnancies while living as a Diabetic do carry some risk, but with careful planning, consistent glucose testing and tightly managed care during pregnancy, Diabetic mums can produce very healthy babies at birth. So. let’s look at DM in more detail.  It’s defined as a metabolic disorder, characterized by persistent hyperglycaemia (high blood glucose levels), usually diagnosed at a young age. This condition refers to a problem in the way the body regulates and uses glucose (a sugar) as a fuel.  It can result in disturbances in carbohydrate, protein and fat metabolism, resulting from defects in insulin secretion, insulin action or both.  DM usually presents with acute symptoms such as increased thirst, increased urination, changes in vision, fatigue, blurred vision, slow healing wounds and weight loss, in a young child. Insulin dosing is necessary for survival. Persistent high glucose levels over time can eventually result in disorders of the circulatory, nervous and immune systems, if left untreated or managed poorly.  


In people with symptoms, DM is diagnosed when any 1 single test result presents as follows:

  • Random glucose is ≥ 11.1 mmol/L
  • Fasting glucose is ≥ 7.0 mmol/L
  • HbA1c is ≥ 6.5%


In people without symptoms, DM may be diagnosed when any one of the above tests are repeated on separate days, within a 2-week interval. HbA1c of 6.5% is recommended as the cut-off point for diagnosing diabetes. 


Optimizing Diabetes Control During Pregnancy

Optimizing lifestyle in terms of diet and exercise is usually successful in achieving optimal glucose readings in the majority of women with DM and GDM. Fasting BG targets of 4.0 – 5.5 and 2-hour post-meal levels of <6.7mmol/l, should ensure safe, optimal glucose control during this period.


Optimal treatment of women with diabetes in pregnancy can only be achieved with the combined contribution of a multidisciplinary team, including the gynae, a diabetes nurse educator (DNE) and registered dietitian (RD). This team can ensure a well-managed pregnancy, providing you with education and tools to assist you in your pregnant Diabetic journey.  Management can be divided into the following major categories: 

  • Education with regard to Diabetes in pregnancy, including monitoring of blood glucose levels, benefits and risks of medication and a discussion of glucose targets
  • Attention to lifestyle, specifically related to food-intake, weight control and regular exercise 
  • Medication dosages, if required
  • Regular monitoring of the unborn baby
  • Mode and timing of delivery
  • Proposed follow-up plan for the mom, after delivery


How Should your Diet Change

Ideally, patients should be referred to a dietitian at first diagnosis, for a detailed dietary assessment, including a weight history and eating pattern.  Further visits should be encouraged thereafter, for reinforcement, monitoring and evaluation of outcomes.


A variety of different dietary approaches have been shown to be effective in diabetes management, including low fat diets, Low GI diets, Mediterranean diets etc.  Current evidence does not suggest that any one diet  offers greater weight loss benefits or improved glucose control, but a balanced approach, guided by a RD can ensure optimal nutrition benefits to both the unborn baby and to the pregnant mum. 

The objectives of medical nutrition therapy (MNT) include:

  • To promote the enjoyment of a variety of nutrient dense foods in appropriate portion sizes 
  • Achieve individual glucose, blood pressure and cholesterol goals
  • Achieve and maintain body weight goals
  • Delay or prevent complications of diabetes


Carbohydrates/ starches from whole grains which have a low GI value.  These include Low GI bread, sweet potatoes (purple skin), oats porridge, basmati rice, corn on the cob etc.  Legumes, milk, plenty of vegetables and salads, as well as fresh fruit should be used instead of refined food sources with added sugar, fats and sodium.  Legumes provide a good source of fibre and plant protein and assist in optimising blood fat levels.  Low fat, unsweetened dairy products provide a useful intake of calcium, vitamin D and Magnesium.


 Monounsaturated fats from plant sources are preferred to saturated fats. Foods rich in long-chain omega-3 fatty acids, such as fatty fish, nuts and seeds is recommended to prevent cardiovascular disease.  Avo, olives, olive oil and soft, tub margarines are the preferred choices for meals. The intake of processed meats and fatty red meats should be limited, due to the salt and saturated fat content.


Honey, table sugar, sweetened beverages, sweets, chocolates and baked confectionary are discouraged as these enter the bloodstream too quickly, causing glucose levels to rise suddenly. 


Introducing FUTURELIFE® MOTHERS FOOD™ Shake

This is the amazing new product from FUTURELIFE®, scientifically developed for both pregnant and breastfeeding moms.  It’s high in fibre and protein and Low GI in formulation, available in both Vanilla and Chocolate flavours.  It can be enjoyed as a meal, a shake or a smoothie.


This new product contains Development 5™, a special combination of vitamins and minerals that supports mom and baby by providing 100% of mom’s vitamin and mineral requirements (NRVs) for folate, vitamin D, Zinc, Iron and vitamin B12.

  • Folate is essential for the normal development of the unborn baby and contributes to maternal tissue growth during pregnancy. 
  • Vitamin D and Zinc contributes to the maintenance of normal bones. 
  • Vitamin B12 contributes to normal blood formation and is necessary for normal neurological structure and function.


This product is excellent for immune support and helps to reduce fatigue.  It is Low GI, which gives sustained energy throughout the day, preventing less variability in glucose levels, and contributing to normal infant birth weight and steadier weight management in mums.  


The inclusion of choline in this product supports normal brain development for the baby, as research shows that this essential nutrient is often below ideal requirements in pregnant women.  Omega 3 is another constituent of this new product, supporting better skin health, reduced inflammation and protection against cardiac events.  Omega 3 is also very beneficial for the neurological development of brain tissue in the foetus. For more information on this unique new product, please visit www.futurelife.com 


So finally, living with Diabetes in pregnancy is certainly not something to shy away from. Pregnancy is a wonderful, special time, with lots to look forward to, and a healthy baby is the best gift at the end, if one is looking after your body and glucose levels as best as possible. 


REFERENCES

  1. SEMDSA Guidelines 2017
  2. Diabetessa.org.za
  3. https://www.cdc.gov/diabetes/basics/diabetes.html
  4. World Health Organization. Definition and diagnosis of diabetes mellitus and intermediate hyperglycaemia:http://whqlibdoc.who.int/publications/2006/9241594934_eng.pdf (accessed 21 January 2016)
  5. World Health Organization. Diagnostic Criteria and Classification of Hyperglycaemia First Detected in Pregnancy. Geneva: World Health Organization; 2013.
  6. American Diabetes Association. Nutrition therapy recommendations for the management of adults with diabetes. Diabetes Care. 2014;37(1):3821–42.http://care.diabetesjournals.org/content/37/Supplement_1/S120.full.pdf+htmlAccessed 10 March, 2017
  7. American Diabetes Association. Nutrition therapy recommendations for the management of adults with diabetes. Diabetes Care. 2014;37(1):3821–42. http://care.diabetesjournals.org/content/37/Supplement_1/S120.full.pdf+html


BY: Julie Peacock   /   DATE: November 2023

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