Rajeswari P

In charge Dietician, Kauvery Hospital, Salem, India

 

Nutritional management of gestational diabetes mellitus

Background

Gestational diabetes is a type of diabetes that can develop during pregnancy in women who don’t already have diabetes. Every year, 2% to 10% of pregnancies are affected by gestational diabetes. Globally, Gestational Diabetes Mellitus is estimated to affect 13.9% of all pregnancies. Managing gestational diabetes will help make sure you have a healthy pregnancy and a healthy baby.

What does GDM mean in pregnancy?

Gestational diabetes mellitus (GDM) is a condition in which a hormone made by the placenta prevents the body from using insulin effectively. Glucose builds up in the blood instead of being absorbed by the cells.

Causes of GDM in pregnancy

Gestational diabetes occurs when the body can’t make enough insulin during pregnancy. Insulin is a hormone made by the pancreas that acts like a key to let blood sugar into the cells in the body for use as energy.

Can gestational diabetes be caused by stress?

Pregnant women with gestational diabetes mellitus are under more psychological stress than normal pregnant women; anxiety and depression are invariably associated with GDM

Common Symptoms

Some women may develop symptoms if their blood sugar level gets too high, they include:

  • Increased thirst
  • Dry mouth
  • Tiredness
  • Frequent urination

Risk factors for gestational diabetes include

Being overweight or obese, not being physical active, prediabetes, GDM during previous pregnancy, PCOS or PCOD, immediate family member with DM.

Complication that may affect your baby

Excessive birth weight, premature delivery, serious breathing difficulty, low blood sugar, obesity and type 2 diabetes in later life, stillbirth.

Complication that may affect the mother

High BP and pre-eclampsia, surgical delivery(C-Section), future DM.

Can GDM go away after delivery?

Unlike other types of diabetes. GDM usually goes away on its own and soon after delivery blood sugar levels returns to normal.

Glycemic Index Range

Zero to 55 Low glycemic index
56 to 69 Medium glycemic index
70+ High glycemic index

Signal System

Principle Green Yellow Red
Refined cereals and sugars low Moderate to high high
Saturated fat low low high
Total fat low Moderate high
Glycemic index low Moderate to high high
Fibre high low negligible
Cooking method Steaming, boiling, roasting, grilling, less fat in cooking Pan fried, sauteed           moderate amount of fat in cooking Deep fried, rich in fat and sugar, rich sauce, cream dressing
Processing Rich in fibre, Parboiled Low fibre, refined, milled Low fibre, ready to eat, highly processed
How much to eat Eat as permitted moderate Restricted

Glycemic Index food table

Low Glycemic Index Food Medium Glycemic Index Food High Glycemic Index Food
Cereal Grains and  Product

Barley (28)

Red rice (55)

Red rice flakes (55)

Black rice (42)

Brown rice (36)

Bajra/Pearl millet (54)

Barnyard millet (50)

Maize (52)

Finger millet (54)

Little millet (52)

Quinoa (53)

Ragi (54)

Wheat (54)

Oats (55)

 Jowar (62)

Kodo millet (57)

Rice noodles (65)

 Rice (75)

Sago (67)

Rice Flakes (80)

Puffed rice (90)
Pulses and Legumes

Bengal gram (28)

Black gram (43)

Black eyed beans (42)

Broad beans/Field beans/

Lima beans (40)

Chickpeas (33)

Green peas (22)

Green moong dhal (38)

Horse gram (51)

Red kidney beans (24)

Red lentil (21)

Yellow moong dhal (29)

Split red gram (8)

Soya bean (20)

 Cow peas (61)
Vegetables

Brinjal/Egg plant (10)

Beans (20)

Bitter gourd (18)

Bottle gourd (15)

Broad beans (40)

Cauliflower (10)

Cabbage (10)

Carrot (16)

Capsicum (15)

Cluster Beans (27)

Cucumber (15)

Chow chow (50)

Raw mango (51)

Drumstick (0)

Garlic (10)

Ginger (10)

Ivygourd/Littlegourd (15)

Kohl Rabi (20)

Laddies finger (20)

Mushroom (15)

Onion (10)

Palmyra Root (35)

Tomato (15)

Banana flower (5)

Broccoli (15)

Yam (51)

Banana stem (5)

 Ash gourd/Winter melon (65

Beetroot (61)

Corn (56)

Raw banana (55)

Sweet potato (54)

Taro root (58)

 Potato (77)

Pumpkin (77)

Tapioca root (70)
Leafy Vegetables

Green leafy (0 to 2)

Mint (29)

Curry leaves (10)

Coriander leaves (33)

Fenugreek leaves
Fruits

Amla (40)

Apple (38)

Avocado (15)

Custard Apple (54)

Gooseberry (15)

Blackcurrant (15)

Guava (12)

Kiwi (52)

Lemon (20)

Lichi (50)

Lime (10)

Mulberry (25)

Orange (52)

Passion fruit (30)

Peach (42)

Pears (38)

Plums (39)

Pomegranate (53)

Sapota (37)

Strawberry (41)

Wood Apple (55)

 Banana (56)

Figs (61)

Grapes (59)

Jackfruit (60)

Mango (56)

Muskmelon (65)

Papaya (58)

Pineapple (66)

Raisins (64)

 Dates (70)

Watermelon (80)
Sugars

Palm Jaggery (41)

 Honey (64)

White Sugar (65)

Brown Sugar (65)

 Jaggery (84)

Fat and Cholesterol in Food

Low Fat and Cholesterol Food Medium Fat and Cholesterol Food High Fat and Cholesterol Food
Nuts and Oil Seeds

Almond

Coconut water

Chia seeds

Flax seeds/Lin seeds

Pumpkin seeds

Basil seeds(soaked)

Walnut

 Coconut

Cashew nut

Ground nut

Pistachio
Fish and Other Sea Foods

Barracuda

Malabar Trevelly

Salmon fish

Shark

Seer

 Catfish

Tuna

Tilapia

Eel

 Crab

Anchovies

Shrimp

Sardines

Pomfret
Meat and Poultry

Egg Hen

Egg Duck

Chicken

 Goat meat

Beef

Pork
Milk And Milk Products

Buttermilk

Skimmed milk

Soya milk

 Cheese

Curd

Milk (cow’s)

Goat milk

Paneer
Fat And Edible Oil

Rice bran oil

Corn oil

Peanut oil

Gingelly oil

Olive oil

 Butter

Ghee (cow)

Coconut oil

Palm oil

Case Presentation

A primi mother of 36 weeks + 2 days with GDM admitted for labour, perceives foetal movements well, bowel and bladder habits normal.

Past History: Not a known case of DM/HTN/TB/BA

Marital history: Married for 1 year; NCM

Obstetric history: 1st Pregnancy: Present pregnancy

Menstrual History

Regular cycles 3/30 days; normal flow.

Medical History: Conceived after Ovulation Induction, cervical circlage done at 16 weeks followed by Arabin pessary insertion.

She was admitted with Dengue at 22 weeks.

She had 2 episodes of generalized seizures at 24 weeks and was treated at Dharmapuri GH, and started on Tab. Levigant 500 mg BD. She was diagnosed with gestational diabetes mellitus. Diabetologist’s opinion was obtained and started on 4 IU Insulin injections, 2 doses of Inj. Betamethasone 12 mg given, Inj. MgSO4 IV in 100ml NS give. After her condition was stable, she got discharged from the hospital. Follow-up care was at Kauvery Hospital, Salem.

GDM was confirmed, and she started to take regular medicine and diet as per instruction. Initially she took Injection Levemir Flex Pen 4 unit and Tablet Glycomet SR 500 mg after food. In between sugar level was elevated, that time insulin was increased to 7 unit. After that strict GDM diet advice followed, and maintained the sugar level, and insulin dose was reduced to previous levels. Cervical stitch was removed at 36 weeks.

On Examination at admission

Patient is conscious, comfortable, afebrile.

Vitals: BP, 110/70 mmHg; PR, 80/min; RR, 20/min; SpO2, 96% in room air.

Systemic Examination: CVS, S1S2(+); RS, BAE (+); P/A, Uterus – TS; Cephalic, 3-4/40″/10′; FHS (+); P/V, Cervix; 3 cm dilated; PPVx – 3 station.

Delivery Notes

With good uterine contraction, patient was put in position, parts painted and draped. Bladder care given. RMLE (Right Medio Lateral Epistomy) given. Baby delivered as LOA (Left occiput anterior), cord clamped and cut, placenta and membranes delivered in toto, episiotomy sutured in layers with 2-0 vicryl, rapide.

Baby details

B: Boy baby

A: 8/10 9/10

B: 26.11.22 at 1.11PM

Y: 3.38 Kg

Sample meal plan planned for the mother with Gestational Diabetes

Early morning (6.30 to 7.00 am)

Start the day with a 250 ml glass of milk (without sugar). If you prefer a flavoured one, you can add cardamom, cinnamon or kesar.

You can also have dry carbs like whole grain rusk or digestive biscuits (sugar free) limit it to just one piece.

Consume soaked almond 4 to 5 will provide protein and omega 3 for a good head start.

Breakfast (8.30 to 9.00 am)

Millet based food -2 no(or) cooked food 200 g

Dhal or sambar + curry leaves chutney -100 ml

Mid morning (11.00 am)

Fruit (Pear, Guava, musambi, kiwi, pomegranate) -100 g

Lemon juice salt and sugar – 200 ml

Lunch (12.00 to 1.00 pm)

Brown rice 3 tablespoon + 2 plain chapati (or) Plain chapathi – 3

Dal/sambar/rasam/Buttermilk – 200 ml (each 50 ml)

(or)

Fish curry/Rasam-150ml

Evening (4.00 pm)

Milk-250 ml

Whole wheat bread -2 slice

Late evening (6.00 pm)

Sundal – 50 g

Pre -Dinner(7.30 pm)

Veg Soup – 200 ml

Dinner (8.30 pm)

Plain Chapathi – 2 no’s(or) Millet based idly – 3no’s

Palak panner/Sambar/mixed vegetable curry-100ml

Bed time (one to one and a half after dinner)

Milk – 250 ml

It is important to eat a healthy diet or follow a meal plan for the entire pregnancy to improve health and to help ensure a healthy pregnancy. Changes may be needed to be made to the diet or meal plan to keep glucose levels in the healthy range.

Conclusion

Course in Hospital

A Primi mother at 36 weeks + 2 days with GDM got admitted with pain abdomen, patient spontaneously progressed, and delivered a boy baby on 26.11.22 at 04.45 pm. The postnatal period was uneventful. so considered fit for discharge.

There are no guarantees when it comes to preventing gestational diabetes-but the healthier habits one can adopt before pregnancy, the better. If one has had gestational diabetes, healthy choices may also reduce the risk of having GDM again in future pregnancies or developing type 2 diabetes in the future.

  • Eat healthy foods.
  • Keep active.
  • Start pregnancy at a healthy weight.
  • Don’t gain more weight than recommended.

 

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