How changes in diet can manage gestational diabetes

Jenny Madrid, MPH, RD, CDCES, BC-ADM, diabetes care and education specialist, gave a presentation on nutrition therapy used to treat gestational diabetes at the Nurse Practitioners in Women’s Health (NPWH) 25th Annual Premier Women's Healthcare Conference in Houston, Texas, from September 29 to October 2.

In the presentation, Madrid discussed the key components of Medical Nutrition Therapy (MNT) for Gestational Diabetes Mellitus (GDM). In cases of diabetes in pregnancy, Madrid mentioned how women will have to change their lifestyle behavior for proper management, developing a plan with a health care provider for MNT.

Diets should be a minimum of 175 g of carbohydrates, 71 g of protein, and 28 g of fiber. Nutrient dense carbohydrates were the most vital part of the diet mentioned, as they control glucose, reduce free fatty acids and excess infant adiposity, improve insulin action, and can provide vascular benefits.

When designing an MNT plan, Madrid recommended focus on carbohydrate intake, quality of carbohydrates, nutrient dense carbohydrates, nutrition needed for pregnancy, and level of saturated fat consumed. Plans should suit the individual and be culturally appropriate.

As insulin resistance is part of pregnancy and increases over time, total insulin doses should as well. The increase should be linear and 5% a week for 36 weeks. Cases will vary between individual women, with some women modifying their diets while others rely on insulin, which is the primary way to treat diabetes during pregnancy.

Though GDM is common, Madrid noted how it can be confusing, scary, and anxiety producing, along with how changes in diets can be difficult with cases of nausea, vomiting, heartburn, and food cravings. There may also be challenges in food insecurity and ability to cook, along with cultural norms surrounding pregnancy. These are just some of the barriers which can prevent optimization of MNT.

To reach the appropriate level of carbs, Madrid recommended steps such as limiting consumption of sugar beverages, carb counting, analyzing food labels, and reviewing and addressing barriers. For nutrient dense carbs, Madrid suggested grains, oats, beans, vegetables, fruit, and dairy products.

Saturated fat increases insulin resistance, leading Madrid to push for healthy fats which are provided by seeds, nuts, avocados, olive oil, and sesame oil. When measuring grams, 30 grams for breakfast, 60 for lunch, and 60 for dinner is best.

Madrid encouraged attendees not to make nutrition harder than in needs to be, reminding them that no diet is perfect. Each MNT should be individualized, and even with a strong MNT, some women will still need insulin. Proper expectations should be set by both healthcare providers and patients.

In a diet, Madrid found that carbs should not be low, nor should fat be high saturated. According to Madrid, tools should be customized for target populations.

This article was published by our sister publication Contemporary OB/GYN.

Reference

Madrid J. Nutrition therapy for the treatment of gestational diabetes. Presented at: 25th Annual Premier Women's Healthcare Conference. Houston, Texas. September 29 to October 2, 2022.