medigraphic.com
Federación Mexicana de Ginecología y Obstetricia, A.C.

2006, Number 04

<< Back Next >>

Ginecol Obstet Mex 2006; 74 (04)

Physiopathology and nutritional care of patients with gestational diabetes

Perichart PO, Alonso VP, Ortega GC

Language: Spanish
References: 26
Page: 218-223
PDF size: 332.57 Kb.


ABSTRACT

Maternal risks include the development of diabetes after pregnancy, as well as having an infant with macrosomia, with elevated risk of developing obesity and diabetes in childhood. The main goal of treatment is to maintain an adequate glycemic control during pregnancy and guarantee the recommended weight gain. The first treatment strategy is diet therapy, however, some women need insulin therapy to achieve adequate glycemic control. The risk of diabetic fetopathy decreases when maintaining postprandial glycemic levels within normal ranges. These levels are directly associated with the amount and type of carbohydrates consumed during meals. So, nutrition therapy should be an integral part of gestational diabetes treatment. Nutrition therapy includes a complete nutrition assessment, an individual food plan that meets energy and protein requirements for pregnancy (in obese women never lesser than 1,700 kcal/day), in which lipids and carbohydrates may provide lesser than 40 and between 40 and 45% of total energy intake. Education about food groups that provide carbohydrates, portion sizes and how to achieve an equal carbohydrate distribution throughout the day should be provided. Orientation about eating healthy fats and increasing the consumption of high-fiber foods should also be included. This approach requires that treatment of women with gestational diabetes should be provided by a multidisciplinary team, including nutrition specialists.


REFERENCES

  1. Jovanovic L, Pettitt D. Gestational diabetes mellitus. JAMA 2001;286:2516-8.

  2. Forsbach G, Cantu-Diaz C, Vazquez-Lara J. Gestational diabetes mellitus and glucose intolerance in a Mexican population. Int J Gynaecol Obstet 1997;59:229-32.

  3. Forsbach G, Contreras-Soto J, Fong G, Flores G, Moreno O. Prevalence of gestational diabetes and macrosomic new borns in a Mexican population. Diabetes Care 1988;11:235-8.

  4. Anuario Estadístico del Instituto Nacional de Perinatología. México, 2003.

  5. Catalana PM, Kirwan JP, Haugl-de Mouzon S, King J. Gestational diabetes and insulin resistance: role in short and long term implications for mother and fetus. J Nutr 2003;133:1647S-83S.

  6. Butte N. Carbohydrate and lipid metabolism in pregnancy: normal compared with gestational diabetes mellitus. Am J Clin Nutr 2000;71:1256S-61S.

  7. American Diabetes Association. Position statement: gestational diabetes mellitus. Diabetes Care 2003;26(Suppl 1):S103-S5.

  8. Wijendran V, Bendel RB, Couch SC, Philipson EH, et al. Maternal plasma phospholipids polyunsaturated fatty acids in pregnancy with and without gestational diabetes mellitus: relations with maternal factors. Am J Clin Nutr 1999;70:53-61.

  9. Jovanovic L. American Diabetes Association’s Fourth International Workshop Conference on Gestational Diabetes Mellitus: Summary and Discussion. Diabetes Care 1998;21:B131-B7.

  10. Carr SR. Screening for gestational diabetes mellitus. Diabetes Care 1998;21(Suppl 2):B14-B18.

  11. Frenkel W, Metzger B, Phelps P, Dooley S, Belton A. Gestational diabetes mellitus: heterogenicity of maternal age, weight, insulin secretion, HLA antigens, and islet cell antibodies: the impact of maternal metabolism on pancreatic beta cell and somatic development in the offspring. Diabetes 1985;34(Suppl 2):1-7.

  12. Gunderson EP. Intensive nutrition therapy for gestational diabetes. Diabetes Care 1997;20:221-6.

  13. Pastors JG, Warshaw H, Daly A, Franz M, Kulkarni K. The evidence for the effectiveness of medical nutrition therapy in diabetes management. Diabetes Care 2002;25:608-13.

  14. Committee on Nutritional Status During Pregnancy and Lactation. Food and Nutrition Board. Institute of Medicine. Nutrition during pregnancy. Part I: weight gain, Part II: nutrient supplements. Washington, DC: National Academy Press, 1990.

  15. Guest editorial: nutrition management of the obese gestational diabetic pregnant woman. J Am Coll Nutr 1992;11:246-50.

  16. Major CA, Henry MJ, De Veciana M, Morgan MA. The effects of carbohydrate restriction in patients with diet controlled gestational diabetes. Obstet Gynecol 1998;91:600-4.

  17. Knopp RH, Magee MS, Raisys V, Benedetti T, Bonet B. Hypocaloric diets and ketogenesis in the management of obese gestational diabetic women. J Am Coll Nutr 1991;10:649-67.

  18. Homko CJ, Sivan E, Reece EA. The impact of self-monitoring of blood glucose on self-efficacy and pregnancy outcomes in women with diet-controlled gestational diabetes. Diabetes Educ 2002;28:435-43.

  19. Medical nutrition therapy: nutrition practice guidelines for gestational diabetes. American Dietetic Association, 2001.

  20. Jovanovic L. Medical nutrition therapy in pregnant women with pregestational diabetes mellitus. J Matern Fetal Med 2000;9:21-28.

  21. Jovanovic-Peterson L. Medical management of pregnancy complicated by diabetes. 2nd ed. Alexandria: American Diabetes Association, 1995.

  22. Dornhorst A, Frost G. The principles of dietary management of gestational diabetes: reflection on current evidence. J Hum Nutr Diet 2002;15:145-56.

  23. Ilic S, Jovanovic L, Pettitt DJ. Comparison of the effect of saturated and monounsaturated fat on postprandial plasma glucose and insulin concentration in women with gestational diabetes mellitus. Am J Perinatol 1999;16:489-95.

  24. Bo S, Menato G, Lezo A, Signorile A, BardelliC. Dietary fat and gestational hyperglycaemia. Diabetologia 2001;44:972-8.

  25. Glueck C, Goldenberg N, Streicher P, Wang P. The contentious nature of gestational diabetes: diet, insulin, glyburide and metformin. Expert Opin Pharmacother 2002;3:1557-68.

  26. Jovanovic L. Role of diet and insulin treatment of diabetes in pregnancy. Clin Obstet Gynecol 2000;43:46-55.




2020     |     www.medigraphic.com