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Managing Gestational Diabetes (GDM) during Pregnancy

Most women get a glucose screening test during their prenatal visit between 24 and 28 weeks of pregnancy.1 This is done to see if the pregnant mother has Gestational Diabetes Mellitus (GDM). If your one of the lucky ones that has just left the OB office this week with a positive diagnosis for GDM, this article is for you. Here are some tips and guidelines that can help you gain control of your diabetes during pregnancy. This is not meant to replace your doctor’s recommendations, so be sure to check with your doctor before starting any intense exercise program or diet.

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What is Gestational Diabetes? 

pregnant mother has Gestational Diabetes Mellitus (GDM). If your one of the lucky ones that has just left the OB office this week with a positive diagnosis for GDM, this article is for you. Here are some tips and guidelines that can help you gain control of your diabetes during pregnancy. This is not meant to replace your doctor’s recommendations, so be sure to check with your doctor before starting any intense exercise program or diet. 

Gestational diabetes occurs in women who are pregnant and can be cause serious health risks for mother and infant. According to the American Diabetes Association, “Gestational diabetes mellitus (GDM) is defined as any degree of glucose intolerance with onset or first recognition during pregnancy. The definition applies whether insulin or only diet modification is used for treatment and whether or not the condition persists after pregnancy.” 

According to the American Diabetes Association, “Approximately 7% of all pregnancies are complicated by GDM, resulting in more than 200,000 cases annually.” This is a lot more common than some people think. According to research from the Evidence Analysis Library3, pregnant women are at more risks for GDM if they have any of the following factors: 

  • Excessive weight gain prior to pregnancy
  • Increase Saturated fat Intake
• Not exercising, “Regular physical activity during pregnancy reduces the risk of Gestational Diabetes.”

What are the risks to the mother and baby? 

Many women wonder and ask how their GDM can affect the infant. Here are symptoms and side effects for both mother and infant when having GDM.
According to the American Diabetes Association,4 when your baby has uncontrolled diabetes your baby can have some of the following symptoms: 

  • Macrosomia, or a “fat” baby- This could cause damage to the shoulders after birth.
  • Low blood sugars after birth

• Higher risk for breathing problems.
The department of Health and Human Services5, state that,” Women who have had gestational diabetes are at greater risk for developing type 2 diabetes during their lifetime.” They also mentioned additional risks for the baby:5 

  • Early/preterm birth
  • Jaunice (Yellowish color of the skin and white parts of the eye)
  • Breathing problems
  • Low levels of certain minerals in the blood
  • Later in life glucose intolerance and insulin resistance

 

How to treat Gestational Diabetes Mellitus (GDM)?
Luckily, most of the time, gestational diabetes goes away after the baby is born. Furthermore, with the right diet, taking certain medications, and maintaining a healthy weight, many of these risks can be reduced. Here are recommendations from the Evidence Analysis Library which has the most up to date reviews of the research.

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1. Calories: “Consume adequate calories to promote appropriate weight gain, with guidance from the Dietary Reference Intakes (DRI) for pregnant women. Research indicates that low or inadequate weight gain during pregnancy is associated with an increased risk of preterm delivery, regardless of pregnancy BMI levels.”6 

2. Macronutrients-Carbohydrates 

When controlling gestational diabetes, the carbohydrate intake count is essential for 

optimum results. To get a personalized carbohydrate count, meet with a dietitian. 

However, women should receive at least the Dietary Reference Intake(DRI) 

recommendations for adequate amounts of carbohydrates, protein, and fiber during 

pregnancy.5 “The DRI for all pregnant women, including those with GDM, recommends 

a minimum of 175g carbohydrate(CHO), a minimum of 71g protein (or 1.1g per kg per 

day protein) and 28g fiber.”6 

Types of Carbohydrates. 

Increase in the right types of carbohydrates and decrease in the not so desired carbohydrates can improve your diabetes and thus helping your infant. 

First, make sure you eat breakfast throughout the day. This is the most important meal of the day. Here are some examples of foods to increase and reduce in your diet: 

Increase 

  • Alfalfa Sprouts
  • Celery
  • Iceberg Lettuce
  • Zucchini
  • White Mushrooms
  • Radishes
  • Cucumbers
  • 100% stone-ground whole wheat
  • Oatmeal (rolled or steel-cut)
  • Sweet potato
  • Beans
  • Berries 

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High Carb Foods to Avoid:

  • White bread or bagel
  • Corn flakes, puffed
    rice, bran flakes,
    instant oatmeal
  • Short Grain white
    rice, rice pasta, macaroni and cheese from mix
  • Russet potato, pumpkin
  • Pretzels, rice cakes, popcorn, saltine crackers 
  • Fruit Juice
  • Limit sweets and Desserts
  • Don’t add honey, sugar or
  • Processed foods
  • AVOID any type of Alcohol during pregnancy!!!! Period.

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Pregnancy-Exercise

3.Physical Activity 

The EAL recommends moderate daily exercise for 30 minutes a day for those with GDM. “In addition to a healthy diet, exercise can help improve blood glucose control and achieve weight gain recommendations. Both aerobic exercise and non–weight-bearing exercise (e.g., stretching, swimming, yoga, etc.) have been shown to lower blood glucose levels in women with GDM. Lifestyle therapy for GDM results in lower birth weight and a lower incidence of large-for-gestational-age births and pre-eclampsia.”3 

 

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By Misty Kay, RDN, IBCLC

References 

1.Glucose Screening Tests During Pregnancy. US National Library of Medicine. https://medlineplus.gov/ency/article/007562.htm. Accessed on 9/28/18. 

2.American Diabetes Association. Gestational Diabetes Mellitus.
Diabetes Care 2003 Jan; 26(suppl 1): s103-s105.https://doi.org/10.2337/diacare.26.2007.S103. Accessed on 9/28/18.

3. Evidence Analysis Library. GDM: EXECUTIVE SUMMARY OF RECOMMENDATIONS (2008). https://www.andeal.org/topic.cfm?menu=5288&pcat=3719&cat=3731. Accessed on 9/28/18.

4. American Diabetes Association. What is Gestational Diabetes? http://www.diabetes.org/diabetes-basics/gestational/what-is-gestational- diabetes.html

5. Am I at risk for gestational diabetes? U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES NatioNal iNstitutes of HealtH Eunice Kennedy Shriver National Institute of Child Health and Human Development. June 2012 NIH Publication No. 12-4818

6. Glycemic Index and Diabetes. http://www.diabetes.org/food-and-fitness/food/what-can-i-eat/understanding-carbohydrates/glycemic-index- and-diabetes.html. Accessed on 9/29/18. 

Image 1- American Diabetes Association. Gestational Diabetes. http://www.diabetes.org/diabetes-basics/gestational/. Accessed on 9/29/18.

Image 2 & 3-Eenfeldt. Low-carb fruits and berries – the best and the worst (2018). https://www.dietdoctor.com/low-carb/fruitsGestational Diabetes

Image 4- Daily Health Post Editorial. 2018. 87 Low-Carb Vegetables That Will Make Weight Loss Easy. https://dailyhealthpost.com/low-carb- vegetables/. Accessed 9/29/18. 

Image 5-144 High Carb Foods to Avoid If You’re on a Diet. https://www.general-health-tips.com/144-high-carb-foods-to-avoid-if-youre-on-a- diet. Accessed on 9/29/18.

Image 6- What you need to know about exercise during pregnancy. 2017. https://www.nurturemamas.com/blog/what-you-need-to-know-about- exercise-during-pregnancy 

Kids & Fruit Juice Consumption Should My Kids Drink Fruit Juice?

Little asian boy drinking fresh orange juice.

Fruit juice consumption associated with childhood obesity has been debated among pediatricians and dietitians for many years. Although 100% fruit juice is sometimes promoted as a “health” food, it also may have side effects such as increased dental caries and/or obesity in children. This article’s goal is to guide you as you make the informed decision of consuming fruit juice for you and your family. 

What is 100% Fruit Juice? 

According to the Food and Drug Administration’s1 definition (Code: 21CFR101.30), fruit juice is defined as “juices directly expressed from a fruit or vegetable (i.e., not concentrated and reconstituted) shall be considered to be 100% juice and shall be declared as 100% juice.” When reading labels, make sure it states 100% fruit juice. 

 

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Guidelines for Giving Kids Fruit Juice 

The American Academy of Pediatrics (2) recently changed their policy recommendations for fruit juice consumptions for the first year of life stating, there is “no nutritional benefit to children under age 1 and should not be included in their diet according to a new policy statement.” Here are additional recommendations from the American Academy of Pediatrics: 

  • “Intake of juice should be limited to, at most, 4 ounces daily for toddlers age 1-3. For children age 4-6, fruit juice should be restricted to 4 to 6 ounces daily; and for children ages 7-18, juice intake should be limited to 8 ounces or 1 cup of the recommended 2 to 2 1⁄2 cups of fruit servings per day.
  • Toddlers should not be given juice from bottles or easily transportable “sippy cups” that allows them to consume juice easily throughout the day. The excessive exposure of the teeth to carbohydrates can lead to tooth decay, as well. Toddlers should not be given juice at bedtime.
  • Children should be encouraged to eat whole fruits and be educated about the benefits of the fruit as compared with juice, which lacks dietary fiber and may contribute to excessive weight gain.
  • Human milk or infant formula is sufficient for infants, and low-fat/nonfat milk and water are sufficient for older children.
  • Consumption of unpasteurized juice products should be strongly discouraged for children of all ages.”
  • Children who take specific forms of medication should not be given grapefruit juice, which can interfere with the medication’s effectiveness. In addition, fruit juice is not appropriate in the treatment of dehydration or management of diarrhea.”

The Good Qualities of 100% Fruit Juice 

Fruit juice is widely promoted as a health food among consumers. A systematic review conducted by the Evidence Analysis Library (EAL)1 discovered the benefits of fruit juice. They found that children who consume 100% fruit juice consume more calcium and potassium then those who do not.Although fruit juice does contain more calcium and potassium; however, these minerals and vitamins can also be found in fresh fruits or vegetables and/or a multivitamin. 

Additional benefits as found by, Nicklas, Kleinman, and Neil,2 discovered that daily fruit recommendations, with four ounces of serving of fruit juice providing half of daily fruit recommendations. 

The Risks of 100% Fruit Juice Consumption 

Although, fruit juice has benefits, it also comes with risks. When I see my pediatric dentist for my children, he usually inquiries me about my children’s fruit juice and crackers consumption. He does think because of the link between fruit juice and increased cavities. Fruit juice is a delicious beverage that many families consume today. However, it comes with a price. Research indicates that it causes obesity, digestive problems and tooth decay.(4) 

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Juice Alternatives 

Furthermore, Zimmer et al.3 of the school of dentistry in Germany and United Kingdom evaluated the influence of various acidic beverages on tooth erosion. They researched non- alcoholic beverages like sprite, apple juice, and orange juice and found them five times more erosion than Coca Cola light.(5) 

Although fruit juice does contain vitamins, I would recommend getting the vitamins from fresh fruits and vegetables which contain more fiber or from a vitamin supplement to save on cavities and obesity. In my house, I occasionally purchase juice. However, 

when choosing beverages, I tell my children to choose juice over soda. 

Delta Dental, 4 recommends some alternatives to fruit juice consumption. Here are their suggestions: 

• “Instead of offering juice, offer your child whole fruit every day. The sugar in a piece of fruit is less concentrated, the fiber has not been removed, and fruit is more filling for the total calories eaten. 

• To help manage the amount of fruit juice your little one consumes, try these suggestions: • Limit preschoolers to 4 to 6 ounces of juice a day; 8 to 12 ounces for older children and 

teens, the AAP says. Make sure what they drink is 100 percent juice, not a fruit- flavored beverage. Remember that because of labeling laws, “made with 100 percent real juice” does not necessarily mean that the drink contains only natural juice. Read the label carefully to see if sugar, artificial flavors, or other substances were added.4 

• Encourage your child to drink from a cup by his first birthday. Always offer juice in a cup instead of a bottle. Sucking on a bottle of sugary liquid will contribute to tooth decay.(2) 

• Offer milk and water instead of juice. 

• Limit or eliminate carbonated drinks, especially those with sugar. Even diet soda contributes to tooth erosion.” 

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By Misty Kay, RDN, IBCLC

References 

  1. Evidence Analysis Library. Dietary and Metabolic Impact of Fruit Juice Consumption (FJ) Systematic Review (2014). Accessed on 9/25/18. https://www.andeal.org/topic.cfm?menu=5113
  2. American Academy of Pediatrics. 2017. American Academy of Pediatrics Recommends No Fruit Juice For Children Under 1 Year. https://www.aap.org/en-us/about-the-aap/aap-press-room/Pages/American-Academy-of-Pediatrics-Recommends- No-Fruit-Juice-For-Children-Under-1-Year.aspx. Accessed 9/26/18.
  3. Nicklas t, Kleinman R, O’Neil. 2012. Taking Into Account Scientific Evidence Showing the Benefits of 100% Fruit Juice. Am J Public Health; 102(12): e4.
  4. Delta Dental. Oral Health Library. Too Much Juice? http://oralhealth.deltadental.com/Search/22,21408. Accessed on 9/26/18.
  5. Zimmer S,Kirchner G, Bizhang M, and Benedix. Influence of Various Acidic Beverages on Tooth Erosion. Evaluation by a New Method. PLoS One. 2015; 10(6): e0129462.

6. Image 1: Manchir M. AAP Says Juice a No-No for Babies. 2017. https://www.ada.org/en/publications/ada-news/2017-archive/may/aap-says-juice-a-no-no-for-babi Es 

7. Image 2: Top 7 Impressive Benefits of Orange Juice. https://www.organicfacts.net/health-benefits/beverage/orange- juice.html. Accessed on 9/26/18. 

8. Image 3: Burhenne. 2018. What is baby bottle tooth decay? https://askthedentist.com/baby-bottle-tooth-decay/.. Accessed on 9/26/18.