Diet for pregnant women with diabetes

Your diet for diabetes needs to be modified when you are pregnant. The total calories you need are based on your prepregnancy weight, age, activity level, and whether you are carrying more than one fetus. Your calorie needs:

• Remain the same during the first trimester (weeks 1 through 12) as they were before pregnancy; however, you may need extra calories if you have nausea, vomiting, or a low blood sugar level.
• Increase during the second and third trimesters (week 13 through 40). During this time, you need 300 calories per day more than your prepregnancy intake.

Aim for a total weight gain of 25 lb to 35 lb, with a rate of weight gain at about 1 lb each week during the second and third trimester.

• Excessive weight gain [greater than 6.5 lb per month for a woman who was of normal weight or overweight at conception] can contribute to insulin resistance.
• Inadequate weight gain [less than 0.5 lb per week or less than 2 lb per month] may be an indication that you and your baby are not receiving enough nourishment.

Dieting to lose weight during pregnancy is not recommended because you may not receive enough nourishment for you and your baby, and it may increase your risk for premature delivery.

Follow these guidelines for your diet during pregnancy.

Carbohydrate

About 40% to 50% of your calories should come from carbohydrate foods, and these should be spread throughout the day. Inadequate carbohydrate intake can result in low blood sugar (hypoglycemia) for women taking insulin and in ketone production for women with gestational diabetes. Excessive carbohydrate intake can result in elevated blood sugar levels.

Your snacks should include less carbohydrate than meals, and your breakfast should be no more than 10 hours after your bedtime snack. This helps prevent low blood sugar (hypoglycemia) in women taking insulin and ketone production in women with gestational diabetes.

Make sure your diet contains:

• Complex carbohydrates, especially those high in fiber, such as oatmeal, brown rice, bran cereal, whole wheat bread, whole wheat pasta, and beans.
• Fresh fruits.
• Milk.
• Fresh or frozen vegetables.

Limit these carbohydrate foods in your diet:

• Refined sugar and foods with a high content of refined sugars (sweets)
• Refined starches, such as highly processed breakfast cereals, instant potatoes, instant rice, or instant noodles
• Fruit juice

Protein

About 20% to 25% of your daily calories should come from protein foods. If your kidney function is impaired, your protein allowance may be lower.

Fat

About 30% of your calories should come from fat. Monounsaturated fats and omega-3 fats, rather than saturated fats, should continue to be the primary source of fat in your diet. Less than 10% of your daily calories should come from saturated fats and your cholesterol intake should be less than 300 mg each day.

Fiber

Get 20 g to 35 g of fiber each day. Fiber can help stabilize your blood sugar levels and relieve constipation, which is common during pregnancy.

Sodium

You do not need to restrict your sodium intake, unless you have a health problem that requires it. If you have high blood pressure, you may need to eat less than 2,300 mg of sodium daily. If you have impaired kidney functioning and high blood pressure, you may need to get less than 2,000 mg of sodium daily.

Vitamins and minerals

Take a prenatal vitamin with folate and iron to meet your body's increased need for these micronutrients. Folate is needed for the production of blood cells, and iron is needed for red blood cells to deliver oxygen throughout the body. Folate has also been proven to reduce the risk of fetal neural tube defects. You need to get 0.4 mg of folate each day.

You may need to take a vitamin B12 supplement, which is important for the production of red blood cells, and a vitamin D supplement if you are a strict vegetarian (vegan). Vitamin B12 can only be obtained from animal sources in the diet. You can get the amount of vitamin D you need each day by eating a variety of dairy products.

Other vitamins and minerals, such as the B vitamins and calcium, are important during pregnancy for producing energy and preserving your body's calcium stores.

Very large doses (megadoses) of vitamins, especially vitamins A and D, are not recommended during pregnancy. Vitamins and minerals should only be taken under your health professional's supervision.

Artificial sweeteners

Saccharin and Acesulfame-K can cross the placenta into your baby's system. Do not use saccharin. Whether Acesulfame-K is safe to use during pregnancy is not known.

You can use aspartame, but do not have more than three servings per day. Avoid using aspartame if you have phenylketonuria (PKU).

You can use sucralose (Splenda) safely during pregnancy, but as with all artificial sweeteners, do not overdo it.

Caffeine

Limit your intake of caffeine to no more than 2 cups of coffee, tea, or soda each day.

Alcohol

Do not drink alcohol. No amount of alcohol has been proven to be safe to drink during pregnancy.

Herbs

Some herbs may cause premature labor and others may cause high or low blood sugar levels. Talk with your health professional if you are taking any herbs.