Nutrition During Pregnancy with Diabetes Gary Scheiner 8 June, 2015 Expert, Nutrition, Pregnancy We often get asked about Diabetes during pregnancy and this is the latest fascinating piece by expert Dr Gary Scheiner. OK. You’ve mastered the fine art of carb counting. You can spot fibre from across a crowded room. And you’ve learned which frozen desserts contain the least amount of fat. Diabetes aside, pregnancy brings its own assortment of nutritional recommendations designed to enhance your chances of having a healthy baby. General Guidelines Eating for two, while true to a certain extent, does not mean that you should consume double the usual calories. After all, the second “consumer” won’t need the same calories as you until he/she enters middle school. In most cases, 300 extra calories per day is all that is needed during pregnancy. Ideally, those 300 extra calories should contain many of the special nutrients that a baby needs for optimal growth and development. For example, the following contain approximately 300 calories: A spinach salad and a piece of whole fruit A sandwich containing turkey and swiss cheese A bowl of cereal with milk Sufficient protein is essential to a healthy pregnancy. An increase in protein needs is the result of the baby’s tissue growth as well as changes in your body as the pregnancy progresses. During pregnancy protein needs rise by about 25 grams per day. This can be met by adding a portion of meat (including beef, poultry and fish), nuts, nut butters, and dairy products such as cheese, milk, and yogurt. Dairy products are often preferred because they provide extra calcium as well as protein. Most meats are a good source of iron and zinc, which are also needed in increased amounts during pregnancy. Women who are vegans should have a careful assessment of their diet to assure adequate protein intake. Vegans often need a supplement of vitamin B12, zinc, calcium, and perhaps vitamin D to meet pregnancy requirements. In addition, fluid needs are greatly increased during pregnancy. Extra fluids are needed to provide sufficient blood flow to the baby, maintain the cushioning properties of the amniotic sac, and keep you from overheating. For most women, about 10 cups of fluid per day is recommended – more when exercising or spending time in warm/humid weather. Any food that is liquid at room temperature is considered a fluid, including soup and milk. Water remains the preferred beverage. Special Supplements During the first several weeks of pregnancy, the baby’s heart and central nervous system develop. Folic acid has been shown to decrease the risk of neural tube defects, including spina bifida. 400 mcg (micrograms) of folic acid is recommended for all women prior to and after conceiving. Most prenatal vitamins provide 400 mcg of folic acid, as well as some other important vitamins and minerals – but check the label to make sure. Tell your obstetrician if you cannot tolerate prenatal vitamins. Fortified breakfast cereals, breads, rice and pasta, as well as green leafy vegetables are food sources rich in folic acid. Include 6-8 servings of these items (particularly whole grains and dark green leafy vegetables) daily. Calcium is essential for the bone development of the fetus. If adequate calcium is not provided via your diet, then your own calcium stores will be drawn upon. This puts your bone health at risk. Approximately 1200 mg of calcium per day is recommended during pregnancy. This is equivalent to four cups of milk. Other good sources of calcium include cheese, yogurt, calcium fortified soy milk, spinach, broccoli, and canned salmon. Iron needs increase during pregnancy as blood flow to the baby increases. This is particularly true during the second and third trimesters. Nearly half of all women become anemic during pregnancy; many require iron supplements. To prevent anemia, look for animal-based products (beef, poultry, fish) as these tend to be the best iron sources. Some non-animal products can also provide reasonable amounts of iron: enriched breakfast cereals, pumpkin, sesame seeds, canned beans, lentils, dried apricots, raisins, or prunes, spinach, wheat germ, and bran. Consuming foods that are high in Vitamin C helps the body do a better job of absorbing iron. Citrus fruits, red and green peppers, strawberries, and potatoes are good sources of vitamin C. Including a citrus fruit when having enriched cereal, or red peppers and a potato when having a steak, will help your body absorb the iron more efficiently. In addition, some studies show that pregnant women who include foods rich in vitamin C in their diet have lower risks of pre-eclampsia, a dangerous form of high blood pressure. Look to have two to four servings of fruit and four or more servings of vegetables per day. DHA (Docosahexaenoic acid), an Omega-3 fatty acid, is important for proper brain and eye development. Choose safe sources of DHA in the diet. Salmon and fortified eggs are generally considered good, safe sources of DHA. Beware of shark, tuna, swordfish, king mackerel, and tilefish which may contain high levels of mercury and can be toxic to the developing baby’s nervous system. Things to Avoid In addition to avoiding seafood with potentially high mercury levels during pregnancy, there are a few other things to stay away from. These include caffeine, alcohol, saccharin, unpasteurized cheeses and lunch meats. Caffeine is a stimulant and a diuretic (causes extra urination). In large amounts, caffeine has been linked to an increased risk of miscarriage and low birth weight. Limit coffee and tea to two cups per day, or choose decaffeinated beverages. Alcohol is a concern because it increases the baby’s risk of fetal alcohol syndrome, a series of developmental problems that can affect the child throughout his or her lifetime. No one knows the threshold for “safe” alcohol consumption during pregnancy, so it is best to avoid alcohol completely. Artificial sweeteners are used (and consumed) routinely by most people with diabetes. Of all the artificial sweeteners available, saccharin is the one of greatest concern during pregnancy. Saccharin has been shown to cross the placenta and reach the baby. The developing fetus is not as efficient as you are at breaking down and removing saccharin from the bloodstream, so there is potential for it to build up in large amounts. It is best to avoid saccharin entirely during pregnancy. The short-and long-term effect of other artificial sweeteners is not completely understood, so they should be used only in moderation and with approval of your obstetrician. Unpasteurised meats and cheeses can cause a form of food poisoning called Listeriosis. The bacteria that cause Listeriosis may be found in unpasteurized fruit juices, soft cheeses such as feta, brie and Roquefort; lunch meats, deli meats, and hot dogs. Listeriosis can increase the risk of miscarriage, premature birth, and stillbirth. Most foods that have been pasteurised are labeled as such. If you are not sure whether a cheese, lunch meat or other food has been pasteurised, avoid it. Or, if you want to be sure to kill the bacteria in lunch meats and hotdogs, put them in boiling water for at least one minute before eating. So before you start complaining, let’s put all this together. Less caffeine, alcohol and lunch meat. More fluids, whole grains, green leafy vegetables and lean protein sources. Sounds to me like pregnancy might be the best thing to ever happen to your diet! Eat well, and have a healthy pregnancy! Note: Gary Scheiner MS, CDE is owner and clinical director of Integrated Diabetes Services, a private practice specializing in blood glucose regulation and advanced self-management training for people who utilize intensive insulin therapy. One of the specialties of his practice is pregnancy and type-1 diabetes. He and his staff of CDEs offer their services remotely via phone and the internet for clients throughout the world. A devoted husband and father of four, Gary has had type-1 diabetes for 28 years and makes extensive use of both pump and CGM technology. For more information, contact him at firstname.lastname@example.org, or call him in the US: 877-735-3648, or outside the US: +1-610-642-6055.