carbohydrates
Carbohydrates are converted into glucose and have the biggest impact on postprandial blood glucose results. Therefore, it is important to control carbohydrate intake throughout the day. Appropriate distribution of carbohydrates over the day helps attain optimal glycemic control and can prevent hypoglycemia and ketonemia in pregnant women.
The IOM recommends 130 g of carbohydrate per day for women of childbearing years based on the minimum of carbohydrate utilized by the brain and red blood cell function. For pregnancy, the RDA is a minimum of 175 g of carbohydrate per day (11) (Table 2).
The pregnant woman with diabetes needs to be educated on the amounts and types of carbohydrate that will promote postprandial blood glucose control with individualized recommendations that pertain to her food preferences. It is important to tailor information to the learning level of the individual particularly when choosing a carbohydrate counting method.
The first step in learning how to count carbohydrates is learning which foods are rich in "carbs." Many foods contain carbohydrate, for example, whole grains, beans, fruit, milk, and some vegetables. So, when developing a healthy meal plan, it is important to have a variety to optimize nutrient intake.
Table 2
Distribution of Macronutrients for Pregnancy (Reprinted with Permission from Joslin Diabetes Center and Joslin Clinic Guideline for the Detection and Management of Diabetes in Pregnancy (http://www.joslin.org). Copyright © by Joslin Diabetes Center. All rights reserved)
Table 2
Distribution of Macronutrients for Pregnancy (Reprinted with Permission from Joslin Diabetes Center and Joslin Clinic Guideline for the Detection and Management of Diabetes in Pregnancy (http://www.joslin.org). Copyright © by Joslin Diabetes Center. All rights reserved)
|
Macronutrient |
Gestational diabetes mellitus |
Preexisting diabetes |
|
Carbohydratea |
40-45% total calories |
45-55% total calories |
|
Breakfast |
15-30 ga,b |
Individualize as per usual intake |
|
and premeal BG levels | ||
|
HS Snack |
15-30 g carb |
15-30 g carb |
|
Fiber |
25-35 g |
25-35 g |
|
Protein |
1.1 g protein/kg DBW or 25 g of extra protein/day | |
|
Fat |
<40% total calories |
30-35% total calories |
|
<10% from saturated fat |
<10% from saturated fat | |
a Pregnant women should consume a minimum of 175 g carb/day b May be increased if insulin is added a Pregnant women should consume a minimum of 175 g carb/day b May be increased if insulin is added
Table 3
Nutrition Resources for Carbohydrate Counting and Meal Planning
Free nutrition Web sites
http://www.diabetes.org/my-food-advisor.jsp
http://www.calorieking.com/foods/
http://www.nal.usda.gov/fnic/foodcomp/search/
Carbohydrate counting books
The CalorieKing Calorie, Fat & Carbohydrate Counter. 2008 Edition
The Diabetes Carbohydrate and Fat Gram Guide, 3rd Edition. Lea Ann Holzmeister, 2006
Fast Fact Series: Carb Counting Made Easy. Marie McCarren, 2002
The ADA's Complete Guide to Carb Counting. Hope Warshaw, MMSc, RD, CDE and K. Kulkarni, MS, RD, C.D.E. 2004
Practical Carbohydrate Counting, 2nd Edition. A How-to-Teach Guide for Health Professionals. Hope S.
Warshaw, MMSc, RD, CDE and Karen M. Bolderman, RD, LD, CDE. 2008 Ultimate Guide to Accurate Carb Counting. Gary Sheiner, 2006
Label reading is important when trying to estimate the amount of carbohydrate in a portion and is an essential concept of nutrition education. Labels can be tricky. The total carbohydrate and fiber content of a food is based on a single serving size that is listed on the package. In addition to label reading, there are many carbohydrate resources available; reference books, as well as Internet and software programs, help identify the carbohydrate content of a food (see Table 3).
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