A well-planned, nutritious diet is recommended for all pregnant women, and is of particular importance to women with a medical condition such as type 2 diabetes (T2DM). Although gestational diabetes, usually diagnosed in the second trimester, is the most common form of diabetes in pregnant women, those with pre-existing diabetes are challenged with the need to tightly manage blood sugars during their entire pregnancy to reduce the risk of birth defects and miscarriage. Diet plays an important role in blood sugar management, so women with T2DM would benefit from starting a healthy diet prior to conception. Choose nutritious foods, eat regularly and manage portions to help keep blood sugar levels in an optimal range and provide good nutrition for mom and baby.
Nutrition in Pregnancy
The best time to start making dietary changes is before becoming pregnant. According to the American College of Obstetricians and Gynecologists, a healthy pregnancy diet includes a variety of foods, including fruit; vegetables; whole grains such as whole wheat bread, brown rice and whole grain pasta; calcium-rich foods such as milk, yogurt and fortified soy milk; and high protein foods such as chicken, lean meat, nuts and beans. The Academy of Nutrition and Dietetics, in its 2009 position statement on vegetarian diets, says well-planned vegetarian diets are appropriate to meet pregnancy nutrition needs. Pregnant women may also be advised to take supplements, such as a folic acid supplement to prevent neural tube defects.
Carbohydrates in Pregnancy
Carbohydrates in starches and sugars provide an important source of energy for pregnant women. High carbohydrate food choices include beans, grains, breads, cereals and starchy vegetables like sweet potatoes and corn, as well as fruit, milk, yogurt, desserts and candy. Because the body turns carbohydrates into sugar, portions of these foods must be closely monitored in women with T2DM. To keep blood glucose levels stable, the American Diabetes Association (ADA) recommends that carbohydrate foods be distributed throughout the day in three small to moderate meals and two to four snacks. Women who take certain diabetes pills or insulin may experience low blood sugar levels if they miss meals or eat low carbohydrate meals -- a consistent amount of carbohydrates in the diet helps prevent high and low blood sugars.
The ADA recommends that all pregnant women with diabetes receive an individualized meal plan from a registered dietitian. This nutrition plan provides a specific amount of calories, based on weight, activity level, and whether the pregnancy is single or multiple. Women in their first trimester usually do not require additional calories, but the meal plan accounts for the increased calorie and protein needs in the second and third trimesters. This meal plan also provides the desired amount of carbohydrates at meals and snacks to help with blood sugar management. A dietitian will assess if additional vitamins or minerals are needed to supplement the diet -- such as additional calcium if diet intake is low, or vitamin D or B-12 on a vegan diet.
Warnings and Next Steps
Because uncontrolled blood sugars in T2DM can cause birth defects, birth complications and miscarriage, the ADA recommends pregnancies be planned when possible. According to an article published in the October 2005 issue of "Clinical Diabetes," women with T2DM who plan their pregnancies and regularly see their physicians have better birth outcomes, because they are more likely to be able to keep their blood glucose levels in an optimal range through diet and medications. Any woman with diabetes who plans to become pregnant should discuss these plans with her diabetes care team and her doctor, so a proper diet can be implemented and a strategy to achieve near-normal blood sugars can be in place. If already pregnant, she needs to meet with her diabetes care team and dietitian as soon as possible. In addition, any use of supplements should be discussed with a diabetes care team.