Women with type 1 diabetes (T1DM) are accustomed to meal planning to control blood sugar levels. But the changing nutritional and insulin needs that accompany pregnancy require exceptional dietary consideration and planning. For this reason, the American Diabetes Association recommends an individualized meal plan for pregnant woman with diabetes. Careful diet planning along with blood sugar monitoring and insulin adjustments help keep blood sugar levels in a safe range to promote the health of the mom and baby.
Goals and Quality Choices
Every pregnant woman with T1DM is unique. Therefore, the American Diabetes Association doesn't recommend a standard diet with specific foods or amounts to eat and avoid. Rather, the goal is to craft an individualized, well-balanced diet that provides the calories and nutrients needed for the baby’s growth and mom’s health while keeping blood sugar levels stable. Each woman's pregnancy diet is different, depending on factors such as her weight, activity level, food preferences and where she is in her pregnancy. Consuming 3 nutritious meals plus 2 to 4 snacks at around the same time each day helps stabilize blood sugar levels. Eating a variety of high-quality foods that are rich in multiple nutrients helps ensure healthy levels of proteins, carbohydrates, fats, fiber, vitamins and minerals.
Matching carbohydrate intake to insulin therapy is more complex during pregnancy because insulin sensitivity and needs change. Low blood sugar is most likely during the first trimester, and high levels are common during the second and third trimesters as insulin resistance builds. As both highs and lows are risky for the mom and baby, the carbohydrate content of meals and snacks is a key consideration in T1DM meal planning and insulin matching -- and providing some of the additional daily calories needed during the second and third trimesters.
Foods like whole-grain breads and pasta, fruits, vegetables and beans provide carbohydrates along with fiber, which helps stabilize blood sugar while curbing pregnancy-related constipation. Limiting foods with added sugar -- such as candy, sodas and pastries -- promotes healthy nutrient intake while avoiding excess calories and carbohydrates.
According to the ADA, pregnant women in their second and third trimesters require about an ounce of extra protein daily to support the mother's body and the growing baby. Animal protein sources -- including lean meat, poultry, fish, eggs and milk products -- provide the full complement of protein building blocks, called amino acids. Plant-based protein sources -- such as nuts, seeds and beans -- typically lack the full range of amino acids but can provide them when eaten in appropriate combinations. Too much dietary protein may be a concern for pregnant women with T1DM who have kidney problems and thus might affect diet recommendations.
Dietary fat is necessary for nutrient absorption and hormone regulation, which is particularly important during pregnancy. Fats are also necessary to support growth of the baby's nervous and visual systems and to help meet the increased calorie needs during the last 2 trimesters of pregnancy. Nuts, nut butters, avocados and olive, canola, safflower and sesame oils are healthy sources of monounsaturated fats. Sunflower, corn and soybean oils, and fatty fish like salmon and mackerel, are rich in healthy polyunsaturated fats. For heart health, a nutritious T1DM pregnancy diet contains a limited amount of saturated fat and avoids trans-fat from foods such as butter, lard, fatty animal meats and processed foods.
Vitamins and Minerals
Pregnant women with T1DM typically have the same vitamin and mineral needs as those without diabetes. Along with prescribed prenatal vitamins, a well-balanced diet containing a wide variety of fruits, vegetables and other foods helps ensure adequate vitamin and mineral intake. However, dietary levels of some of these micronutrients are particularly important for women with T1DM, who have an increased risk for certain pregnancy complications. For example, women with diabetes have an increased risk of pregnancy-related high blood pressure. Too much dietary sodium may increase this risk, so salty foods like lunch meats, chips, and canned and prepackaged foods are discouraged. A diet high in potassium-rich foods -- including fruits, vegetables and reduced-fat dairy products -- is encouraged to help fend off high blood pressure.
Ensuring a healthy pregnancy for a woman with T1DM ideally begins 6 to 12 months in advance. Teaming up with your doctor and dietitian to achieve a healthy diet and optimal blood sugar control before conceiving reduces the likelihood of miscarriage and birth defects. Prepregnancy planning also allows you to stop or change medications that may pose a risk for your unborn child, such as certain blood pressure and cholesterol-lowering drugs. Additionally, preplanning enables you to eliminate consumption of alcohol, which should be avoided throughout pregnancy. While artificial sweeteners are generally considered safe, some women opt to eliminate them before and during pregnancy as well.
- Diabetes Care: Management of Diabetes in Pregnancy
- Ohio State University Wexner Medical Center: My Diabetic Meal Plan During Pregnancy
- North American Journal of Medical Sciences: Pregnancy Issues in Type 1 Diabetes Mellitus: How Special Are Special Issues?
- Reviews in Obstetrics & Gynecology: Type 1 Diabetes Mellitus and Pregnancy
- Weight Gain During Pregnancy: Reexamining the Guidelines; Kathleen M. Rasmussen and Ann L. Yaktine (eds.)
- Diabetes Care: Managing Preexisting Diabetes for Pregnancy: Summary of Evidence and Consensus Recommendations for Care
- Managing Preexisting Diabetes and Pregnancy: Technical Reviews and Consensus; John L. Kitzmiller, M.D., et al.
- U.S. Department of Agriculture Center for Nutrition Policy and Promotion: Consumption of Food Group Servings: People’s Perceptions vs. Reality