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Medical Nutrition Therapy in Gestational Diabetes Mellitus PowerPoint Presentation

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Description : This medical presentation titled ""Medical Nutrition Therapy in Gestational Diabetes Mellitus"" tells us how nutrition intervention for GDM has been recognized as the cornerstone of therapy.

Tags : Medical Nutrition Therapy, Gestational Diabetes Mellitus, nutrition intervention, GDM, diet therapy

Published on : Apr 22, 2021 | Views : 1838 | Downloads : 14

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Medical Nutrition Therapy in Gestational Diabetes Mellitus Dr. Parvin Mirmiran Obesity Research Center, Research Institute for Endocrine Department of Human Nutrition, Faculty and Institute of Nutrition and Food Technology, Shahid Beheshti University of Medical Sciences M. Akhoundan Dr. Mirmiran / SBMU 1
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Definition & Worldwide Prevalence of GDM GDM is defined as any degree of glucose intolerance with onset or first recognition during pregnancy Approximately 7% of all pregnancies are complicated by GDM ranging from 1 to 14% depending on the population studied the diagnostic tests more than 200,000 cases annually Dr. Mirmiran / SBMU 2
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Risk factors for the development of GDM marked obesity older age personal history of GDM glycosuria strong family history of diabetes ethnicity polycystic ovary syndrome hypertension Cheung,2009 Dr. Mirmiran / SBMU 3
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GDM Complication adverse pregnancy outcomes: macrosomia shoulder dystocia Jaundice polycythemia respiratory distress hypocalcemia Cheung,2009 Dr. Mirmiran / SBMU 4
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GDM Complication (cont’) adverse pregnancy outcomes (cont’) Increase fetal malformation and perinatal mortality predispose the child to a diabete phenotype in later life Cheung,2009 Dr. Mirmiran / SBMU 5
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Maternal complication : Weight gain Maternal hypertensive disorders Miscarriages Third trimester fetal deaths Cesarean delivery (due fetal growth disorders) Long term risk of type 2 diabetes mellitus Dr. Mirmiran / SBMU 6 GDM Complication (cont’)
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Medical Nutrition Therapy (MNT) in GDM Dr. Mirmiran / SBMU 7
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Medical Nutrition Therapy (MNT) in GDM MNT is the primary therapy for 30 –90% of women diagnosed with GDM Reader,2007 Dr. Mirmiran / SBMU 8
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Medical Nutrition Therapy (cont’) Goals: Achieve normoglycemia Recommended treatment targets ADA,2004 Dr. Mirmiran / SBMU 9
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Providing the required nutrients for normal fetal growth and maternal health Prevent excessive maternal weight gain, particularly in women who are overweight or have gained excess weight in pregnancy. Prevent ketosis Dr. Mirmiran / SBMU 10 Medical Nutrition Therapy (cont’)
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Medical Nutrition Therapy (cont’) Include: Nutrition therapy Exercise Self-monitoring of blood glucose (SMBG) Pharmacologic therapy Education Dr. Mirmiran / SBMU 11
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Dr. Mirmiran / SBMU 12 Nutrition therapy
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Efficacy of dietary therapy for GDM Nutrition intervention for GDM has been recognized as the cornerstone of therapy In patients receive diet therapy: Fewer patients require insulin therapy Decrease HbA1c lower serious perinatal complications among the infants: lower birth weight lower % large-for-gestational-age Less macrosomia Crowther ,2005 , Reader,2006 , Cheung,2009 Dr. Mirmiran / SBMU 13
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Nutrition therapy (cont’) All women should receive individualized counseling Food plan should be individualized & culturally appropriate to provide adequate calories & nutrients to meet the needs of pregnancy and consistent with the blood glucose goals Cheung,2009 Dr. Mirmiran / SBMU 14
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Nutrition therapy (cont’) Maternal weight-gain & Calorie intake for women with GDM There is no indication that normal-weight and underweight women with GDM should not follow the IOM weight-gain guidelines and calorie intake Reader,2007 Dr. Mirmiran / SBMU 15
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weight-gain recommendations based on prepregnancy BMI (Institute of Medicine’s Nutrition for Pregnancy 1990) Nutrition therapy (cont’) Dr. Mirmiran / SBMU 16
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overweight and obese women: Severe calorie restriction, increases ketonuria and ketonemia American Diabetes Association have suggested: a 30–33% calorie restriction for obese women with GDM, noting a minimum 1600-1800 calorie Ada,2000 Nutrition therapy (cont’) Dr. Mirmiran / SBMU 17
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Calorie formulas have been suggested in articles and guidelines for GDM: 35–40 kcal/kg for underweight 30 –35 kcal/kg for normal weight 25–30 kcal/kg for overweight 23–25 kcal/kg (pregravid weight) for obese Reader,2007 Nutrition therapy (cont’) Dr. Mirmiran / SBMU 18
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Macronutrient intake Carbohydrate (CHO) : 50 to 55% kcal intake Protein: 20-25 % kcal intake Fat: 25-30% kcal intake Nutrition therapy (cont’) Cheung,2009 Dr. Mirmiran / SBMU 19
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CHO are an important dietary source of energy, vitamins, minerals & fiber content. CHO is the main nutrient that affects postprandial glucose levels. CHO intake can be manipulated by: Nutrition therapy (cont’) controlling the total amount of CHO distribution of CHO over several meals and snacks type of CHO Reader,2007 Dr. Mirmiran / SBMU 20
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The ADA Standards of Medical Care state : the glycemic index (GI) can provide additional benefit to total carbohydrate control Foods with a low GI (<55) produce a lower postmeal glucose elevation Foods with a high GI (>70) show higher postprandial glucose values Nutrition therapy (cont’) Reader,2007 Dr. Mirmiran / SBMU 21
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Fiber : Soluble (legumes, oats, fruits) Insoluble (whole grain breads, cereals and some vegetables) Both: increase satiety slowing absorption time lower glycemic index Nutrition therapy (cont’) Reader,2007 Dr. Mirmiran / SBMU 22
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Carbohydrate Counting Works as follows: a dietitian determines a person’s dietary needs the individual is given a daily CHO allowance divided into a pattern of meals & snacks according to individual preferences the carbohydrate allowance can be expressed in grams or as the number of carbohydrate portions allowed per meals Nutrition therapy (cont’) Dr. Mirmiran / SBMU 23
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Carbohydrate Counting Emphasis is given to spreading the dietary intake over six meals daily: 3 main meals 3 snacks Distribution of CHO in daily meals Nutrition therapy (cont’) Dr. Mirmiran / SBMU 24
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Additional dietary components are usually based upon the general recommendations for diabetes mellitus. A reduction in simple carbohydrates and fat intake is advisable Nutrition therapy (cont’) Cheung,2009 Dr. Mirmiran / SBMU 25
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Fat intake: less than 10 % SFA up to 10 % PUFA the remainder derived from MUFA Nutrition therapy (cont’) Cheung,2009 Dr. Mirmiran / SBMU 26
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Nutrient needs There is no indication that women with GDM should not follow the same guidelines for nutrient intakes for all pregnant women (Dietary Reference Intakes for pregnancy 2001) Nutrition therapy (cont’) Reader,2007 Dr. Mirmiran / SBMU 27
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Nutrition therapy (con’t) 28
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Exercise is an obvious adjunct therapy to MNT for women with GDM light and moderate intensity activities such as walking for 20–30 min/day: can be safely encouraged, modest improvements in glycemic control might be achieved Exercise Reader,2007 Dr. Mirmiran / SBMU 29
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Criteria for adding pharmacological therapy such as insulin or glyburide: One or more blood glucose values outside the target range within a designated time frame. Elevated fasting glucose values alone Pharmacologic therapy Reader,2007 Dr. Mirmiran / SBMU 30
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CONCLUSIONS Nutrition recommendations for women with GDM, including: Management of gestational weight gain Control of calorie intake Modifying macronutrient composition & distribution Providing vitamins & minerals to meet pregnancy's need Dr. Mirmiran / SBMU 31
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The food plan should be designed to : Fulfill minimum nutrient requirements for pregnancy Achieve glycemic goals without weight loss and ketonemia Be culturally appropriate and individualized to take into account the patient’s body habitus, weight gain, and physical activity CONCLUSIONS Dr. Mirmiran / SBMU 32
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Nutrition interventions for GDM emphasize healthy food choices portion control Cooking practices that can be continued postpartum and may help prevent later diabetes, obesity, cardiovascular disease, and cancer CONCLUSIONS Dr. Mirmiran / SBMU 33
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