Gestational Diabetes Mellitus (GDM)

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  Notes
 
 
Slide 1 : Nutrition Issues: Women's Life Stages Dr. Judith Wylie-Rosett jwrosett@aecom.yu.edu Learning Objectives Identify nutrition issues for a women: During pregnancy focusing on high risk In midlife to reduce chronic disease risk In older age to address multiple medical and/or social problems Assess Weight, Activity, Variety and Excess for each age cycle and determine when refer for medical nutrition therapy with Registered Dietitian (RD) is needed.
Slide 2 : Weight Pregnancy: 1-2 lb mo 1st trimester; 0.5-2 lb week in 2nd & 3rd Trimester Midlife: Weight distribution & risks relate to metabolic syndrome. Older Age: Unintentional weight loss > 10 lb at risk Activity Pregnancy: ? impact weight-baring activity > fetal distress. Midlife: Weight-baring activity ? risk of osteoporosis. Older Age:. Assess for unsteady gait. Variety Pregnancy: Calcium iron, protein, fiber/water, and folate Midlife: Metabolic syndrome, N-3 fatty acids; calcium intake, vegetables Older age: Absorption/nutrient requirements; Calcium/Vit D, Vit B-12, and zinc supplements may be needed. Excess Pregnancy: Screen for cravings, EtOH intake, Midlife: CHO & lipids, meat & calcium excretion Older Age: Food/EtOH behaviors to cope with loneliness.
Slide 3 : American Dietetic/Diabetes Association Exchange System Overview FREE FOOD < 15 calories per serving
Slide 4 : Quick Carbohydrate Counting One Carbohydrate choice = 15 grams based on the ADA’s Exchange system Exchange groups included are: - Starch (1/2 cup, slice of bread) - Fruit (1/2 cup) - Milk (1 cup) - Other Carbs (varies by concentration) Glycemic Indexing Issues
Slide 5 : Typical GDM Carbohydrate (~35-40% of Energy)
Slide 6 : GDM Carbohydrate ~35-40% of Energy Meat, Cheese, Vegetables- not measured
Slide 7 : Weight Gain Recommendations for Pregnant Women (Overweight Cuts Weight Gain Rx in Half) Normal weight 3-5 pounds per month 1st trimester 1-2 pounds per week 2nd and 3rd trimesters Overweight 11/2 - 21/2 pound per month 1st trimester 1/2 -1 pound per week in 2nd and 3rd trimesters
Slide 8 : Dietary Approach to Stop Hypertension DASH Daily Recommendations 7-8 Serving - grains, emphasis on whole grains 4-5 Serving - vegetables 4-5 Servings - Fruits 2-3 Servings - low-fat dairy products < 2 Servings - Meats 2-3 Servings Oils * Eat 4-5 servings of nuts, seeds and dried bean per week Limit intake of sweets to 5 per week
Slide 9 : Nutrition-Related Pregnancy Problems Rates in the United States Hypertension ~ 12-22% Preeclampsia ~ 6-8% Gestational Diabetes~ 2-14% Anal fissures/external hemorrhoids disease occur ~ 35% of pregnancies. Postpartum Iron Deficiency rates: 30% if < 130% of poverty level 7% if > 130% of poverty level Neural tube Defects ~ 4000 annually
Slide 10 : Recommended Weight Gain based on Prepregnancy BMI* BMI< 19.8 kg/m2 28-40 pounds BMI 19.8-26 kg/m2 25-35 pounds BMI > 26 kg/m2 15-25 pounds *American Diabetes Association Guide to Medical Nutrition Therapy
Slide 11 : Tight Glucose Control in GDM Reduction in Adverse Outcome
Slide 12 : Midlife CVD Risk for Women Metabolic Syndrome Synonyms Insulin resistance syndrome (Metabolic) Syndrome X Dysmetabolic syndrome Multiple metabolic syndrome
Slide 13 : Metabolic Syndrome Therapeutic Objectives To reduce underlying causes Overweight and obesity Physical inactivity To treat associated lipid and non-lipid risk factors Hypertension Prothrombotic state Atherogenic dyslipidemia (lipid triad)
Slide 14 : Specific Dyslipidemias: Possible Causes of Elevated Triglycerides High carbohydrate diets (>60% of energy intake) Several diseases (type 2 diabetes, chronic renal failure, nephrotic syndrome) Certain drugs (corticosteroids, estrogens, retinoids, higher doses of beta-blockers) Various genetic dyslipidemias
Slide 15 : Lipoprotein pattern: atherogenic dyslipidemia (high TG, low HDL, small LDL particles) Baseline triglycerides: ?200 mg/dL Lifestyle option: Weight loss ? EtoH and Carbohydrate Supplement options: Niacin Omega-3 fatty acids LDL-cholesterol goal: <100 mg/dL Diabetic Dyslipidemia
Slide 16 : Older Age Assessment of Nutritional Risk Unintentional weight loss or BMI < 22 kg/m2 Serum Albumin < 3.5 mg/dL Unintention reduction in cholesterol or < 150 mg/dL Reduced calorie or protein intake Difficult swallowing and/or gastric reflux Decreased appetite or ability to eat/obtain food Depression Economic Issues
Slide 17 : Treatment Options for Low Weight in Older Adults Liquid suppmements Medications that stimulate appetite and weight gain Vitamin/mineral supplementation Referral to RD and social service Use enteral nutrition before considering TPN
Slide 18 : Congestive Heart Failure Nutritional Evaluation Fluid retention (pedal edema or ascities) All blood levels in relation to fluid retention Serum electrolytes (high sodium and low potassium) Hypotension Protein (risk of cardiac cachexia)
Slide 19 : Treatment of Congestive Heart Failure Reduce sodium to < 2400 mg; DASH diet Check adequacy of protein and calorie intake Check fluid status daily (sign of edema and daily weights) Stablize before surgery and invasive medical procedures monitor afterwards
Slide 20 : Nutrition Referral Issues Integrate nutrition into your overall workup by briefly assessing weight, activity, variety and excess. Refer women to RD for in-depth Medical Nutrition Therapy consultation if: 1. You identify a nutrition-related problem and 2. Patient is ready to address the problem.

 


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