Nutritional management in diabetes and pregnancy

During pregnancy it is necessary for the mother with diabetes to maintain careful control of the diabetes in order to lessen both fetal and maternal morbidity and mortality. The diet must take into account not only the metabolic requirements of the mother, but also those of the developing fetus. A total weight gain of 22 to 26 pounds is recommended, with the pattern of weight gain being more important than the total amount. Pregnancy is not a time for weight reduction. Caloric requirements can be met by the addition of 300 kcal. per day to the prepregnancy meal plan, or about 36 kcal. per kilogram. This can be met by the addition of 50 gms., carbohydrate and 30 gms. protein. Diets will contain approximately 1800 to 2500 calories a day. Calcium, iron, folic acid, and sodium also require attention in meal planning. The importance of regular meals and snacks must be emphasized. In particular, bed-time snacks are important because of the tendency towards overnight hypoglycemia and ketosis.