Dietary advices on carbohydrate intake for pregnant women with type 1 diabetes

Abstract

The impact of the quality and quantity of carbohydrate intake on glycaemic control and pregnancy outcome was evaluated with focus on pregnant women with type 1 diabetes. For women with type 1 diabetes, a gestational weight gain within the lower range of the guidelines of the Institute of Medicine (IOM) is generally recommended. A low-glycaemic index diet is considered safe, and has shown, positive effects on the glycaemic control and pregnancy outcomes for both healthy women, those with type 2 diabetic and gestational diabetes (GDM). In general, carbohydrate counting does improve glycaemic control in type 1 diabetes. A moderately low carbohydrate diet with a carbohydrate content of 40% of the calories results in better glycaemic control and comparable obstetric outcomes in type 2 diabetes and GDM when compared to a diet with a higher carbohydrate content, and is regarded safe in diabetic pregnancy. In type 1 diabetes pregnancy, a moderately low carbohydrate diet with 40% carbohydrates has been suggested; however, a minimum intake of 175 g carbohydrate daily is recommended. Despite limited evidence the combination of a low-glycaemic index diet with a moderately low carbohydrate intake, using carbohydrate counting can be recommended for pregnant women with type 1 diabetes.

Breastfeeding at night is rarely followed by hypoglycaemia in women with type 1 diabetes using carbohydrate counting and flexible insulin therapy

“…A minimum daily total carbohydrate intake of 210 g has been suggested during breastfeeding (www.nap.edu/read/10490/chapter/8#293, accessed 31 July 2018). A daily intake of 180 g carbohydrate from the main sources, as in the current study, corresponds roughly to 205 g carbohydrate by adding approximately 25 g from vegetables and other minor sources [35]. We did not investigate whether ketonaemia occurred but there were no incidences of ketoacidosis.…”

Effect of motivational interviewing on gestational weight gain and fetal growth in pregnant women with type 2 diabetes

“…The goals for glycemic control and gestational weight gain were the same in the two cohorts as was the routine obstetrical control and management. The focus of the motivational interviewing was to encourage the women to follow the recommended diabetes diet21 and to comply to local gestational weight gain recommendations 22. Gestational weight gain (kg) and LGA infants (birth weight >90th percentile) were the main outcomes.…”

“…The women received information from a dietitian about the recommended diabetes diet21 and education in carbohydrate exchange including an introduction to a local smartphone application with pictures and information on the carbohydrate amounts to aid learning. The goals were: (1) adequate nutrient intake to support a healthy pregnancy; (2) carbohydrates mainly deriving from low glycemic index sources; and (3) a total daily energy intake of approximately 1673 kcal (7000 kJ) including 175 g carbohydrates in total (43 E%) with approximately 150 g deriving from the major carbohydrate sources (bread, potatoes, rice, pasta, fruits, and dairy products).…”

Assessment of adherence to the dietary recommendations concerning the amount of carbohydrates intake in type 1 diabetic patients treated with continuous subcutaneous insulin infusion during pregnancy and 8 weeks after the delivery

“…In clinical practice, benefits of applying diet containing carbohydrate compositions of low glycemic index, i.e. carbohydrates from whole grain cereal products, legumes, fresh, unprocessed vegetables and starchy foods are observed [7]. Carbohydrate content shall depend on initial body weight as well as on observed in individual trimesters body weight increase, physical activity, insulin therapy model and obtained daily glycemic profile.…”

“…In order to obtain very good metabolic control in pregnant women, a low-carbohydrate diet is recommended, with carbohydrate content equal to 40-45% of daily energy demand. Due to the risk of ketonuria, minimum daily intake of carbohydrates cannot be below 175 g [7][8][9]. Patients with high insulin resistance and obesity may require reduction of carbohydrate dietary content down to 33-35% [4].…”