Diet & diabetes gravidarum

Diet and diabetes gravidarum

Dietetics

What is diabetes gravidarum (diabetes during pregnancy)?

During pregnancy, the amount of glucose (sugar) in the blood of the mother(-to-be) can sometimes become too high.

If the OGTT (oral glucose tolerance test) shows that the level exceeds 6.1 mmol/l (when fasting) and/or 7.8 mmol/l after two hours, this is known as diabetes gravidarum. If this is the case, you will receive dietary advice to normalise your blood glucose (blood sugar) values , which means a maximum of 5.3 mmol/l when fasting, a maximum of 6.7 mmol/l two hours after a meal, and a maximum of 7.0 mmol/l at bedtime.

Diabetes gravidarum (diabetes during pregnancy) is a type of diabetes, generally temporary. Diabetes gravidarum occurs under the influence of hormones that are formed during pregnancy.

Having diabetes means you have problems maintaining your blood glucose levels within the normal range. The carbohydrates that we consume are converted to glucose in our intestines.

The glucose is transported to the blood through our intestines. The blood carries the glucose to the cells of our body (for instance, in our muscles and brain). Once there, the glucose acts as a source of energy.

We need insulin in order to get glucose out of the blood and into our body cells. Insulin is a hormone made in the pancreas.

Insulin keeps the amount of blood glucose in our body in balance. During a normal pregnancy your body makes extra insulin. This compensates for the temporarily reduced sensitivity to insulin. This does not happen in cases of diabetes gravidarum, or insufficiently, and the levels of blood glucose remain too high.

So you need more insulin because:

• your body has to work harder;

• pregnancy hormones are counteracting the insulin.

If your body is incapable of making the sufficient amount of insulin, the amount of glucose in your blood will rise. The excessive amount of glucose goes to the baby, who will grow heavier as a result. A heavy baby can cause problems during birth. After the pregnancy, your insulin requirement will normalise. In most cases your blood glucose will also normalise.

It is estimated that one in twenty pregnant women develop pregnancy diabetes, although we do not have exact figures for the Netherlands.

If you had diabetes gravidarum in the past, you have a 50% chance of developing type 2 diabetes later in life and a bigger chance of diabetes gravidarum during a possible next pregnancy. This means it is important to continue to eat healthy after your pregnancy, to exercise regularly and to keep an eye on your weight.

Carbohydrates

A lot of the glucose in your blood comes from your diet. Carbohydrates are converted to glucose as your food is digested.

Carbohydrates is a collective name for:

Starch:	bread, potatoes, rice, couscous, legumes and pasta;
Milk sugar (lactose):	all sorts of milk (products), also the unsweetened types, such as milk, buttermilk, custard, yogurt, curd;
Fruit sugar (fructose):	fruit, fruit juices, fruit purees, also the unsweetened types;
Sugar from the sugar bowl:	cookies, cake, ice cream, sweets, etc.

Purpose of the diet

In order to make sure your blood glucose does not get too high, it is important to spread your consumption of carbohydrates over the day. Leave at least 2 hours between meals and snacks that contain carbohydrates. This ensures that just a small quantity of glucose gets into your blood at these moments and it prevents peaks in your blood glucose levels.

In fact, it is better to eat 6 small meals than 3 large meals a day.

Besides this, it is important to have a more or less set amount of carbohydrates per mealtime. Choose products that are high in fiber and that are unprocessed and avoid sugary, processed products as much as possible.

Sugar

Limit your intake of sugar and products that contain sugar, such as:

• sweet sandwich toppings, such as jam, honey, sprinkles, syrup (you can eat limited amounts of sugar-free/low-sugar jam);

• lemonade (syrups) or soft drinks;

• tea or coffee with sugar;

• cake, cookies, sweets, ice cream, chocolate;

• fruit juice or fruit puree;

• fruits in syrup;

• custard and fruit yogurt with sugar.

Sweeteners

Sweeteners are a possible replacement for sugar. Examples of sweeteners are: saccharin, sorbitol, aspartame and cyclamate. Sweeteners are safe to use during pregnancy. However, make sure that you do not exceed the Accepted Daily Intake (ADI).

There is not enough (good) evidence that sweeteners do not influence the blood sugars, but it has been proven that the blood sugar increases lesss from sweeteners (compared to sugar). So products with sweeteners are a better choice than products with sugar. Use products with sweeteners in moderation.

Fibre

Fibre (or dietary fibre) is a group of carbohydrates that cannot be digested by the intestines. Fibre stabilises the blood sugar level. Fibre also makes you feel fuller, so you will feel satisfied more quickly with a small(er) portion and you will be less likely to want to continue eating.

Fibre is found in the following products:

• Whole grain products, such as: wholewheat bread, wholewheat pasta and brown rice;
• Vegetables;
• Fruits;
• Legumes, such as lentils, chickpeas and brown beans;
• Nuts.

Practical tips

Introduce a little variety into your meals by replacing carbohydrates in your daily menu with other dishes or foods that contain just as many carbohydrates.

The following is a list of alternative foods you can use to replace other foods containing carbohydrates (while still obtaining the same number of carbohydrates).

Bread (have a maximum of 2 slices of bread as a meal)

Instead of 1 slice of bread (15 grams of carbohydrates) you could eat:

• 2 (wholewheat) rusks;

• 2 pieces of (wholewheat) knäckebröd (crispbread);

• 3 slices of a wholewheat baguette (weighing 10 g each).

Savoury sandwich toppings

Savoury toppings such as cheese and processed meat provide hardly any carbohydrates, so they will not raise the level of your blood glucose.

Milk and milk products

Instead of 1 glass with 150 ml semi-skimmed milk (7 grams of carbohydrates), you could drink:

• 1 glass of buttermilk;

• 1 small bowl of (low-fat) yogurt;

• 1 small bowl of (low-fat) curd.

Potatoes and alternatives

Potatoes and other alternatives such as rice and pasta are the most important sources of carbohydrates in our dinners. Instead of 4 small potatoes (200 grams, approx. 32 g carbohydrates), you could eat:

• 4 large spoons (200 grams) of mashed potato;

• 3 large spoons (150 grams) of cooked (high-fibre) pastas, such as wholewheat macaroni and spaghetti;

• 3 large spoons (150 grams) of cooked legumes such as brown beans, white beans, field peas, lentils;

• 2 large spoons (100 grams) of boiled (brown) rice;

• 2 slices of wholewheat bread;

• 6 slices of a (brown) baguette (10 grams per slice).

A large spoon is a normally filled serving spoon (+/- 50 grams).

Fruit (eat a portion of fruit 2 hours after a meal, as a snack, but not 2 portions at a time)

An average portion of fruit (approx. 15 g carbohydrates) could be:

• 1 apple, 1 orange, 1 pear, 1½ grapefruit, 2 nectarines, 3 mandarins, 2 kiwis, 1 slice of a fresh pineapple, 1 small bowl of cherries, 1 small (or half a) banana, 3 plums, 7 apricots, 10 grapes, 300 g strawberries, 200 g melon or a quarter of a mango;

• 1 small dish of fresh fruit (125 grams).

Desserts (a dessert should be eaten 2 hours after the meal)

Instead of 1 small bowl of 150 ml custard without added sugar (12 g carbohydrates), you could eat:

• 1 small bowl of (low-fat) yogurt or semi-skimmed milk with ½ a portion of fruit;

• 1 small bowl of ready-to-eat non-fat fruit yogurt without added sugar;

• 1 small bowl of porridge without added sugar;

• 1 small bowl of non-fat yogurt or buttermilk or semi-skimmed milk with 1 tablespoon of muesli;

• 1 popsicle.

Snacks (leave 2 hours between snacks and meals)

For a snack (approx. 15 grams of carbohydrates) you could choose:

• 1 slice of wholewheat bread with ‘light’ margarine and a savoury topping;

• 1 portion of fruit (see above);

• 1 small slice of (wholewheat/low-sugar) Dutch spiced cake (25 g per slice);

• 2 wholewheat biscuits;

• 5 salted biscuits (e.g., Tuc);

• 2 tablespoons of dried fruit and nuts;

• 4 small pieces of toast or 3 slices of a baguette (weighing 10 grams each), with, e.g., vegetable salad, cheese or sliced meat.

Drinks

A number of drinks do not contain any carbohydrates. These are tea and coffee without sugar, tap water and mineral water, light soft drinks, bouillon or low-fat soups with no binding agent. As an extra you can drink one glass of tomato juice or vegetable juice a day without omitting something else from your diet.

Unrestricted products

You can eat and drink the following products without having to omit something else from your diet as they have no effect/hardly any effect on the blood glucose:

• raw vegetables (wash them well);

• sugar-free chewing gum;

• tea/coffee without sugar;

• (mineral) water;

• light soft drinks;

• bouillon or soup without a binding product (do not have it every day if you have high blood pressure);

• cheese;

• (processed) meats;

• fish;

• nuts (in moderation, 1 handful a day);

• egg (2-4 eggs a week);

• olives.

Your dietician can advise you on the best way of adjusting your mealtimes and spreading them over the day. This can vary per person, depending on the measured blood glucose levels.

A healthy diet

In order to be able to keep to the diet in a way that is healthy and sustainable, it is important to introduce variety into your diet.

People often think they need to eat and drink more, or even twice as much, during pregnancy. This is not the case at all.

It is true that pregnancy demands a little extra energy, but most women are less active during pregnancy, so they also use less energy. This is why you do not need to eat a lot of extra food. A mother and her baby will automatically get sufficient nutrients with the recommended basic diet.

The following basic diet is the average that is needed each day during pregnancy:

Wholewheat bread	4 - 7 slices
Wholewheat grains (pasta/rice) or potatoes	4 serving spoons or 4 pieces (200 grams)*
Vegetables	5 serving spoons (250 grams)
Fruit	2 portions (200 grams)
Dairy products	3 - 4 portions
Cheese	40 grams
Legumes, fish, egg or meat	1 portion (100-125 g, weight after preparation, including processed meat). Have fish twice a week.
(Low-fat) margarine, baking oils and similar fats	40 - 50 grams
Unsalted nuts	25 grams
Drinks	1.5 - 2 liters (including dairy products)

*Quantities in consultation with your Diabetes Gravidarum dietician.

Supplements

From the moment you want to get pregnant up until 10 weeks pregnancy it is important to take 400 micrograms of folic acid. Next to this, 10 micrograms of vitamin D is advised during the entire pregnancy.

Besides this it is important that your nutrition contains a sufficient amount of calcium, iodine and fish fatty acids. These can mostly be found in dairy, bread and fish. Are you not able to eat the recommended amount of these products, then it might be necessary to take a supplement.

When you eat too little, when you have to vomit or when you are afraid of not getting enough nutrients, you can take a multivitamin supplement for pregnant women. This supplement also contains folic acid and vitamin D, then you do not have to take these as an extra supplement.

Nausea

If you are nauseous during pregnancy and/or you are vomiting frequently, it can help to have multiple small meals during the day. Avoid strong odours.

Are you mostly nauseous in the morning? Try to have a light breakfast in bed.

Do you have to use insulin and are you vomiting (a lot)? Discuss the amount of insulin with your diabetes nurse and/or dietician. You might need fewer units of insulin.

More information

For current information, consult the internet:

www.voedingscentrum.nl; this is also where you will find a list of brochures in the ‘webshop’.

The contents of this folder were drawn up by the Dietetics Department (2023) of Ikazia Hospital Rotterdam, using the following brochures and articles:

• Dietary guidelines 2023: Guideline Diabetes Mellitus and pregnancy/Diabetes gravidarum (revised)

• information from the website, www.voedingscentrum.nl;

• information from the website, www.diabetesfonds.nl.