Global guideline on pregnancy and diabetes - International ...

<strong>Global</strong> Guideline on Pregnancy and Diabetes
from tablets or electing to be treated with insulin, if diet
alone is inadequate, will also need careful advice about
their carbohydrate choices. The same observations about
carbohydrate regulation apply to women diagnosed with
GDM [60,61].
There may be an involuntary decrease in energy intake at
the beginning of the pregnancy related to nausea. Later
in pregnancy the total energy requirements are likely to
increase. For those women who are insulin treated, there
is likely to be an increase in the total dose of insulin during
the pregnancy related to the physiological decrease in
insulin sensitivity. Thus the dietary carbohydrate content
and distribution will need to be changing to fulfil nutritional
requirements and as the insulin dose and type are changed.
It is possible that maternal obesity could be associated
with an increased risk of fetal abnormalities [62,63].
Weight loss diets are in general not recommended during
the course of a pregnancy. However, at least for women
with GDM who are considerably overweight, reducing
energy intake by no more than 30% of habitual intake
[64] is not associated with ketosis and does not cause
harm [65,66].
The proportion of energy intake derived from carbohydrates
will vary depending on the traditional diet and the
availability of alternative sources of energy. Regulating
and potentially reducing the carbohydrate intake is an
effective strategy for helping to control glucose levels
[67,68]. Changing the nature of the carbohydrates consumed,
particularly with respect to the use of foods with
a low glycaemic index (GI), can reduce the postprandial
glucose excursions. For women with GDM, postprandial
glucose elevations are associated with adverse pregnancy
outcomes [49,69]. In normal pregnancies, a low GI diet
will result in a reduced rate of LGA babies [70,71]. For
women with GDM, a low GI diet can reduce the rate
of insulin use, with no compromise of obstetric and
fetal outcomes [72].
4.3.2.2 Exercise
A moderate amount of exercise is beneficial for most people
most of the time, and pregnancy is no exception. The ‘expert
opinion’ of ACOG was that a minimum of 30 minutes exercise
on most days of the week was recommended during
a normal pregnancy [73]. There is no indication that this
opinion, with common sense precautions, would be any
different for pregnant women with diabetes. Women who
were exercising before pregnancy should be encouraged to
continue this during the pregnancy though the extent and
type of exercise may need to be modified. For women with
GDM, exercise can be seen as a useful adjunct to treatment
[3,64,74]. Exercises that effectively avoid excessive abdominal
muscular contraction are preferred [59].
Women who exercise regularly are probably less likely
to develop GDM, although this reduced rate appears
to be related to the habitual amount of exercise rather
than exercise started in the year before the pregnancy
[75]. An exercise programme may be an alternative to
the use of insulin in women with GDM who have not
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