Maternal Nutrition and Diabetes

Question 1

How much weight gain during pregnancy?

Answer 1

15-25 lbs

Question 2

How many more kcal a day in pregnancy?

Answer 2

350-450 kcal/day

Question 3

Iron requirements in pregnancy

Answer 3

Required for maternal and fetal hematopoiesis, and fetal neurocognitive development
16-20 mg elemental iron per day in a supplement for prevention of iron deficiency
Treatment of anemia with more iron if low Hb or ferritin at any time in pregnancy

Question 4

Folic acid in pregnancy

Answer 4

Required for maternal hematopoiesis and fetal neural tube development
Supplementation with 0.4 mg/day
Smokers and those on seizure meds need more (5 mg/day)

Question 5

Calcium and vitamin D requirements in pregnancy

Answer 5

Required for bone metabolism
Calcium 1000 mg/day
VitD = 5 mcg/day or 200 IU/day
From diet and supplement combined

Question 6

Zinc in pregnancy

Answer 6

Required for neurodevelopment
Worldwide more a concern than NA
No specific supplement we recommend

Question 7

Omega 3, 6, 9 in pregnancy

Answer 7

Required for fetal neurodevelopment and retinal development
Fish consumption more effective than supplementation
Recommend 150 gm of fish/week or 2 servings
Mercury concern in certain fish
Alternates: walnuts, flax seed oil, canola oil

Question 8

Vitamin B12 in pregnancy

Answer 8

Required for fetal neurodevelopment as well as hematopoiesis

Concerns in certain populations: vegan, gastric bypass, celiac, crohn’s, UC

Question 9

Vitamin A in pregnancy

Answer 9

Required and easily available in typical NA diet
Upper limit recommended as higher doses are teratogenic is 10,000 IU/day from combined retinol, retinoids, betacarotene in supplements and diet

Question 10

Choline in pregnancy

Answer 10

Required for cell membrane synthesis, neurotransmission, and overall essential to fetal brain development
Too little intake associated with decreased placental function and reduced fetal tolerance to stress
450 mg/day recommended in diet
Not yet recommended or included in supplements

Question 11

3 infections to avoid in pregnancy

Answer 11

Listeria
Toxoplasmosis
Salmonella

Question 12

Complications with

1. Cigarettes
2. Marijuana
3. Alcohol

Answer 12

1. Low birth weight, still birth, miscarriage, premature delivery, abruption, SIDS
2. Still birth, neurocognitive development
3. FASD

Question 13

Who do we screen for gestational diabetes? When?

Answer 13

Everyone from 24-26 weeks

High risk pregnancies from 12-16 weeks

Question 14

Who is high risk for gestational diabetes?

Answer 14

Previous gestational diabetes
Macrosomic babies
Certain racial minorities
Those over 35
BMI > 30
Steroid use

Question 15

Cut offs for 50 gm glucose test

Answer 15

Normal: under 7.8
GDM: > 11
Do step two if 7.8-11

Question 16

Diagnostic cut offs for 75 gm GTT

Answer 16

Fasting: > 5.3
1 hour: > 10.6
2 hours: > 9

Question 17

Screening cut offs for 75 gm GTT

Answer 17

Fasting: > 5.1
1 hour: > 10.0
2 hours: > 8.5

Question 18

Gestational diabetes nutritional advice

Answer 18

3 meals, 3 snacks per day with one snack at bed time
Avoid low calorie intake (ketones), avoid obvious sugars and sugar substitutes, avoid high fats, have protein with all meals and most snacks

Question 19

Do you need more calories in pregnancy or breastfeeding? By how much?

Answer 19

400-600 calories more during breastfeeding

On top of the extra calories you need during pregnancy