prenatal wt gain
Mamas on Bedrest: Self Care of Gestational Diabetes
December 7th, 2011In this podcast, Bedrest Coach Darline Turner-Lee offers some Self Care Tips for Gestational Diabetes. Drawing from her most recent blog, The Skinny on Low Glycemic Index Diets and Gestational Diabetes, Turner-Lee suggests that listeners and readers educate themselves about gestational diabetes; get more details about individual circumstances and treatment options, know the short term and long term risks and consult with specialists and diabetic educators.
Mamas on Bedrest: The Skinny on Low Glycemic Index Diets and Gestational Diabetes
December 5th, 2011
Gestational Diabetes is on the rise and is increasingly the cause of excessive weight gain during pregnancy, difficult delivery and injury during delivery to both mother and baby. According to a MedScape Reference Article,
“Abnormal maternal glucose regulation occurs in 3-10% of pregnancies, and gestational diabetes mellitus (GDM), which is defined as glucose intolerance of variable degree with onset or first recognition during pregnancy, accounts for 90% of cases of diabetes mellitus (DM) in pregnancy. However, the rising prevalence of diabetes mellitus—21 million people (7% of the population) have some form of diagnosed diabetes; another 6 million people may be undiagnose —particularly type 2 among women of childbearing age in the United States, has resulted in increasing numbers of pregnant women with preexisting diabetes. Currently, type 2 diabetes mellitus accounts for 8% of cases of diabetes mellitus in pregnancy, and preexisting diabetes mellitus now affects 1% of all pregnancies.”
Scientists at the University of Sydney in Sydney Australia have done extensive research into glucose metabolism and have been at the forefront of the Low Glycemic Index research. Through their research, they discovered that not all foods and in particular not all carbohydrates, are metabolized equally. While some foods, proteins for example, are metabolized slowly requiring more time to be broken down resulting in a steady release of energy (sugar) into the blood stream, other foods are very rapidly broken down (simple sugars such as those in processed foods), causing spikes in blood sugar levels and stressing the body to rapidly remove the excess blood sugar from the blood stream. Much of their work is posted on a very useful website called The Glycemic Index.
Jennie Brand-Miller, PhD is one of the leading experts on the Glycemic Index. She and her colleagues at the University of Sydney conducted a study to determine if a low glycemic index (LGI) diet could have an impact on pregnant women’s glucose metabolism (reducing sugar spikes and insulin resistance) and hence lower their chances of developing gestational diabetes and the associated complications for mothers and babies. They compared a LGI Diet with a High Fiber Diet in 99 pregnant women diagnosed with Gestational Diabetes between 20 and 32 weeks gestation. They assigned the women to one of two healthy diets containing similar proportions of protein, fat and carbohydrate — but one with a low glycemic index (target GI <50) and the other with a high-fiber (HF) content and moderate GI (target GI ~60).
The researchers found that fewer women gained excessive weight on the LGI diet (25%) than the HF diet (42%), and fewer needed insulin treatment (53% vs. 61%). However, newborn outcomes were virtually the same in both groups. Mean birth weight in both arms was 3.3 kg (7.26 lbs), the rate of macrosomia (excessive nutrient {fat} storage in the infant) was 2.1% with the LGI diet compared to 6.7% on the HF diet. While these differences were noted, they were not statistically significant, and hence the researchers concluded,
“this randomized controlled trial of an LGI diet versus a conventional high-fiber diet found no differences in key pregnancy outcomes in GDM.”
While its easy to appreciate the scientific method behind their conclusions, I respectfully disagree and hope that people (pregnant women at risk for or who may have developed gestational diabetes) won’t read this information and essentially “toss all caution to the wind”.
Often in science a finding is given value only if it shows a statistical significance. This means that there has to be a specific, measurable numeric difference between that which is manipulated in the study and the control to make the results relevant. While that makes sense in many cases, (in a medication trial for example with no measurable benefits and potential negative effects should not be prescribed!), should all “scientific” findings be evaluated this way? This question becomes important in this case when we look at the findings of the study. Women who were put on the LGI diet were less likely to gain excessive weight and were less likely to require insulin. Yet, because the birth outcomes of the babies didn’t yield significant differences, they authors seem to say, “there is no value in following a LGI diet if you are pregnant and at risk of developing gestational diabetes.
That’s where things get sticky. It is well known that it isn’t safe for mothers to gain excessive weight during pregnancy as the excess weight can lead to complications such as Gestational Diabetes, dysfunctional labor and labor and delivery complications (especially in the case of cesarean sections). So if there is a method, essentially a lifestyle change, that can help mothers curb excessive weight gain which would lead to a reduction in these outcomes, which is non-toxic to mothers and their babies, even though there is no guarantee that babies won’t store excess fat, why not at least try it? Additionally, mothers who followed a LGI diet were less likely to require insulin. Isn’t that a good enough reason to recommend a LGI diet for women at risk?
Science is a good thing and it’s a good thing to make medical recommendations based on well designed, evidence-based research. However, we cannot become so rigid in our thinking and “throw the baby out with the bath water” when the science shows promise, but the numbers are not “statistically significant.” In my opinion, if a woman is at risk for developing gestational diabetes or has been diagnosed with gestational diabetes, I think that she should be educated about the glycemic index and counseled to make low glycemic food choices.
If you are a mama on bedrest and want to learn more about making the Glycemic Index and following a LGI diet, sign up for our Complimentary 30 min Bedrest Breakthrough Session. It’s a way to learn the basics Low Glycemic eating and foods and products we’ve found to be helpful in maintaining a low glycemic diet. To schedule your complimentary consultation, share a comment below or send an e-mail to info@mamasonbedrest.com.
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Mamas on Bedrest: Lifestyle Counseling May Improve Some Pregnancy Outcomes
June 2nd, 2011
Lifestyle Counseling May Improve Some Pregnancy Outcomes is the title of a Medscape continuing education module that I just completed. I am a staunch advocate of lots of support and education during pregnancy, so to see my belief somewhat validated was heartening to say the least.
In this particular study, Finnish researchers sought to determine if antenatal counseling of pregnant women at risk for developing Gestational Diabetes Mellitus (GDM) in mamas, reduce the birth weights in newborns born to mothers at risk for GDM and effect ( avoid adverse) outcomes. 2271 Finnish women were enrolled in the study and screened with oral glucose tolerance tests between 8 and 12 weeks gestation. Women in the intervention group received individual intensified counseling regarding physical activity, diet, and weight gain at 5 antenatal visits.
The researchers found that intense counseling regarding diet, exercise and weight gain was effective in controlling birthweight of the newborns, but did not have an effect on whether or not a mother developed GDM. The authors concluded,
“Results from ongoing clinical trials may strengthen the evidence on the effectiveness of lifestyle modifications on maternal and fetal hyperglycemia and its consequences,” the study authors conclude. “The findings of our study emphasize counseling on the topics of physical activity, diet, and weight gain in maternity care especially for women at risk for GDM in order to prevent LGA newborns possibly causing problems in delivery, and both the mother’s and the child’s later weight development.”
So while the authors did not reach their desired endpoint, lowering the incidence of gestational diabetes in women at risk, they did learn that counseling could in fact reduce the incidence of Large for Gestational Age infants and hence potentially reduce incidence of problems during delivery for both mother and baby.
Many researchers may read this study and conclude, “since there was no effect on incidence of GDM, then there is really no need to emphasize diet, exercise and weight management” during pregnancy. And it is with this attitude that I disagree. It has been my experience that women who are given no guidelines regarding their diets, how to exercise safely during pregnancy and counseled about appropriate weight gain during pregnancy do fare better and have fewer complications. I don’t have specific numbers so I cannot say that the results are statistically significant, but I have seen these results anecdotally. I prefer to educate pregnant women about their pregnancies and what they can do to make their pregnancies a little easier; to ease the nausea, pain and/or aches associated with pregnancy, to sleep better and to prepare as best possible for potential complications.
Many may argue that there is little evidence that counseling or coaching has any effect on a high risk pregnant woman, her pregnancy or her baby and that I am potentially coming between a pregnant woman and her health care provider. However, the women that I have had the opportunity to work with have been pleased and thankful to have someone with whom they can reach out to at all hours (via e-mail) and pose even those “silly questions”. They appreciate having someone who can point them to resources for more information and for many of the services that they may need.
If it takes a village to raise a child, I believe it takes that same village to support the mama who is going to give birth to that child. It’s in everyone’s best interest to ensure that pregnant women have all of the health care , support and resources that they need to have successful, uncomplicated (as much as possible) pregnancies and healthy babies. We are all working towards the same goal, so let’s all work together to make it happen.
If you are pregnant, particularly if you are on bed rest and want to know what you can do to positively effect your situation, schedule a Complimentary 30 Minute Bedrest Breakthrough Session. It’s free and accessed by e-mailing info@mamasonbedrest.com.
The full Finnish study is available at icine.
