Once you fall pregnant it’s important to continue to maintain the best health that you can. This includes having safe blood sugar levels and a diet high in nutrients.
The first trimester is usually plagued with horrible morning sickness, in an analysis of 800 normal pregnancies, 90% of women reported some sort of nausea and/or vomiting.
Up to 3% of pregnancies are effected by a type of severe morning sickness, called hyperemesis gravidarum, resulting in weight loss from incessant vomiting. Hyperemesis gravidarum usually requires medical management and close monitoring, particularly in women with diabetes.
Morning sickness can increase risk of diabetic ketoacidosis (DKA) in women who take insulin, so it’s important to ensure you have a sick day plan in place - chat to your diabetes team about this. Finding foods that you can tolerate (such as dry crackers), maintaining optimum insulin doses, as well as, regularly monitoring your blood glucose and ketone levels are important in the prevention of DKA. DKA can occur at lower blood glucose levels (BGLS) in pregnancy than in non-pregnant women, so it is important to be extra vigilant.
With so many hormonal changes it can be hard to keep blood sugar levels under control in the first trimester. Often women require less insulin in their first trimester, and an increased amount towards the end of the second and during their third trimester. Regular appointments with you diabetes team are important to monitor your diabetes, as you’ll probably require frequent insulin dose adjustments.
During pregnancy it’s also important to choose the most nutritious foods, to help your baby grow. It’s a myth that you need to ‘eat for two’, as this could lead to excess weight gain, and increased risk of complications. On the flip side, strict dieting and restriction is not a good idea, as this could be dangerous for the unborn baby. It’s recommended that most healthy weight women gain around 11-16kgs during pregnancy, with most of this weight gain occurring in the third trimester. Women who are overweight (BMI >25kg/m2) need to gain a little less (7-11kgs).
Healthy weight women don’t need any extra calories in their first trimester, and only need approximately 350-450 calories more each day during their second and third trimester (that’s equal to 1 handful of nuts and a piece of fruit). Your dietitian can advise you on the appropriate balance of carbohydrates, protein, and fats to help manage your blood glucose levels, whilst getting the best nutrition. As you’ve probably guessed, your requirements are not hugely different a pre-pregnancy healthy diet.
It is important to observe good food hygiene during pregnancy including regular handwashing and avoiding foods that have a high risk of containing bacteria, such as listeria. Ensure meat, fish, chicken and eggs are well cooked, all dairy and juices are pasteurised, observe safe food storage times and wash fruit and vegetables well before eating. Check local government websites in your area, for specific location recommendations.
Pregnancy is a wonderful time, but what can often be confronting changes to your body and diabetes can be well managed with your diabetes team, with a little planning and self-monitoring.
Please see the following articles for more information: