Clin Nutr Res.  2016 Oct;5(4):305-309. 10.7762/cnr.2016.5.4.305.

In-depth Medical Nutrition Therapy for a Woman with Diabetes: From Pregnancy to Delivery

• Jang M
• Ju DL
• Kweon M
• Park M

• KMID: 2355302
• DOI: http://doi.org/10.7762/cnr.2016.5.4.305

Abstract

Diabetes in pregnancy is associated with higher rates of miscarriage, pre-eclampsia, preterm labor, and fetal malformation. To prevent these obstetric and perinatal complications, women with diabetes have to control levels of blood sugar, both prior to and during pregnancy. Thus, individualized medical nutrition therapy for each stage of pregnancy is essential. We provided in-depth medical nutrition therapy to a 38-year-old pregnant woman with diabetes at all stages of pregnancy up to delivery. She underwent radiation therapy after surgery for breast cancer and was diagnosed with diabetes. At the time of diagnosis, her glycated hemoglobin level was 8.3% and she was planning her pregnancy. She started taking an oral hypoglycemic agent and received education regarding the management of diabetes and preconception care. She became pregnant while maintaining a glycated hemoglobin level of less than 6%. We provided education program for diabetes management during the pregnancy, together with insulin therapy. She experienced weight loss and ketones were detected; furthermore, she was taking in less than the recommended amount of foods for the regulation of blood sugar levels. By giving emotional support, we continued the counseling and achieved not only glycemic control but also instilled an appreciation of the importance of appropriate weight gain and coping with difficulties. Through careful diabetes management, the woman had a successful outcome for her pregnancy, other than entering preterm labor at 34 weeks. This study implicated that the important things in medical nutrition therapy for pregnant women with diabetes are frequent follow-up care and emotional approach through the pregnancy process.

Keyword

Diabetes in pregnancy; Individualized medical nutrition therapy; Ketones; Glucose control

MeSH Terms

Abortion, Spontaneous
Adult
Blood Glucose
Breast Neoplasms
Counseling
Diagnosis
Education
Female
Follow-Up Studies
Hemoglobin A, Glycosylated
Humans
Insulin
Ketones
Nutrition Therapy*
Obstetric Labor, Premature
Pre-Eclampsia
Preconception Care
Pregnancy*
Pregnant Women
Weight Gain
Weight Loss
Blood Glucose
Insulin
Ketones

Reference

1. International Diabetes Federation. Global guideline on pregnancy and diabetes. Brussels: International Diabetes Federation;2009.

2. Ray JG, Vermeulen MJ, Meier C, Wyatt PR. Risk of congenital anomalies detected during antenatal serum screening in women with pregestational diabetes. QJM. 2004; 97:651–653.

3. Kitzmiller JL, Buchanan TA, Kjos S, Combs CA, Ratner RE. Pre-conception care of diabetes, congenital malformations, and spontaneous abortions. Diabetes Care. 1996; 19:514–541.

4. Ray JG, O’Brien TE, Chan WS. Preconception care and the risk of congenital anomalies in the offspring of women with diabetes mellitus: a meta-analysis. QJM. 2001; 94:435–444.

5. Hadden D, Traub A. Outcome of pregnancy in women with insulin dependent diabetes. Centralisation of care leads to better outcome. BMJ. 1998; 316:550.

6. Hadden DR, Alexander A, McCance DR, Traub AI. Northern Ireland Diabetes Group. Ulster Obstetrical Society. Obstetric and diabetic care for pregnancy in diabetic women: 10 years outcome analysis, 1985-1995. Diabet Med. 2001; 18:546–553.

7. American Diabetes Association. 12. Management of diabetes in pregnancy. Diabetes Care. 2016; 39:Suppl 1. S94–S98.

8. Mahmud M, Mazza D. Preconception care of women with diabetes: a review of current guideline recommendations. BMC Womens Health. 2010; 10:5.

9. Rasmussen KM, Yaktine AL, editors. Institute of Medicine (US), Committee to Reexamine IOM Pregnancy Weight Guidelines. Weight gain during pregnancy: reexamining the guidelines. Washington (D.C.): National Academies Press;2009.

10. Leontos C, Geil PB. Individualized approaches to diabetes nutrition therapy: case studies. Alexandria (VA): American Diabetes Association;2002.