Diabetic Pregnancy Meal Exchange List

Much of what we eat is chemically broken down into glucose, which moves through the blood into the cells where it is used as an energy source. Diabetes is the inability of the body to move glucose into its cells; the glucose goes unabsorbed, it backs up and the blood glucose levels elevate. In pregnancy, diabetes is a significant factor to be managed or severe risks are posed to both mother and infant.

Two Types of Diabetes

• In Type 1 diabetes, also known as juvenile onset diabetes mellitus, the body produces little or no insulin, a hormone needed to usher glucose to its cellular destinations. Insulin injections are typically needed to manage the condition. In Type 2 diabetes, known as adult onset diabetes and accounting for 90 percent of all diabetic patients, the body produces its own insulin but the cells have developed an insulin resistance so, once again, the glucose in the bloodstream does not reach its cellular destinations and elevated blood glucose levels result. Unmanaged diabetic illness, be it Type 1 or 2, can wreak major havoc over time leading to stroke, heart and kidney disease, blindness and other devastations. Thankfully, these can all be forestalled, even averted. Proper dietary management is the first line of defense.

Gestational Diabetes

• There are diabetics who become pregnant and there are other women whose diabetes manifests only during pregnancy; upon delivery or shortly thereafter the diabetes resolves. This is gestational diabetes and these patients are at risk for Type 2 onset within 10 to 20 years after the baby's birth. For either patient type, a diabetic pregnancy poses serious risks. Early unmanaged high blood glucose levels in pregnancy are associated with a 30 percent to 40 percent chance of birth defects. Proceeding through the trimesters, elevated blood glucose levels can lead to large birth weights complicating delivery. The mother whose diabetes is poorly controlled is at risk for diabetic retinopathy, nephropathy, severe blood glucose drops resulting in confusion or coma and preeclampsia in which there is swelling, excess protein in the urine and surges of high blood pressure. Unchecked, preeclampsia can lead to maternal and fetal death.

Blood Glucose Control

• Dietary choices are a cornerstone of diabetes management, along with exercise, insulin shots or oral medication if indicated, and frequent blood glucose checks throughout the day. A meal-planning tool known as the Diabetic Food Exchange (also called the Diabetic Exchange List), put together by the American Diabetes Association and American Dietetic Association, helps diabetics plan nutrient balance and limit carbohydrates, thereby keeping blood glucose levels in a normal range.

The Diabetic Food Exchange

• Specifically, this meal planning tool consists of six lists of like foods―alike in possessing approximately the same amount of carbohydrates, protein, fat and calories. All items per list are interchangeable―exchangeable―and thus called "exchanges." The six lists consist of starches, meat (or protein), vegetables, fruits, milk and fat. The diabetic patient's individually tailored meal plan calls for X number of exchanges from each list per meal and per snack.

Fiber, Fiber, More Fiber

• In a 2008 study performed at the Swedish Medical Center in Seattle, Washington, researchers assessed the relationship between fiber intake in early pregnancy and related risk of preeclampsia and found that "dietary total fiber intake was associated with reduced preeclampsia risk." However, note it is specifically soluble fiber (as opposed to insoluble fiber) that is understood to lower blood lipid levels and improve blood glucose control. Good sources of soluble fiber include black-eyed peas, dry or cooked oat bran, cooked oatmeal, kidney beans, pinto beans, split peas, butter beans, lentils, fresh peas, baked potato with skin, brussels sprouts, corn, zucchini, prunes, apricots, bananas, blackberries, barley, nuts, seeds, spinach, broccoli, figs, papaya and artichokes.

Every Pregnancy is Different

• The Diabetic Food Exchange serves as a framework within which a diabetic pregnant woman might devise meal plans tailored to her needs and tastes. As there are many variables to manage, she is well advised to consult with a dietitian. The American Dietetic Association (www.eatright.org) has a "Find a Nutrition Professional Consumer Search" tool in which one finds a qualified counselor to work with. Having drawn up her personalized meal plan, fitness goals and blood glucose-testing schedule, a diabetic mom can have the same expectations of her pregnancy as any other pregnant woman.