Question

Case Study 26-2: Military Wife with Gestational Diabetes Amelia Smith is a 31-year-old military wife referred to a registered dietitian after being diagnosed with gestational diabetes at 30 weeks of pregnancy. She is 65 inches tall and weighs 215 pounds. Her pre-pregnancy weight was 185 pounds. Her first child weighed 9 pounds 7 ounces at birth but she states she was never diagnosed with GDM during that pregnancy. She is on a limited budget and says she shops in bulk at the commissary. Meals often include pasta or rice. She drinks milk with breakfast only. Her RD calculates her daily kcalorie needs at 2000 kcalories. She is given a food plan that limits her carbohydrates to 30 grams at breakfast and 45 grams cach at lunch and dinner. She is also encouraged to eat 3 snacks a day and to limit the carbohydrates at snacks to 30 grams or less. She is also advised not to drink fruit juice and to restrict milk and fruit at breakfast. 1. Refer to Table 26-5 and Table 26-6. Plan a one-day menu for Amelia that stays within her carbohydrate goals and meets her other nutritional needs for pregnancy, including 3 servings of dairy foods, 3 cups of vegetables, and 2 servings of fruit. 2. What are some of the risks to Amelia's fetus if she is not able to control her blood sugar during pregnancy? 3. How would you counsel Amelia after delivery in order to decrease her risk for developing type 2 diabetes? MacBook Air

Answer 1

1. One day menu for Amelia:

	Menu	Carbohydrates in grams
Breakfast	whole wheat bread - 2 slice Boiled egg - 1 Non-fat plain Greek yogurt- 1/2 cup	30
Morning snack	Wheat crackers with cheese - 4	15
Lunch	Bread sandwich with Lettuce and tomato - 1 Boiled Mix veggies - 1 cup turkey - 3ounce Berries - 1 cup	45
Evening snack	Apple - 1 Popcorn with peanut butter - 3 cups	30
Dinner	Chicken breast - 3 ounces Baked potato - 1 Vegetable salad dressings with reduced-fat sour cream - 1 ounce Fat-free milk - 1 cup	45
Bedtime snack	Banana - 1/2 Nuts - 1 tablespoon	15

2. If Amelia does not control diabetes, then the fetus would have the risk of developing

• macrosomia
• preterm delivery
• respiratory distress
• development of congenital abnormalities
• perinatal complications
• fetal death

3. Usually, blood sugar returns to normal after 6 weeks of delivery. Try to maintain a healthy weight after delivery helps to reduce the risk of diabetes.  Follow regular exercise after delivery. Eat healthy foods of vegetables, fruits, whole grains, and lean protein. Follow healthy lifestyle practices. This will helps to reduce the risk of type 2 diabetes.