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					    Gestational Diabetes

        Nutrition During Pregnancy




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        Gestational Diabetes

    An important aspect of nutrition management
    of diabetes during pregnancy is prevention of
    excessive weight gain.
    The focus of Medical Nutrition Therapy is on
    the achievement of dietary and exercise goals.



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                Gestational Diabetes

     The American Dietetic Association’s Nutrition Care
     Manual (Nutrition Care Manual. org) noted that one of
     the nutrition goals for gestational diabetes mellitus is to :
     Improve health through nutrition recommendations that
      apply to all women during pregnancy.




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         Presenters


       Suly Monreal, MS, RD
     Mable Everette, DrPH, RD




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               Presentation Focus


    This summary places emphasis on factors to consider
    when working with pregnant women- low health literacy
    and/or English as a second language- who live in urban
    areas. Comments are based upon more than 15 years of
    nutrition-related work in the Los Angeles, CA area.




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     Food and Nutrition-Teaching Points


 Advice about food and nutrition should be centered
  around cultural food preferences as applicable.
 Provide suggestions regarding meal planning and food
  purchasing around the food needs of the entire family
  rather than just focusing on the individual pregnant
  woman.
 Remind the pregnant woman that even though the cost
  of food may be very expensive, the health of the new
  born baby, in part, depends on her healthy food choices.
          Exercise Teaching Points

 Encourage all of the family members to participate in the
  physical activities with the pregnant women.

 Plan physical activity per the Medical Doctor’s directive.


 If there are no restrictions, walking after each pre-scheduled
  meal would be recommended.
                           Topics

     What are the woman’s priorities?


     How can health care professional intervene and improve
      compliance?




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                          Topics

     Some recommended approaches for working with
     families

     Connecting families to community resources/improving
     food security




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     What are the woman’s priorities?

          1st priority is the concern for the family rather
           than her own health.
          Sometimes, the woman is the last to eat meals,
           after making sure that family members are fed
           first of all.
          If working outside of home, this may also change
           the focus from her own health and well-being.



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     What are the woman’s priorities?
        If working outside of the home, there may be
         limited food preparation at home– more eating
         meals at restaurants providing high fat, high salt
         and high sugar content.

        Even though the woman is considered the
         “gatekeeper” and the target of interventions; family
         concerns should still be considered.


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       Interventions by health professional


      Provide “taste testing” of recommended foods in order
       to improve acceptance.

      Have knowledge of the specific markets used for food
       shopping by families. Determine which grocery stores
       are marketing to low income clients .




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         Interventions by health professional



        Food Label Reading-what do the words mean?

        Practice meal planning for the entire family based
         upon recommended foods during gestational diabetes.




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               Recommended Family-Centered
                      Approaches

        Involve the men whenever possible-sometimes
         separate foods are provided for these family members.

        Focus on the nutrition and exercise improvement in
         the overweight child.




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       Recommended Family-Centered
              Approaches

      Reward the pregnant woman for health improvements-
       provide incentives i.e. plants, items for home gardening
       as vegetable seeds.

      Provide specific examples of exercises that can be done
       with other family members within safe surroundings.




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                        Food Security

     Food Security: The Federal Safety Net

      Programs that expand food sources for the entire family
      Provide lists of available resources in specific
       neighborhoods.
      Follow-up discussions to determine if resources are
       actually being utilized


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                       Food Security
      School Meals Programs
        Breakfast
        Lunch
        After school
      Emergency Food Assistance
        Food Banks
        Food Pantries



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                       Food Security
      Summer Food Program for Youth
       Free Lunch For Youth 18 and under.

      Food Stamps


      Child Care Food Programs-children up to age 12 in daycare
       settings.




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                      Food Security

      Adult Food Program for impaired adults


      Women Infant and Children Program for low income
       women and children up to age 5 years.




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                       Summarizing

      Educating low income women diagnosed with
       gestational diabetes should focus on the woman’s health
       and well being as well as health concerns of the entire
       family.
      Family concerns are a priority and should be a focus of
       health education efforts.




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