Poster Presentation Australasian Diabetes in Pregnancy Society Annual Scientific Meeting 2019

Nutrient intake, carbohydrate counting and self-management skills in pregnant women with Type 1 Diabetes Mellitus (#56)

Julia Martin 1 , Danielle Wilton 1 , Katie Wynne 2 3
  1. Department of Nutrition & Dietetics, John Hunter Hospital, Newcastle, NSW, Australia
  2. Department of Diabetes & Endocrinology, John Hunter Hospital, Newcastle, NSW, Australia
  3. School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia

Background Optimal nutrition is crucial in women with T1DM during pregnancy. Adequate knowledge, carbohydrate counting and diabetes self-management tools enable women to reach recommended nutritional goals and glycaemic targets.1

Aims To establish the nutritional profile and carbohydrate counting skills in a prospective cohort of pregnant women with T1DM attending the John Hunter Hospital antenatal clinic.

Methods Data was collected using the Cancer Council Food Frequency Questionnaire2 and a standardised questionnaire of diabetes knowledge including carbohydrate counting. Medical history and anthropometric data were collected from the electronic health record.

Results Twenty-five consecutive women attending with T1DM were included, aged 25.6±5.4 years, with BMI 27.1±4.8kg/m2. At the time of data collection they were 19.3±9.4 weeks gestation. Eight patients (32%) reported they had not received education with a dietitian or diabetes education prior to pregnancy. Five women (20%) could not define the hypoglycaemic threshold.

When given a standard nutritional information panel, five women (21%) could not identify the serving size and six women (25%) could not calculate the number of carbohydrate exchanges. Given a list of thirteen types of food, only three foods were correctly identified by all participants to contain carbohydrate (bread, lettuce, chips) and only one participant could identify the correct number of carbohydrate exchanges in the three test foods (milk, Weetbix and diet coke).

Dietary data demonstrated the women consumed less than recommended amounts of carbohydrates (39%vs.45-65%), but consumed excessive sugar (17%vs.<10% total energy), fat (41%vs.20-35%) and saturated fat (16%vs.≤10%) as a proportion of their total energy intake. The participants did not meet Nutrient Reference Values3 for intake of fibre, calcium, iron or folate.

Conclusions Diabetes self-management skills and the nutritional intake of pregnant women with T1DM require further study.4 Despite clear nutritional deficits, these participants did not wish to engage with a dietitian (75%) and felt they had adequate education (96%). Improving self-management skills requires a multidisciplinary team with embedded dietary input.

 

  1. McElduff A, Cheung NW, McIntyre HD, Lagström JA, Oats JJ, Ross GP, Simmons D, Walters BN, Wein P and Australasian Diabetes in Pregnancy Society (2005). The Australasian Diabetes in Pregnancy Society consensus guidelines for the management of type 1 and type 2 diabetes in relation to pregnancy, Medical Journal of Australia, 183(7): 373–377.
  2. Hodge A, Patterson AJ, Brown WJ, Ireland P and Giles G (2000). The Anti Cancer Council of Victoria FFQ: relative validity of nutrient intakes compared with weighed food records in young to middle-aged women in a study of iron supplementation, Aust NZ J Public Health, 24(6):576-83.
  3. https://www.nrv.gov.au/resources/nrv-summary-tables Accessed 24th May 2019.
  4. Neoh SL, Grisoni JA, Feig DS, Murphy HR; CONCEPTT Collaborative Group (2019). Dietary intakes of women with Type 1 diabetes before and during pregnancy: a pre-specified secondary subgroup analysis among CONCEPTT participants, Diabet Med, Feb 20 [Epub ahead of print].