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Women at Increased Nutritional Risk During Pregnancy 69
●● perinatal mortality required. Maintaining these levels throughout
pregnancy will reduce the risk of miscarriage,
●● postnatal adaptation problems such as congenital malformation, stillbirth and
hypoglycaemia. neonatal death. It is important to explain that
risks can be reduced but not eliminated (NICE
A recent study suggests that hyperglycaemia 2008c).
during pregnancy is associated with an increased
risk of childhood obesity at 7 years of age (Hillier Adolescents
et al. 2007).
The UK has one of the highest rates of teenage
Gestational diabetes pregnancy in Europe. Studies have shown that
The risk factors for gestational diabetes are: teenage pregnancy is associated with:
●● BMI >30 ●● lower gestational weight gain
●● previous macrosomic baby (4.5 kg or above) ●● an increased risk of low birthweight
●● previous gestational diabetes ●● pregnancy-induced hypertension (PIH)
●● family history of diabetes (first-degree relative ●● preterm labour
with diabetes)
●● iron-deficiency anaemia
●● family origin with a high prevalence of diabetes,
such as South Asian (specifically women whose ●● maternal mortality.
country of family origin is India, Pakistan or
Bangladesh), black Caribbean or Middle Eastern Nutritional status at conception is more likely to be
(specifically women whose country of family suboptimal as the diets of teenagers in the UK are
origin is Saudi Arabia, United Arab Emirates, poor. National Diet and Nutritional Surveys have
Iraq, Jordan, Syria, Oman, Qatar, Kuwait, shown that a large percentage of teenage girls have
Lebanon or Egypt). inadequate intakes of vitamin A, riboflavin, folate,
calcium, iron and zinc. Blood tests showed low
Women with any one of these risk factors should be blood levels of iron, folate and vitamin D (Gregory
offered testing for gestational diabetes (NICE et al. 2000, Nelson et al. 2007).
2008b).
Factors influencing poor dietary intakes in
In most women, gestational diabetes will teenage girls include:
respond to changes in diet and physical activity.
NICE (2008c) recommend that women with ●● making own independent food choices
gestational diabetes:
●● finalizing their autonomy and rejecting family
●● should receive dietary advice including meals and family food values
choosing low glycaemic index carbohydrates
●● high intake of high-calorie, low-nutrient foods
●● take moderate exercise of at least 30 minutes such as sweet drinks and junk foods
daily
●● dieting to manage weight – 16 per cent of 15–18
●● are advised to restrict calorie intake (to 25 kcal/ year old girls (Gregory et al. 2000)
kg/day or less) if their pre-pregnancy BMI is
above 27 (a registered dietitian can give this ●● following vegetarian diets without substituting
advice) alternative sources of iron when meat is
eliminated
●● should aim to keep fasting blood glucose
between 3.5 and 5.9 mmol/L and one-hour ●● low intake of milk and milk products.
postprandial blood glucose below 7.8 mmol/L.
Oral hypoglycaemic agents or insulin may be Adolescent girls may have increased nutritional
requirements because they need to complete their
own growth as well as providing for the fetus
