November is National Family Caregivers Month, a time to honour the myriad sacrifices caregivers make for their loved ones. Pregnant mums are one subset of caregivers whose charges directly rely on their food intake. In particular, those who suffer from gestational diabetes need a sound diet plan so they can take care of themselves, as well as their premature babies.
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The one thing family caregivers want for their loved ones: the best care possible. Yet that exceptional care rarely extends to caregivers themselves, even if they have their own health conditions to manage.
Caregivers may not have adequate time or bandwidth to manage their own health. Aligned with National Family Caregivers Month 2019’s theme, “#BeCareCurious”, HiDoc Pulse addresses nutrition, a simple aspect that impacts the health of give their energy to the wellbeing of those in their charge.
We invite Ms Suzanne Khor, a principal dietitian, to share her expertise on nutrition for mothers who are not only caregivers to their premature babies, but also recovering from gestational diabetes developed during their pregnancy.
Ms Khor, who practices at O&G The Women’s Medical Specialist, Mount Elizabeth Novena, is a principal dietitian with more than 18 years of experience. She works together with doctors and their patients to optimise patients’ nutritional needs. “Health outcomes are improved when a patient is receiving adequate nutrition, as compared to a patient whose nutritional needs are not being fulfilled,” she explains.
What are the most important components of a nutritional plan?
The most important factor to a successful nutritional plan is the input of the patient. Every individual has different nutritional requirements, medical conditions, lifestyle and diet preferences. So, a sound nutritional plan has to be individually tailored to be effective. It is not one-size-fits-all. “My philosophy is to work with each individual patient to discuss various aspects of their diet and lifestyle, to optimise their success and health. The readiness of an individual to commit to dietary changes is key to the success of any nutritional plan,” says Ms Khor.
She’s also found that teleconsultations, the use of telecommunication and information technology to provide clinical healthcare remotely, is a great way to stay attuned to the needs of those she consults with. It is discrete, appeals to mobile users, and is accessible to them at their convenience. Whether at home or at the office, teleconsultations allow patients to virtually consult with ancillary healthcare providers. “Some patients who are busy at work or at home resting during their pregnancy or taking care of their newborn may not be able to make time for a follow-up diet visit,” Ms Khor notes.
Follow-up visits are also very important as not only do health conditions change over time, but also nutritional needs and psychological states. The well-being of the mother needs to be regularly reviewed to ensure she is not distressed or worried due to her high sugar levels. Studies have indicated that high levels of the stress hormone cortisol in the pregnant mother may adversely affect the developing baby in terms of low birth weight, sleep problems or neurodevelopmental issues such as attention deficit hyperactivity disorder (ADHD).
“Teleconsultations provide convenience and peace of mind when the need to review your diet with your healthcare provider arises. Similarly, if you are overseas and are unfamiliar with the local food options on offer, teleconsultations are beneficial as you do not have to stress over your nutritional needs and ruin the work trip or holiday.”
What risks are posed to mother and child because of gestational diabetes?
Ms Khor has comprehensive knowledge in treating adults and children with nutritional problems, with gestational diabetes being a common cause of these problems.
Gestational diabetes pose complications for mother and child, as new and expecting mothers simply do not have enough time or resources to self-care. What awaits them after pregnancy is the double whammy of having to care not just for their babies, but also themselves to avoid developing even more serious health complications.
Gestational diabetes develops during pregnancy, usually between weeks 24 to 28, and if left untreated after delivery, could put you at risk of developing type 2 diabetes — which hampers the body’s ability to maintain normal sugar levels and has no cure.
Normally, when sugar enters your bloodstream after food has been digested, your pancreas produces insulin, a hormone that helps transport the sugar into the body’s cells to store as energy. Pregnancy impairs the function of insulin as the placenta — which provides oxygen and nutrients to your baby — produces high levels of hormones that raise the blood sugar level. For mothers suffering from gestational diabetes, their placenta causes such a spike in blood sugar that the wellbeing of the baby is compromised.
This is so as high sugar levels in the pregnant mother can result in higher insulin hormone levels in the developing baby, which increases fat deposits. What this leads to for the child is impaired glucose metabolism and insulin resistance. As the child is exposed to a higher level of glucose in the womb — due to the mother’s gestational diabetes — the likelihood of becoming overweight or obese is also higher for them as they grow older.
One other complication resulting from gestational diabetes is an elevated risk of premature delivery. High blood sugar in the bloodstream can cause macrosomia, meaning your baby grows to a size that’s significantly larger than the average baby. This might pose serious problems during delivery as the baby might become wedged in the birth canal and sustain birth injuries. Early delivery is sometimes opted for by the doctor to safeguard both the baby’s health as well as the mother’s.
Ultimately, mothers with gestational diabetes need to keep their glucose levels within a controlled range for optimal birth outcomes.
Good diets promote faster recovery for those with gestational diabetes
For optimal management of glucose whilst ensuring adequate nutrition to the baby and mother, women with gestational diabetes need to control their carbohydrate intake by maintaining a well-balanced diet.
The diet should be adequate in protein, calcium, iron and other vitamins and minerals. “My practice is to arrange a diet plan consisting of three main meals and three snacks throughout the day. The meal timings will be adjusted after taking into account the mother’s lifestyle and schedule,” Ms Khor explains.
What nutritional plans are best for children who are born prematurely?
Happily, gestational diabetes need not determine the future health and wellbeing of your child. With adequate nutrition and care, your baby can surmount the challenges brought on by the health condition. “For a premature infant, breast milk is still the best for the baby. Mothers who have given birth to a premature baby produce milk that specially meets the nutritional needs of the infant at that particular age. Luckily, Nature always finds a way to sustain life,” she smiles. To optimise the calories for an infant not putting on weight well, she may also recommend adding on special powders or oils to the breast milk to supplement it. “Education to the breastfeeding mother on the optimal diet to produce breast milk that’s beneficial to the baby is also crucial,” adds Ms Khor.
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