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What to Eat When You're Pregnant and Vegetarian : Common complaints and how to deal with them - Gestational diabetes, Pre-eclampsia

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Gestational diabetes

This is a temporary form of diabetes that affects about 5% of pregnant women. It develops when hormones from the placenta interfere with insulin, the hormone that regulates blood sugar levels. As a result, the level of glucose or sugar in your blood can rise and dip steeply. You are more likely to develop gestational diabetes mellitus (GDM) if you have a family history of diabetes, have had a very large baby before, have a BMI over 30, or are of South Asian, black Caribbean or Middle Eastern origin.

Gestational diabetes is usually detected at 24–28 weeks of pregnancy. The first sign is likely to be glucose in your urine. A single positive test is not generally seen as a cause for concern. But if glucose is found on several occasionss, or if you are at high risk of GDM, you may be given an oral glucose tolerance test (OGTT or GTT). This involves having a blood test before breakfast and another two hours later after having a glucose drink.

Women who develop the condition, like those who have diabetes before pregnancy, are likely to have bigger-than-average babies. This is because the baby receives more glucose, and therefore more calories, than normal. This in turn increases the likelihood of problems during delivery, including the need for a caesarean. If blood sugar levels aren’t controlled, it can also affect the development of a baby’s heart and lungs and increase their chances of developing obesity and diabetes in later life. However, if the condition is controlled carefully, it should not harm you or your baby.

To combat the effects of gestational diabetes, you need to keep your blood sugar levels as stable as possible so that the baby doesn’t receive extra glucose. This can be done by changing what you eat and exercising more, which isn’t always easy. The most important thing is to avoid high-sugar foods and drinks, including fruit juices, and to have low-GI carbohydrates whenever possible . Some people may need extra insulin. If you have gestational diabetes, you will be given more frequent antenatal appointments to check that you and your baby are both well. You should also receive advice about what to eat and how to monitor your blood glucose levels.

After the birth, the condition usually goes away completely. Both you and your baby will have your blood glucose levels checked after delivery. Unfortunately, having GDM during one pregnancy increases the chances of developing it in future pregnancies, particularly if you are overweight. Also, according to Diabetes UK, women with GDM have a 30% chance of developing Type 2 diabetes at some time during their life, compared to a 10% chance in the general population.

Pre-eclampsia

This is a potentially serious pregnancy disorder characterised by high blood pressure, swelling due to fluid retention and protein in the urine. Other symptoms may include headaches and blurred vision. An estimated one in 20 pregnancies is affected. You are more likely to develop pre-eclampsia if you are severely overweight, aged over 40 or expecting more than one baby, or if any of your close relatives has had it.

Mild cases of pre-eclampsia have no significant effect on pregnancy, but if the condition isn’t treated, it can progress to a more serious condition called eclampsia. Severe cases can result in convulsions and, very occasionally, death. However, drugs can usually be given to treat the symptoms of pre-eclampsia and, if necessary, the baby will be delivered early.

A good diet appears to reduce the risk of pre-eclampsia. When the medical records of 775 mothers living in a vegan community in Tennessee were examined, only one case of pre-eclampsia was found (0.1%). This is much lower than expected and is probably related to the women’s healthy balanced diet, multivitamin and mineral supplement intake, and generally healthy lifestyle. Research has also shown that pre-eclampsia is less common in women with higher intakes of antioxidants. Having a healthy diet, rich in vitamins C and E, appears to be particularly important, although vitamin C and E supplements do not have the same effect. Multivitamin and mineral supplements might, however, help prevent pre-eclampsia, according to another study. It has also been found that calcium supplements may help protect against pre-eclampsia for women who have low intakes of calcium. This is another good reason to make sure you get enough calcium.

Research has also looked at whether garlic and chocolate might reduce the incidence of pre-eclampsia. It is thought that garlic may help by lowering blood pressure, but findings have been inconclusive. In 2010, the media reported that eating chocolate halved the risk of premature birth, because it prevented pre-eclampsia. However, these claims weren’t backed up by the evidence. It does seem plausible that chocolate might reduce the risk of pre-eclampsia, as studies in the past have shown dark chocolate may reduce the risk of heart disease, possibly by lowering blood pressure. A study from the USA found that women who ate chocolate at least once a week during pregnancy reduced their risk of pre-eclampsia by 50%. This sounds pretty convincing but it may be a case of ‘reverse causality’ – maybe women with pre-eclampsia eat less chocolate because of their diagnosis, rather than women who eat less chocolate getting pre-eclampsia more often. Cause and effect couldn’t be differentiated in the study.

Foods to kick-start labour – or not

If your due date comes and goes and nothing seems to be happening, it can be very frustrating, particularly if family and friends start calling to see what’s happening. There are many myths and old wives’ tales about what you can do to kick-start labour – some of the ideas are more pleasant than others. When it comes to diet, there are several suggestions:

  • raspberry leaf;
  • evening primrose;
  • pineapple;
  • curry.

Raspberry leaf is thought to be a uterine stimulant which helps strengthen the muscles of the womb, so that contractions are more effective and labour is easier. Several trials have been carried out, including an Australian study in which women were given either two raspberry leaf supplements (1.2g each) or two placebo tablets a day from 32 weeks of pregnancy. It was found that the second stage of labour (pushing the baby out) was 10 minutes shorter in the group who took raspberry leaf. They also had a lower rate of forceps delivery (19% versus 30%). However, they didn’t go into labour any sooner.

Although raspberry leaf doesn’t seem to bring on labour, the general advice is not to take it until you are at least 32 weeks’ pregnant. You should also talk to your midwife first as it isn’t suitable for everyone and probably isn’t a good idea if you’ve previously had quite a quick labour, you’re expecting twins or you’ve had problems such as high blood pressure or vaginal bleeding. If you do decide to give it a try, you can either drink raspberry leaf tea or, if you don’t like the taste, take raspberry leaf tablets or capsules.

Some women take evening primrose supplements, or use them vaginally, to kick-start labour. Although some people swear by them, because they took them and went into labour, there is no objective evidence that they are more effective than just waiting. The National Institute of Health in the US advises pregnant women not to take evening primrose oil because, although evidence is inconclusive, it could possibly increase the risk of complications.

Fresh pineapple could theoretically help, as it contains an enzyme called bromelain, which breaks down proteins. In a highly concentrated form, bromelain is used to treat inflammation. Taking bromelain tablets or capsules during pregnancy is not recommended, however, as it may cause abnormal bleeding. However, some alternative therapists may recommend them at the end of pregnancy to help soften and dilate the cervix, although there is no evidence that this is effective. To get enough bromelain from fresh pineapple to have any possible effect, you would need to eat between seven and ten whole fresh pineapples at one sitting. Tinned pineapple and pineapple juice contain little or no bromelain.

The final strategy, eating curry, has the greatest potential for getting things moving, but only if it is so hot that it causes discomfort and acts as a strong laxative. Then it could have the same effect as castor oil, which has been used for centuries to kick-start labour. It is thought that when the gut is stimulated, it in turn stimulates the uterus to cramp and spasm, thereby bringing on labour. Castor oil contains ricinoleic acid, or ricinic acid, which irritates the small intestine and has a strong laxative effect. One American study found that after a 60ml dose, 58% of women started labour within 24 hours, compared with just 4% of untreated women. However, this was just a small study, and self-treatment is not recommended. Castor oil can result in severe nausea and cramps, persistent diarrhoea, dehydration and other complications. If you want to try castor oil or an extremely hot curry, it is important to talk to a doctor or midwife first. They will be able to advise you according to your medical history, the position of your baby and the condition of your cervix.

There are other non-dietary strategies that might help and are less likely to have unpleasant side-effects, including sex, nipple stimulation or an alternative therapy such as homeopathy or acupuncture.

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