1. Nutrition During Pregnancy 1 Gestational Diabetes

2. 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. 2 Gestational Diabetes

3. 3 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.

4. Presenters 4 Suly Monreal, MS, RD Mable Everette, DrPH, RD

5. Presentation Focus 5 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.

6. 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.

7. 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.

8. Topics 8 What are the woman’s priorities? How can health care professional intervene and improve compliance?

9. Topics 9 Some recommended approaches for working with families Connecting families to community resources/improving food security

10. What are the woman’s priorities? 10 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.

11. What are the woman’s priorities? 11 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.

12. Interventions by health professional 12 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.

13. Interventions by health professional 13 Food Label Reading-what do the words mean? Practice meal planning for the entire family based upon recommended foods during gestational diabetes.

14. Recommended Family-Centered Approaches 14 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.

15. Recommended Family-Centered Approaches 15 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.

16. Food Security 16 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

17. Food Security 17 School Meals Programs Breakfast Lunch After school Emergency Food Assistance Food Banks Food Pantries

18. Food Security 18 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.

19. Food Security 19 Adult Food Program for impaired adults Women Infant and Children Program for low income women and children up to age 5 years.

20. Summarizing 20 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.