妊娠糖尿病營養建議

Dietary Recommendations and Food Choices for Gestational Diabetes Mellitus

妊娠糖尿病(gestational diabetes mellitus, GDM)是妊娠期間最常見的併發症，曾診斷GDM的女性會提高往後發展為第2型糖尿病(type 2 diabetes, T2DM)的風險，且易導致新生兒高出生體重使生產時難產風險增加與新生兒低血糖等情形發生。飲食控制及孕期適當體重增加為GDM之控制重點，2022年美國糖尿病學會(American Diabetes Association)指南建議GDM的婦女應接受個別化的專業營養醫療建議，以達到孕期良好的血糖與體重控制。

遵循美國醫學研究院(Institute of Medicine, IOM)指引建議孕前體重過輕、正常、超重和肥胖女性總體重增加應分別為12.5-18 kg、11.5-16 kg、7-11.5 kg和5-9 kg。飲食中醣類是對餐後血糖影響最大的因素，醣類食物攝取應質重於量，建議選擇富含膳食纖維食物，且醣類攝取應平均分配於全天餐次含點心中，避免過量導致餐後高血糖，須注意每日醣類攝取量不少於175g/天，孕前體位肥胖婦女亦遵守此原則。蛋白質可幫助胎兒肌肉組織與各器官發育，依據國人膳食營養素參考攝取量(Dietary Reference Intakes, DRIs)第8版建議孕婦孕期每日需額外增加10g蛋白質，鼓勵以黃豆製品、魚、蛋、瘦肉類等優質蛋白質為攝取來源。脂肪以植物性烹調用油為主，針對罹患心血管疾病或高三酸甘油酯的高危險群婦女，鼓勵每週至少攝取2-3次海魚，以增加n-3多元不飽和脂肪酸攝取。維生素礦物質需求可參考一般懷孕女性攝取標準，依據台灣第8版DRIs建議孕期間葉酸、碘、鐵質、鈣的需求增加，除食物獲取外亦可由營養補充劑補充達到建議量。本文整理妊娠糖尿病飲食指引也針對食物搭配與備餐技巧給予建議，希望能有助於醫護人員在臨床GDM照護工作促進對營養衛教原則的認識。

 

Gestational diabetes mellitus (GDM) is a major complication during pregnancy. Pregnant mothers with GDM tend to have increased risks of developing Type 2 diabetes; their newborns would also have a greater probability of high birth weight and dystocia. The 2022 American Diabetes Association guidelines suggest that personalized medical nutrition therapy can improve blood glycemic control during pregnancy while maintaining adequate weight gain and proper nutritional status.

Based on guidelines of the Institute of Medicine, total weight gain of underweight, normal, overweight, and obese women before pregnancy should be maintained at a range of 12.5-18 kg, 11.5-16 kg, 7-11.5 kg, and 5.5-9 kg, respectively. Carbohydrates in the diet are the major contributor to postprandial blood sugar. A diet rich in dietary fiber and the quality of carbohydrate intake appears to be important in maintaining blood sugar control. Evenly distributed carbohydrate intake among meals and snacks throughout the day may help avoid excessive postprandial hyperglycemia. At least 175 g/day of total carbohydrate intake, even in obese women in pre-pregnancy, is recommended. Protein is essential for the development of fetal muscle and various organs. According to the 8th edition of the Dietary Reference Intakes (DRIs), pregnant women need an additional 10g of protein per day during the second-third trimester of pregnancy. Soy products, fish, eggs, lean meat, and other high-quality protein sources are encouraged. Sources of fat should primarily be mono- and poly-unsaturated, such as vegetable oil. For those with a higher risk of cardiovascular disease or hypertriglyceridemia, consumption of sea foods or fish should be at least 2-3 times a week to increase the intake of n-3 fatty acids. According to Taiwan’s DRIs (8th edition), the folic acid, iodine, iron, and calcium requirements during pregnancy are increased, and nutritional supplements may be used to achieve the recommended amounts. This article summarizes the dietary recommendations and provides suggestions on food arrangement and meal preparation skills, hoping to equip healthcare professionals with a better understanding of the nutrition and education principles for GDM.