Macronutrients: Carbohydrates We have already covered protein and fats in your diet during the childbearing year, so let’s talk carbs.

The body’s fuel If fat and protein are building materials, carbohydrates are the ‘fuels’ we take in to sustain our body’s energy needs and to meet the demands inherent in the development of the fetus. Do we overfill our fuel tanks? Keep our tanks on empty? Or, erratically go from full to empty, thus crashing our blood sugar levels? All of these scenarios can be hard on our bodies and, potentially, hard on our kids, too—and not just because it may influence our mood and capacity for patience.

As we talk about nutrition during pregnancy as it relates to ‘fuel needs’, I’ll explain a bit about the physiological changes during pregnancy. In a healthy pregnancy there is an increase in insulin resistance and a corresponding increase in insulin production to accommodate this change. Insulin is released when blood glucose levels rise and its job is to stimulate cells to make use of the glucose. When all is in balance, this results in a stable pulse of nourishment to the maternal body and to the developing fetus. Glucose, when it’s available, is packaged up for efficient use and the blood levels maintain balance. When things are out of balance gestational diabetes can result, putting both the mother and the fetus at risk for health challenges.

The effect on the metabolism of you and your child In the presence of gestational diabetes, the mother’s body becomes increasingly ill-equipped to keep up with this insulin resistance (IR). Somewhere in the process, the compensation is not occurring. Meanwhile, the fetus is developing its own metabolic system during this time. If the fetus is adapting to something strange that is going on, its system may be set up for some challenges. We not only see high or low birth weights, which have implications of their own, but this “metabolic programming” could carry forward during your child’s life. (Tzanetakou, Mikhailidis, & Perrea, 2011)

We have been aware for some time that the rates of childhood obesity and obesity overall have been climbing in the US. Researchers have not only identified lifestyle and nutrition choices, effects of marketing and other factors as influences on children, but there has also been a fascinating area of research that relates to gene expression and intrauterine exposures to stress and diet that may also play a role in lifetime risk for children.

Maternal over-nutrition as well as under-nutrition during pregnancy can lead to a lifetime of increased susceptibility to metabolic disease for the child. This phenomenon is referred to as “metabolic programming” and researchers have found that the environment in utero can trigger the expression of genetic phenotypes for obesity, diabetes and inflammatory conditions.

Carbohydrates: What kind and how much? In an earlier blog post, I explored some of the research related to caloric targets and pregnancy, and cautioned against a too restrictive diet and a too excessive diet. We also discussed the potential benefits of creating a plan for those of us who may start pregnancy overweight or obese. You will see that as we discuss carbohydrates, this theme reemerges: balance and a diet appropriate to your unique needs are important

How does a low carb/paleo or ketogenic diet fit with pregnancy?  I’ve been watching some of the dialogue and I’m not a nutritionist, but I’ve been waiting to see some actual research emerge.  Indeed, we have many nutrition recommendations that aren’t beautifully researched.  So I understand the skepticism on all fronts.  However, we have to acknowledge that pregnancy and fetal development will require energy.  I think this study was well put together and addresses the criticism that diabetic ketosis and ketogenesis are distinct and yet they still found that the embryonic and fetal development of the keto diet mice were altered.

Carbohydrates may comprise between 40-65% of your total nutritional allowance. Where you should be, in that range, is dependent on multiple factors. Your nutrition expert can offer you sound advice in this area.

Here are some guidelines to take into consideration regarding carbohydrates and your diet:

• If you are overweight, obese or otherwise at risk for diabetes, talk to your health care team about preventative strategies. • Eat complex carbohydrates with the high dietary fiber that can be found in whole grains.

• Stay away from white flours, white sugars and simple carbohydrates.

• Eat lots of plants! Vegetables have lots of good soluble and insoluble fiber which aids in digestion and metabolism.

• Eat small, frequent meals that will keep your ‘fire’ gently burning. If you think of the digestion of carbohydrates as a fire, when we load it up and let it die out (as in “big pancake breakfast and a skipped lunch”), your digestion works hard and then putters out. Think of keeping the ‘embers’ of your fire glowing.

• Explore the Glycemic Index of foods. The following resource may be of benefit to you:

And, next time… We will tie it all together and talk about the joy of connecting with food and keeping things simple, but also staying curious about exploring your own observations about your responses to what and how you eat.

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