The use of a keto diet, which involves high fat and low carbohydrate levels, is controversial and not usually recommended during pregnancy.

A ketogenic diet is a high fat, low carbohydrate, and adequate protein diet. It is a popular lifestyle diet for weight maintenance and body building. In addition to weight loss, the keto diet can help regulate blood sugar levels and normalise menstrual periods.

It is more difficult for the body to use fats as fuel in comparison to carbohydrates. For this reason, people who are on the keto diet are advised to eat less than 50 grams of carbohydrates per day, whilst increasing the fat requirement. The reasoning for this is to obtain most of your daily calories from fats in order to stimulate the natural burning of body fat.

Doctors sometimes recommend the keto diet for people with medical conditions, including diabetes, polycystic ovary syndrome (PCOS), and epilepsy. However, choosing to remain on a keto diet during pregnancy is controversial since it involves burning fat through ketosis. Ketosis is when fats are used to burn energy rather than carbohydrates. This causes the liver to produce ketones, which replaces glucose as an energy source.

Here we provide an overview of the potential benefits and risks of a keto diet during pregnancy:

There is some suggestion that a keto diet can be beneficial during pregnancy, particularly for women who are overweight or obese.  

Eating a low carbohydrate, high fat diet, including foods such as celery, cauliflower, eggs, fish, meats, avocado, and cheese, has been associated with a reduced frequency of morning sickness, nausea, miscarriage, pre-eclampsia, and gestational diabetes.

There is some evidence to suggest that a keto diet may help manage seizures in pregnant women who suffer from epilepsy. A study published in Seizure found that symptoms of epilepsy were able to be controlled using keto therapy in two pregnant women. These women had normal, healthy pregnancies with reduced seizure frequency. Mild side effects included lowered vitamin levels and raised cholesterol levels. However, more investigation is required to evaluate the benefits and risks, as well as long term side effects, of using the keto diet in the management of epilepsy.

Risks of a keto diet during pregnancy

Although the keto diet is normally used to lose weight, a diet during pregnancy is not advised. Eating a balanced diet becomes even more important during pregnancy as the growing baby requires foods that are rich in vitamins, nutrients, minerals, iron, and folate. Since fruits and vegetables are high in carbs and natural sugars, their consumption has to be limited in the keto diet. An inadequate level of nutrient intake can lead to problems in the baby’s growth and development.

Eating carbohydrates during pregnancy is important since grains like wheat flour, rice, and pasta are rich in folic acid, which is critical for fetal development. Since protein is part of the keto diet, it can cause people to eat foods that are higher in saturated fat. Although healthy fats are vital for pregnant women and the growing baby, excessive saturated fat can lead to health problems, including higher cholesterol levels.

Animal studies have found that a keto diet during gestation can lead to changes in embryonic organ growth, such as a larger heart and a smaller brain. This may be associated with organ dysfunction and behavioural changes. A study published in BMC Pregnancy and Childbirth found that a low carbohydrate diet in pregnant mice caused smaller brain development and neurobehavioural changes in offspring. Another study published in Brain and Behavior discovered that pregnant mice on a keto diet had babies that were more likely to suffer from anxiety and depression in adulthood.

The keto diet can cause side effects, known as the ‘keto flu’. This can consist of fatigue, dizziness, nausea, headaches, and muscle cramps. This adds to the side effects that already exist in pregnancy.

A keto diet increases the risk of starvation ketoacidosis, which is a metabolic issue caused by a dangerously high level of ketones. This usually occurs after the body is deprived of glucose as the primary source of energy for a sustained period of time and leads to acidity in the blood. Since ketones can pass freely through the placenta to the baby, a keto diet is generally not advised during pregnancy.

There is evidence that a low carbohydrate can aid the management, treatment, or prevention of gestational diabetes, which is a type of high blood sugar that occurs during pregnancy. A study published in International Journal of Case Reports and Clinical Images found that a low carbohydrate diet lowers the need for insulin. However, it may not be necessary to completely adhere to a keto diet to reduce your risk of gestational diabetes.

It is essential that pregnant women eat a balanced diet with a combination of fats, protein, and carbohydrates. Eating a low carbohydrate diet that has an adequate level of healthy fats, protein, fibre, fruits, and vegetables may be more suitable than a keto diet during pregnancy. The health and development of the fetus should always be the priority. Please consult a doctor if you are planning on following a keto diet or other eating plan during pregnancy.

Written by Albina Babu, MSc

References:

Is low carb and keto safe during pregnancy? (2019). Diet Doctor. Retrieved from: https://www.dietdoctor.com/low-carb/keto

van der Louw, E.J., et al. (2017). Ketogenic diet therapy for epilepsy during pregnancy: a case series. Seizure, 45, pp.198-201.

Sussman, D., et al. (2013). Effects of a ketogenic diet during pregnancy on embryonic growth in the mouse. BMC Pregnancy and Childbirth, 13(1), pp.109-120.

Sussman, D., Germann, J. and Henkelman, M. (2015). Gestational ketogenic diet programs brain structure and susceptibility to depression & anxiety in the adult mouse offspring. Brain and Behavior, 5(2).

Tóth, C. and Clemens, Z. (2014). Type 1 diabetes mellitus successfully managed with the paleolithic ketogenic diet. Int J Case Rep Images, 5(10), pp.699-703.

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As Diwali is around the corner, chances are high that one might indulge in deep-fried snacks and sugar-laden sweets. However, this unhealthy indulgence can impact people with diabetes. Several doctors have recommended a few tips or ways through, you can tackle the situation while indulging in your favourite foods.
According to a BeatO study, festivals adversely impact people’s blood-glucose levels, especially during Diwali. People with levels above 250 mg/dL (milligrams per decilitre) saw an almost 15 per cent rise while those having blood-glucose levels above 300 mg/dL had an 18 per cent increase. Typically, this trend continued until three days after Diwali as per insights based on its data of the last three years’ festive season, beginning on Durga Puja and ending with Diwali. Interestingly, this year Diwali is being celebrated on November 14, which coincides with World Diabetes Day.

“Indian festivals reflect our rich and diverse culture along with the celebration, colors, food, and happiness, and the positive impact of which cannot possibly be quantified. Whether an individual has a chronic health condition or not, it is important not to snatch away the joy of enjoying a festival and everything that it brings along,” Dr Bhavik Saglani, Diabetes Health Physician and Consultant at Mumbai’s Apollo Spectra Hospital, told IANSlife.

Dr Saglani added, “Festivals may involve fasting or feasting or in some instances a bit of both. Exercise routine usually takes a backseat and activity levels to tend to drop. It is a combination of the above that needs to be taken into consideration in individuals with diabetes. Ensuring good pre-festival sugar control, discussing with your physician whether or not fasting is advisable in your case, ensuring that sugary sweets and other carbohydrate-rich snacks are avoided or their portion size is limited, trying to compensate for all of it by ensuring your exercise routine does not take a back seat, keeping yourself well hydrated and ensuring regular home testing are some of the key steps to strike the right balance between enjoying a festival and managing diabetes. Extra care needs to be taken for those who are on insulin and those who have high sugar levels even prior to the festive period. There is a risk of hypoglycaemia (low sugar levels) or hyperglycemia (high sugar levels) due to one or more of the above mentioned factors and it is imperative to get a review with your treating physician prior to the festive period.”

According to Dr Sanjay Ingle, Zonal Pathologist, and Technical Head West India, Apollo Diagnostics, Pune, one must monitor their blood sugar levels in order to check the insulin dose before every meal. Not doing so can invite a lot of problems. “Similarly, those with type 2 diabetes are suggested to go for intensive insulin therapy under the doctor’s supervision. Moreover, even self-monitoring of blood glucose (SMBG) is essential in these people too. There are some people who are on less intensive insulin therapy and they tend to monitor it little or not at all, this is an ineffective practice, as well-controlled patients need monitoring of glucose levels to avoid hypoglycemia, and poorly controlled patients need to control it properly.”

“Your doctor will recommend changes in the diet, will ask you to do physical activity, and opt for medication after assessing your blood sugar levels. You will have to work in sync with your doctor to help yourself get back on track. Even if it is festive season or no, make sure you monitor your blood sugar levels and manage diabetes,” explains Dr Ingle.

For those who are not fasting but prefer to feast on the variety of foods that are served during festivals, there are certain important measures to be taken to ensure the blood sugar control does not go haywire, adds Dr Nishant Singh, Consultant, General Medicine and Diabetology, Meddo Clinic.

One can follow these simple measures:

• Break your meals into smaller portions of about 4 to 5 times every day, instead of 3 large meals through out the day. This can keep your blood sugar levels more stable, while you are nourished adequately.
• You can opt for healthy snacking options such as nuts, olives or a piece of fruit. You could replace traditional sweets with such healthy options to ensure healthy is not compromised in celebrations. Ensure keeping your body hydrated and nourished. However, you can have a small piece of sweets.
• Consider consuming good-quality dark chocolate instead of milk chocolate as they consist of less sugar. One should try and avoid sugary drinks and replace them with either water, sugar free lime juice or even a small tumbler of tender coconut water would be a good choice.
• White rice is a favorite of many however, ones with diabetes should try and avoid it as it has a high glycaemic index and glycaemic load and can increase your blood sugars drastically. Instead, consume brown rice or whole grains as these keep the sugar levels a lot better controlled.
• Bakery foods such as biscuits and cakes must be avoided completely. Avoid deep-fried foods such as samosas and pakodas.
• One should try and avoid excessive indulgence in alcohol during festival seasons. Alcohol also contains a large quantity of sugar in it and can increase blood sugar levels.

Indian festivals are joyous occasions that are marked by the serving of sweets and savoury items. Those with diabetes can still enjoy these festivals, provided certain simple measures are followed to keep the blood sugar levels under check.

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• Definition
• How it’s measured and why
• Measuring large
• Measuring small
• Bottom line

Congratulations, you’re expecting! This exciting and sometimes nerve-wracking time can mean browsing dream strollers, finding fashionable maternity wear — and lots of doctors’ appointments.

Regular doctor checkups and tests during pregnancy are important for your health and your baby’s too. If you’re a pregnant person anywhere in the world, you’ll probably have your belly measured several times during your pregnancy.

As your belly starts to blossom, your doctor will measure your growing bump regularly with a measuring tape. This measurement is called fundal height.

Here’s more on what fundal height means and why it’s an important part of your pregnancy checkups.

Fundal height is a vertical (up and down) measurement of your belly. It’s the distance from the pubic bone to the top of your womb (uterus).

Your doctor might also call it the symphysis-fundal height (SFH). Symphysis is the scientific name for bones that are joined together, like in the pelvis.

Fundal height is always measured in centimeters. To begin, you’ll lay flat on your back on the exam table, just like you’re getting an ultrasound scan.

Your doctor will use a flexible measuring tape to measure the distance from your pelvis area to the top of your uterus. This is about where your belly slopes downwards after going over the highest point of your bump.

Around 24 weeks of pregnancy, the fundal height usually matches the number of weeks you’ve been pregnant. This quick measurement is not just a really good party trick —measuring the fundal height can help tell a few important things about your pregnancy:

• Your doctor will have a better estimate how far along you are in the pregnancy (gestational age).
• Your doctor can chart fundal height over time to make sure you’re gaining weight and your baby is growing consistently.
• Fundal height helps to show how large your baby is (fetal growth) because your bun in the oven is making that belly bump after all!

So if your fundal distance is about 26 centimeters (plus or minus 2 centimeters), you are probably around week 26 of your pregnancy. Of course the fundal height can’t give an exact number of weeks or show the exact size of your baby, but it’s a good estimate.

Measuring the fundal height is especially important in places where there isn’t an ultrasound machine available or if you’re at a checkup at your doctor’s office between ultrasound scan appointments.

The fundal height is used by doctors around the world to help check both mama’s pregnancy health and baby’s growth easily and quickly and without needing any expensive, high-tech equipment.

The fundal height is so important that researchers made an international formulaTrusted Source to help better estimate pregnancy weeks and baby size with this measurement.

The formula takes into account that measuring a pregnant person’s stomach won’t always be accurate, and some mothers-to-be might show more or have a bigger belly than others.

If you’re in week 25 of your pregnancy but your fundal height measurement estimates that you’re in week 28 or 29, don’t worry. There are several reasons why this might happen:

• You may have been pregnant earlier than you or your doctor calculated according to your missed period cycle or first ultrasound.
• Your baby might be bigger than average.
• Your body shape or type might just mean that your stomach is sticking out a bit more.
• You might have a full bladder or really need a bowel movement. Yes, both these things can sometimes make your stomach stick out about 3 centimeters higher!

If your fundal height is too long, your doctor will double-check the measurement and may also give you an ultrasound scan. Some babies are just longer or bigger than average.

If your baby is larger than other babies at that stage in pregnancy, it might be due to:

• Genetics: You, your partner, or both of you may have tall or large genes in your family that are passed down to your baby.
• Weight gain: If you’ve gained excess weight during your pregnancy or before pregnancy, your baby may gain more weight too.
• Diabetes: If you have gestational diabetes or another kind of diabetes, your baby might be larger than usual.

Sometimes fundal height is shorter than it should be and doesn’t match up with how far along your pregnancy is. There are several reasons why this might happen:

• Your pregnancy might have happened later than you or your doctor estimated. For example, you might estimate that you’re in week 28 of your pregnancy, but you’re actually in week 26 or 27.
• Your baby might be smaller than normal.
• Your body shape or type might just mean that your belly doesn’t show as much.

Your doctor may be more concerned if your baby is smaller than normal or is not gaining weight. A lack of weight gain in utero may lead to low birth weight.

Causes of small babies in the womb include:

• Genetics: You, your partner, or both of you may have shorter or small genes in the family.
• Genetic conditions: Certain chromosomal conditions can cause smaller babies early on in the pregnancy.
• Nutrition: Your baby may not be getting as much oxygen, blood flow, and nutrients as they should be.
• Uterine issues: A problem with the placenta might be limiting how much blood and oxygen your baby is getting.
• Mama’s nutrition: If you aren’t taking in adequate healthy foods, or have a body weight of under 100 pounds, baby may not grow as quickly as hoped either.
• Alcohol and drugs: Alcohol, cigarette smoking, or drug use can all affect your baby’s growth and development.
• Mama’s health: Your health matters for your baby’s health and weight gain. A number of conditions that you might have can affect your baby’s health and growth. These include:
  • high blood pressure
  • anemia
  • infections
  • diabetes
  • kidney disease
  • lung disease
  • heart disease

Checking your fundal height is just one way that your healthcare provider can check your pregnancy health and your baby’s growth and development.

It’s not always accurate, but along with ultrasound scans and other tests, measuring the fundal height can help keep your pregnancy and baby healthy.

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