For many women, the diagnosis of gestational diabetes - a type of diabetes that develops during pregnancy, and in most cases, ends once the child is born – is overwhelming. As a Certified Diabetes Educator, I work with people living with prediabetes and Type 2 diabetes, and counsel women who have been diagnosed with gestational diabetes. Typically, the first reaction is self-blame: "I got this because I ate too many sweets." That is not the case. There are many factors that can be considered risk factors for gestational diabetes, including having pre-diabetes, having diabetes in the family, or diagnosis of gestational diabetes in a previous pregnancy. The best thing you can do is to learn about it, which will help you to manage it better. Don’t be afraid to ask your healthcare providers lots of questions and share your concerns. The more we know about you, the easier it is for us to work together to help you manage the condition.
Whether you're pregnant, or part of the support system for a new mom-to-be, below is some important information to help you navigate through a gestational diabetes diagnosis, and plan for a healthy pregnancy and baby.
What is gestational diabetes
Gestational diabetes impacts 1 in 7 births worldwide. In pregnancy, your body produces a number of extra hormones to facilitate the growth of the fetus. These hormones also increase the body’s resistance to insulin, making it hard to control your glucose levels (blood sugars). Gestational diabetes is when your body fails to produce and use all the insulin needed for pregnancy. Insufficient insulin means that the sugar in your blood (glucose) cannot leave the blood and be used for energy. This causes a pile-up of sugars in your blood. If left untreated, high blood sugar levels can contribute to adverse outcomes for you and your baby; including high blood pressure, a heavier baby and increased risk of obstructed labour. Some newborns are also at higher risk for breathing difficulties. While in most cases, the diabetes is only present during pregnancy, there may be occasions where it could lead to a higher risk of Type 2 diabetes for the mother, after the pregnancy. Babies born to mothers with gestational diabetes are also at risk for obesity and type 2 diabetes in adulthood.
The good news is that the condition is entirely manageable with medication, routine monitoring, diet and healthy lifestyle changes.
How carbohydrates affect blood sugars
Carbohydrates, commonly referred to as “sugars, starches and fibre,” are macronutrients that provide your body with the necessary energy to survive. Sugars and starches raise your blood sugar levels, whereas fibre does not. Carbohydrates are found in grain products (bread, pasta, quinoa, barley, rice, etc.), certain vegetables (peas, squash, potatoes, corn), fruits, dairy, and pulses (beans, chickpeas, lentils). Once digested, sugars and starches raise your blood sugar levels, prompting the pancreas to release insulin.
Screening for gestational diabetes
If you're pregnant and receiving consistent care, you will be screened for gestational diabetes as part of your routine prenatal screening. Depending on your country of residence, this may involve consuming a sugar-rich drink, followed by a blood test that is used to analyze your blood sugar level response. Specifically, this test indicates how well the pancreas is working, and whether it can effectively regulate your blood sugar levels. Depending on the results, you may be prescribed insulin therapy for the duration of your pregnancy.
Why home monitoring is important
Monitoring your own blood sugar levels is a critical part of your treatment plan. Your doctor and diabetes education team will ask you to check your blood sugar levels over the course of the day with a glucometer (special device to test blood sugar levels). These regular readings will help you and your diabetes care team make informed decisions to address the high or low blood sugar readings, through changes to your diet, exercise, and/or insulin therapy.
Gestational diabetes can be managed
The most common reaction I see in practice, is women avoiding carbohydrates altogether. You don't need to do that - and it's not even recommended. Remember, your baby is working on filling up those arms and legs with fat and muscles, and carbohydrates provide the necessary energy for this growth. Don't forget, that your body also needs energy to thrive! You may be surprised to hear that a healthy diet to manage gestational diabetes is not very different from an overall healthy diet. You don't need to make drastic changes and it is easier than you may imagine.
Here are some strategies you can adopt to help control your blood sugar levels during pregnancy:
1. Follow your diet plan
- Eat smaller portions more regularly: Limit your meal portions and space out your meals by four to five hours. Avoid skipping meals, and try not to have a sporadic eating pattern; rather, aim for three main meals throughout the day, and two to three healthy snacks in between. This will help to maintain your energy and keep your blood sugar levels better balanced. Feelings of extreme hunger can drive us to opt for less-than-desirable food choices. Have you ever eaten half a bag of chips after work, without thinking twice about it? Chances are, that was driven by falling blood sugar levels. Pregnant women should especially try to avoid such pitfalls.
- Supplement meals with healthy snacks: Include some healthy snacks in between meals to keep your sugar levels regulated. Snacks such as a piece of fresh fruit with a handful of nuts, cheese and whole wheat crackers, or hummus and carrot sticks. One of my favourite snacks is a sliced apple with smooth almond butter. Like some of my patients, you’ll find that eating at regular intervals also helps maintain energy and avoid fatigue - a common issue for pregnant women.
- Create a balanced plate of food: Look to load half your plate with a variety of vegetables – the more colour, the better. Next, fill a quarter of your plate with a lean protein source, such as baked skinless chicken breast, baked fish, beans and lentils, grilled tofu, or lean cuts of red meat. The last quarter of your plate – about the size of your fist – is left for your favorite grains or starch: yam, lentils, whole wheat roti or barley, among others. Lentils and other pulses like dried peas, beans or chick peas, are unique in that they’re both a source of protein and carbohydrates, so they will raise your blood sugar levels. With such high fibre, nutrient-rich and delicious combination of foods, your blood sugars will be better controlled and your taste buds tantalized!
- Opt for low GI foods: Glycemic Index (G.I.) is a system of ranking carbohydrate-containing foods by their effect on blood sugar levels. Low G.I. foods may help you have better blood sugar control because they release sugar slowly - causing lower spikes in blood sugar levels. Contrarily, high G.I. foods can lead to a sudden spike in your blood sugar levels, and tend to have a lower nutritional profile than low G.I foods. It’s advisable to limit intake of these foods as much as possible, though the occasional indulgence is okay. The table below shows where some common foods fit in.
Low GI foods
High GI foods
|Sweet potatoes||Sugar- sweetened beverages, juices, sodas, sports drinks|
|Parboiled rice||Hot chocolate, flavoured lattes|
|Stone ground whole wheat bread||Mango lassi|
|Fruits like apples, strawberries||Breakfast cereals - corn or bran flakes|
|Plain milk||French fries, baked potatoes|
|Yoghurt||White soda crackers, rice cakes|
|Lentils||Sugary desserts, candy bars|
|Pasta||White bread, white naan, white roti|
2. Keep an eye on your weight gain
Pregnancy is not your ticket to 9 months of food indulgence (wouldn't that be nice!). In fact, eating for two is a risky myth. Don't forget, your weight is something you have to watch even after the baby is born. In general, whilst you're pregnant, you do need to increase your calorie intake, but this should be gradual and from nutrient dense foods. It's also important to check-in and see that you're gaining the right amount of weight during pregnancy - not too much, but also, not too little. Too much weight gain can increase the risk of having a larger baby, while low weight gain can increase the risk of delivering a baby with a lower birth weight, which can cause complications like perinatal morbidity and mortality. If you are noticing accelerated or slow weight gain, speak to your doctor to find out what you can do in order to better meet your target weight.
Below are recommendations for weight gain depending on your BMI. While these are recommended, your body type and pregnancy may be different. Always consult with your doctor to monitor your weight changes during pregnancy.
For women carrying a single baby (vs. twins, triplets, or more) and a pre-pregnancy BMI of:
- less than 18.5: you should gain 12.5 – 18 kilograms (27.5 - 40 pounds) over the course of your pregnancy
- 18.5 - 24.9: you should gain 11.5 - 16 kilograms (25 - 35 pounds) over the course of your pregnancy
- 25 - 29.9: you should gain 7 - 11.5 kilograms (15 - 25 pounds) over the course of your pregnancy
- Over 30: you should gain 5 - 9 kilograms (11 - 20 pounds) over the course of your pregnancy
To calculate your pre-pregnancy BMI, visit the National Institutes of Health
3. Stay active
Did you know that a simple 30 minute brisk walk five days a week is considered exercise? Getting into a routine of moving your body is a great way to help your body enhance its insulin action and regulate your blood sugars. Some of you may have been told by well-intentioned family or friends to avoid any sort of exercise for fear of harming the baby – "don't climb steps," "don't walk too much"! In most cases, this is simply not true! If you're thinking of getting active during your pregnancy, make sure you speak to your doctor to get the go-ahead and find out how you can incorporate exercise into your routine.
4. Speak to a professional
If you have been diagnosed with gestational diabetes, it's always recommended that you speak to a registered dietitian, Certified Diabetes Educator, and your doctor to learn how you can best control your blood sugar levels that is right for you.
Remember, the more informed you are, the better you will be able to manage your diabetes. The most important thing is to stay positive, and take each day at a time. We didn’t build our current habits in one day, so it’s understandable that cultivating healthier eating ones may take some time and concerted effort. Don’t go at it alone either. Enlist some help from your loved ones, to make the process a little easier.
Sanja Petrovic is a registered dietitian and Certified Diabetes Educator living and working in the Greater Toronto Area, Canada. She completed her graduate studies in nutrition at Mount Saint Vincent University and has been working with people from all walks of life, helping them to reach their fullest health potential.
- International Diabetes Federation, Gestational Diabetes
- World Health Organization, Global Report on Diabetes, 2016
- International Diabetes Federation, Having a Baby? Now is the time to learn more about gestational diabetes, 2015
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- The American College of Obstetricians and Gynecologists, Committee Opinion: Weight Gain During Pregnancy
- World Health Organization, WHO recommendations on antenatal care for a positive pregnancy experience, 2016
- Canadian Diabetes Association (2013). Building competency in diabetes education: The essentials.
- American Diabetes Association, What is gestational diabetes?
- Diabetes Canada, Living with Gestational Diabetes
- European Journal of Obstetrics & Gynecology and Reproductive Biology, Risk factors for low birth weight: A review