Gestational Diabetes: Diet and Other Management Tips

Gestational diabetes (GDM) affects up to 9 percent of pregnancies in the United States every year. While the diagnosis can be cause for significant concern, the numbers indicate that the condition is common, reports the American Diabetes Association (ADA).[1] It is important to know that getting gestational diabetes, which develops exclusively during pregnancy, is not an indication that you had diabetes before pregnancy or that it will continue after giving birth.

Gestational diabetes develops when blood sugar levels get too high because hormones from the placenta block the body’s ability to make or use insulin.  Gestational diabetes can cause pregnancy complications without treatment,

Insulin is a hormone produced by the pancreas that moves glucose from blood into cells to provide them with energy. The body depends on insulin to maintain the right amount of glucose in the blood.

Gestational diabetes symptoms

The warning signs of gestational diabetes are not obvious. Gestational diabetes symptoms generally are mild and may even go unnoticed until you are tested. The symptoms include:

·         Unusual thirst

·         Frequent urination in large amounts. This is distinguished from frequent but usually light urination, which occurs in early pregnancy.

·         Fatigue, although it can be difficult to differentiate from fatigue normally associated with pregnancy.

·         Sugar in the urine, which would be detected during a routine visit to your healthcare provider.

Risk factors for gestational diabetes

During a pregnancy, anyone can develop gestational diabetes. However, there are certain factors that increase the risk:

·         Heart diseases

·         High blood pressure

·         Obese or overweight before pregnancy

·         Having had gestational diabetes during a previous pregnancy

·         Family history of Type 2 diabetes

·         Have polycystic ovary syndrome, a hormone disorder which can impact fertility and increase the risk of other chronic health conditions

·         Given birth to a baby who weighed over 9 pounds

·         Prediabetes

·         Advanced maternal age

Testing for gestational diabetes

Gestational diabetes usually develops around the 24^th week of pregnancy, so the CDC recommends testing for it – it is a blood test -- between weeks 24-28 of a pregnancy.[2] If you have risk factors for the condition, your provider may screen for it a little earlier.

The first test often is a screening to identify people more like to get gestational diabetes. If you do not pass the screening your health care provider will order a second, more comprehensive test, sometimes called a glucose screening test, glucose challenge test, or one-hour glucose tolerance test. With this test, you drink a sweet liquid and wait for one hour. After an hour, your healthcare provider will take a blood sample from your arm. If the blood sugar is too high, the next step is a glucose tolerance test.[3]

The glucose tolerance involves fasting (for eight hours) before the tolerance test. You will have a blood draw before and at one-, two- and/or three-hour intervals after drinking a sweet liquid. The tolerance test can confirm a gestational diabetes diagnosis. [4]

Preventing gestational diabetes

Taking the following steps can have a significant impact on reducing the risk of developing gestational diabetes and Type 2 diabetes, both before conceiving and during pregnancy.

·         Stay active: Maintain a fitness routine, working under the guidance of your healthcare provider.  A 10-minute walk after dinner is a good way to start. You might want to aim for 30 minutes of light exercise three days each week.[5] Even short bursts of activity, such as parking further away from the store when running errands, add up.

·         Start pregnancy at a healthy weight: Working with your healthcare provider, gain the recommended amount of weight during your pregnancy.

·         Check your blood glucose level: Do this at the same time each day.

Eat a healthy diet

Eating a healthy diet is also a key recommendation for preventing gestational diabetes, although there are no guarantees. For a gestational diabetes diet, you want to select foods that are low in fat and calories and high in fiber, focusing on fruits, vegetables and whole grains.

Also watch for portion sizes for a gestational diabetes diet. The plate method is one way to ensure a balanced meal and to not overeat. The plate method balances the amounts of vegetables, lean protein, and carbs in a meal. From the CDC:^[6]

Start with a 9-inch dinner plate (about the length of a business envelope):

• Fill half with non-starchy veggies
• Fill one quarter with lean protein
• Fill one quarter with a carbohydrate

Examples of each from Medical News Today:[7]

Non-starchy vegetables

·         Carrots

·         Broccoli

·         Brussels sprouts

·         Cauliflower

·         Salad greens

·         Spinach

·         Zucchini

Lean protein

·         Beans

·         Chicken

·         Eggs

·         Lean cuts of red meats

·         Salmon

·         Tofu and Tempeh

·         Turkey

Carbohydrates

·         Brown rice

·         Butternut squash

·         Chickpeas

·         Dairy products such as milk and yogurt

·         Fruits and dried fruits

·         Oats

·         Sweet potato

Milk and whole fruits contain sugar but still you want to include them as part of a balanced diet, according to the National Institute of Diabetes and Digestive and Kidney Disease (NIDDK).

Avoid these foods when on a gestational diabetes diet

·         Sugary foods which will increase blood sugar levels. Limit foods with added sugar as much as possible: cakes, candy, cookies, ice cream, fruit juices, or sugary drinks.

·         High-starch food are high in carbohydrates and can cause a rise in blood sugar. Examples are white potatoes, white bread, white rice, and white pasta.

·         Sugar-sweetened soda, highly processed food, some condiments such as dressings and ketchup, and some fast foods, which, while not obvious contain high levels of sugar.

·         Avoid alcohol during pregnancy since there is no known safe amount.

A registered dietician can help you develop a meal plan. You might also want to keep a food log, which will feature both what you ate and your blood glucose number. The log will help you understand what food are spiking your glucose levels, so you can adjust your meals.  

Treating gestational diabetes during pregnancy and after

If you develop gestational diabetes, you want to manage blood glucose to reach target levels that are the same as those who are pregnant who do not have the condition. Managing gestational diabetes includes following an eating plan and scheduled physical activity. Management also may also include checking your blood glucose level and taking insulin.[8]

After delivery, testing may be done a few months later to make sure your blood levels have returned to normal. Research indicates that those with gestational diabetes have a 3 to 7 percent chance of developing Type 2 diabetes within 5 to 10 years. To keep healthy after your baby is born:[9]

·         Keep up with visits to doctor

·         Talk to registered dietician

·         Continue to make healthy food choices

·         Continue exercise

The risk of complications is low if gestational diabetes is diagnosed and treated effectively. Take preventative measures and follow your physician’s advice.