Gestational diabetes may be controlled through early detection, proper diet and exercise
Gestational diabetes is the term used for diabetes during pregnancy and affects more than 200,000 women each year. In this type of diabetes, your body doesn’t properly manage blood sugar (glucose), its main source of fuel, due to pregnancy hormones and insulin resistance. It is similar to Type 2 diabetes in many ways, but also has important differences.
If not caught early enough or not well controlled, it can result in complications including a large birth weight baby or the baby having low blood sugar immediately after birth. The mother could experience early delivery, preeclampsia, high blood pressure or complications during delivery. Mother and baby are both at increased risk of developing Type 2 diabetes later in life.
A glucose screening test is typically done between 24-28 weeks of pregnancy, during which blood sugar levels are checked for gestational diabetes. Depending on risk factors and medical history, however, it may be done earlier.
Your doctor may recommend a diabetes educator who can teach self-management techniques to support a healthy pregnancy and delivery. Patients learn how to check blood sugar levels multiple times a day, develop an eating plan designed to maintain blood sugar goals set by a physician, determine the ideal amount and timing of exercise and check urine for the presence of ketones (which can indicate diabetes is not well managed).
The eating plan focuses on carbohydrate counting: what foods count as carbohydrates, how much to consume and when to have them. Patients are encouraged to eat a consistent pattern of three meals per day plus snacks in between meals to keep blood sugar levels as stable as possible.
Woman at risk for developing gestational diabetes include those who:
- Previously had gestational diabetes
- Are older than age 25
- Are overweight
- Are of African American, Asian, Native American, Hispanic or Pacific Islander descent
- Gain excessive weight during pregnancy
- Have delivered a baby weight over 9 pounds
- Have had a stillborn baby
- Are pregnant with multiples
Exercise is great for overall health for all pregnant woman, and with diabetes it’s especially important to help control blood sugar levels.
Choosing a bedtime snack with the right amount and mix of carbohydrates, protein and fat helps keep blood sugar stable overnight and into the morning. Believe it or not, because of its composition, a (measured) half cup of regular, full-fat ice cream before bed can be quite effective at moderating sugar levels overnight, coupled with a balanced eating plan. This is one aspect of the diet most women are happy to follow.
It’s ideal for everyone to have more whole grains and fewer refined carbohydrates. Blood sugar goals for those with gestational diabetes are tight and can be very sensitive to minor adjustments such as choosing brown rice over white, or a whole piece of fruit rather than juice.
All pregnant women are encouraged to consume adequate amounts of iron, calcium, folic acid and fiber. Depending on their diet before pregnancy, adjusting to one that includes nutrient-rich foods from all food groups and three meals plus snacks can be challenging. Vegetarians or vegans might have a tougher time keeping blood sugar stable than women who include animal proteins, because their diets tend to be higher in carbohydrates overall (for example, plant based proteins such as beans tend to also be a source of carbohydrates).
Keeping track of when blood sugar rises and noting what you were doing or eating at that time is key. When someone experiences high blood sugar, we can identify what might be causing the rise, such as a certain food, amount of food, stress, etc., and can make recommendations to adjust food intake or encourage activity at that time of day, such as taking a walk. Exercise is great for overall health for all pregnant women, and with diabetes it’s especially important to help control blood sugar levels.
Oftentimes, gestational diabetes can be managed well with diet and monitoring carbohydrate intake. However, as pregnancy progresses, gestational diabetes may also progress due to weight gain and hormonal changes, and some women may need to take oral medications or insulin injections.
Due to fluctuating hormones and other factors, gestational diabetes is constantly changing and strategies that are effective one week might not work the next. It is crucial to work with your health-care team to develop a management plan that works for you and continues to adapt as your pregnancy advances.
Having gestational diabetes on top of all the other changes pregnancy brings can certainly be a challenge. Getting in the habit of monitoring blood sugar levels, diet and exercise takes a lot of work. But pregnant women are some of the most motivated people I’ve ever counseled. Even if the last thing they want to do is trade that sweet treat for a healthy snack, they understand that the outcome of their choices will affect not only their own health but the health of their baby, which makes the effort well worth it.
How is gestational diabetes managed?
- Diet and nutrition
- Physical activity
- Oral medication or insulin shots
Melissa Joy Dobbins, MS, RDN, CDE is a licensed Registered Dietitian Nutritionist and an award-winning, nationally recognized food and nutrition expert, speaker, coach, blogger and podcaster with more than 20 years of experience. She is also a Certified Diabetes Educator and an official spokesperson for the American Association of Diabetes Educators.