MS, RD, LDN, CBS
Janel holds a Master’s in Nutrition Communication from Tufts University. As the recipient of the 2010 Massachusetts Young Dietitian of the Year award, she believes in making healthy eating simple, sustainable, and delicious.
Gestational diabetes, or GDM, is diabetes diagnosed during pregnancy. It is usually diagnosed later in pregnancy and if you were diagnosed earlier in your pregnancy, you may have had undetected diabetes before becoming pregnant.
All pregnant women have some degree of insulin resistance because hormonal changes and weight gain in pregnancy interfere with our cells’ ability to use insulin. But GDM is a metabolic disorder in which your pancreas isn’t producing enough insulin and is characterized by high blood sugar levels.
Pregnant women at higher risk for developing GDM include women who are overweight before they get pregnant, have had GDM before, gave birth to a baby from a prior pregnancy who weighed more than 9 pounds, or have prediabetes (higher than normal blood sugar levels). Also at higher risk are women with a family history of diabetes, those with polycystic ovary syndrome, and women who are African American, American Indian, and Asian American, Hispanic, or Pacific Islander American.
Symptoms of GDM are extreme thirst, more frequent urination, heart palpitations and elevated ketone levels in your urine, although often there are no symptoms.
GDM is diagnosed based on blood sugar levels. Non-diabetic pregnant women are first given a screening glucose challenge blood test consisting of drinking a sugary beverage and having blood drawn an hour later. If you pass the screening test, you’re done and GDM-free.
If the screening test indicates a higher than normal blood sugar level, you’ll next undergo a more extensive fasting glucose tolerance test. During this test, you’ll still drink the sugary beverage, but then have blood drawn four times: before you drink the beverage and then one, two and three hours afterwards. If your blood sugar levels fall within a certain range above normal, you will be diagnosed with GDM. Or if your levels are not quite in the GDM range but still a bit higher than normal, your healthcare provider might still recommend modifying your diet to reduce the risk of developing GDM later in pregnancy.
If you’re diagnosed with GDM or identified as at risk based on testing
It can feel unsettling and even alarming to learn that your blood sugar level is higher than normal but the good news is, GDM will go away after you deliver your baby. It is important to understand the risks so that you can take full advantage of the powerful impact of lifestyle habits in not only controlling your blood sugar, but also in reducing your risk for pregnancy complications and for developing GDM in a subsequent pregnancy and diabetes later in life.
The risks and the reasons you’ll want to keep those blood sugar levels in check: women with GDM are more likely to develop preeclampsia (high blood pressure and too much protein in the urine), deliver by C-section, and develop type 2 diabetes postpartum, in addition to possibly having breast milk production delays or issues and other post-partum complications.
So how do you empower yourself and keep your blood sugar levels in a healthy range? A better (and more consistent) diet and more (consistent, frequent) exercise.
Carbohydrates are mainly responsible for raising blood sugar and those with diabetes often use carbohydrate counting to manage diets and blood sugars. Carbs are found, in varying amounts, in grains (including bread, pasta, and cereals), potatoes, corn, legumes, beans, juice, non-diet soft drinks, and fruit.
How many carbohydrates a pregnant woman with GDM can handle is highly individualized. Your health care provider can help you develop a meal and snack plan to suit your personal carb limitations and the Happy Mama Mentors can provide ideas on how to stay within that meal plan.
Eating consistently throughout the day also helps avoid blood sugar spikes and dips. Blood sugar levels are typically highest in the morning (due to natural hormonal fluctuations) so it’s best for many women to keep breakfast very low carb.
Exercise is another important way to control your blood sugar levels. When you exercise, your body uses foods that your body has converted to sugar as fuel. Muscles also use glucose as fuel so following a pregnancy-friendly strength training program can also help keep sugar levels steady.
The American Congress of Obstetrics and Gynecologists recommends all women engage in aerobic and strength-conditioning exercises before, during and after pregnancy. Not only does regular physical activity during pregnancy reduce the risk of gestational diabetes, but it also improves or maintains physical fitness, helps with weight management, and enhances psychological well-being.
Record, record, record
If you are checking your blood sugar levels on your own, write down all your blood sugars and time of day when checking.
While you’re at it, write down what and when you eat and drink along with when and how much you exercise. Keeping these records will help you see any patterns, activities or foods that raise, lower, or help maintain your blood sugar.
Try to eat every 3 hours. Eating 3 meals and 3 snacks each day will keep you on track and help prevent you from getting too hungry and overeating. Including proteins at meal time typically helps lower the blood sugar response. See Healthy Snacks During Pregnancy for ideas to keep munching healthily.
For breakfast in particular, keep the carbohydrates low. Blood sugar levels are typically higher in the morning, so you’ll want to proactively buck this trend. For the carbs you do eat, choose high fiber and whole grain options. Avoid juice, fruit, milk, and breakfast cereals made with refined (rather than whole) grains.
Favor higher fiber and lower carbohydrate foods
Beans, fresh and frozen fruits and vegetables and whole grains are great choices. Read your labels and make sure the package says 100% whole grain!
Vegetables and protein foods like broccoli, tomatoes, kale, cauliflower, fish, and chicken are especially good foods to reach for when you are hungry but want to keep your carbohydrate count down.
Avoid foods that cause blood sugar levels to spike
Skip concentrated sweets and highly refined grains (high in calories and low in nutrients) and avoid highly processed foods (typically low in fiber and high in saturated or trans fats and calories)
If you are cleared for exercise by your healthcare team, check out the recommendations in Healthy Exercises During Pregnancy.
Follow your healthcare provider’s recommendations about testing your blood sugar
Testing your blood sugar is a very important way to monitor your health and to know when to make adjustments to diet, exercise or medications if necessary.
Prevent and treat low blood sugar or hypoglycemia
Keeping your blood sugar from going too low, especially if you are on insulin, is equally important.
Hypoglycemia can cause lightheadedness, shakiness, anxiety, sweatiness, and blurred vision. If you feel any of these symptoms, check your blood sugar. If your blood sugar level is below 70 mg/dl, eat approximately 15 grams of a fast-acting carbohydrate such as 4 ounces of juice or a few glucose tablets. Wait 15 minutes and check your sugar again. If still below 70 mg/dl, eat your next scheduled snack or meal.
Have a set of instructions from your doctor on hand if your blood sugar drops and discuss it with loved ones, friends, and coworkers in case you are unable to treat yourself.
Know when to call your doctor
If you experience any of the below, call your healthcare provider immediately:
Coustan, Donald R, Laptook, Abbott R, Homko, Carol J, Biastre, Susan, Daley, Julie M. American Diabetes Association. Medical Management of Pregnancy Complicated by Diabetes, 5th Ed., 2013.
“Gestational Diabetes FAQ” American College of Obstetricians and Gynecologists. Date accessed 19 July 2018.
“Gestational Diabetes” American Diabetes Association. Date accessed 19 July 2018.
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