Being diagnosed with gestational diabetes mellitus (GDM) brings up a lot of feelings for many people. Unfortunately, this condition has been stigmatized as a failure on your part. When, in fact, many contributing factors are out of your control and anyone, even those without known risk factors, can develop GDM during pregnancy. This isn’t your fault. And with the help of a supportive healthcare team, this is a very treatable condition and you can enjoy your pregnancy and have a healthy baby.
Get informed
Usually, insulin helps to lower your blood sugar and enables your cells to store or use that sugar. During pregnancy however, pregnancy hormones decrease insulin in your blood and your body naturally becomes insulin resistant to make sure baby gets what they need. Some people’s bodies will respond by making more insulin to control their blood sugar. Some do not, which causes elevated blood sugar, or gestational diabetes.
Frequently elevated blood sugar can put you at risk for having a big baby. That may cause labor complications. You are also at an increased risk of high blood pressure and preeclampsia. For baby, GDM can cause difficulty regulating their own blood sugar initially after birth. They may require a stay in the neonatal intensive care unit.
Many people with gestational diabetes can make dietary and physical activity adjustments to maintain healthy blood sugar levels (glycemic control). For others, medication is an effective way to maintain good glycemic control.
Building your team
Building a team of compassionate healthcare providers is key to your success. If you’re using an OBGYN, they may be comfortable managing your GDM care. Many cases of GDM can be comanaged by a Certified Nurse-Midwife and their collaborating physician. But if you need more support, you may be under the care of a high risk pregnancy specialist called a Maternal Fetal Medicine doctor or MFM. They may also include an endocrinologist experienced in treating gestational diabetes.
Other members of your team might include a diabetes educator who can help you become skilled at checking your blood sugar and adjusting your food and activity levels to respond to your blood sugar readings. You might also want to meet with a dietician who specializes in gestational diabetes.
Consider your carbohydrates
There is no standard recommendation for grams of carbohydrates for those with GDM. Rather, it depends on your glycemic control or overall blood sugar balance. There is evidence that a diet, in which about half of your energy intake comes from carbohydrates may help prevent hyperglycemia. Hyperglycemia is another way to say high blood sugars.
Not all carbohydrate foods impact blood sugar the same. Refined carbohydrates and simple sugars are found in foods like white bread and fruit juice or sweets. These cause a quicker rise in blood sugar because they are quickly absorbed into your body. Complex carbohydrates are whole grains and found in foods like whole wheat bread, brown rice, and oatmeal. These carbohydrates have added fiber and nutrients that slow the absorption of sugar in your body. Complex carbs still impact blood sugar, but do not cause the same quick spike that can be seen with simple sugars.
Some people use the glycemic index to help understand the impact of foods on blood sugar. Complex carbs are low on the index, where simple sugars are high. Generally, it’s recommended to mostly include carbohydrates in your diet that have a low or medium glycemic index.
Set a meal schedule
Spreading out meals and snacks throughout the day can help moderate blood sugar levels. This helps your body manage your blood sugars better by spreading carbohydrates throughout the day. Most people can aim for three smaller meals and two snacks per day. However, this can change based on individual glucose control, activity levels, and nutritional needs. Checking your blood sugars can help you better understand your body’s response to certain foods to best meet your needs.
Think about protein
Adding protein to your meals and snacks is nourishing and helps moderate the rise of blood sugars after meals. Protein does not directly impact blood sugars, but pairing protein with carbohydrates may slow their absorption which helps prevent spikes in blood sugar.
Try non-nutritive sweeteners
Now that you know a little more about carbohydrates, you might choose to use artificial sweeteners in your baking and beverages. Generally, most sweetners are considered safe by the FDA, however, there are some considerations while pregnant. Saccharin is an artificial sweetener that is able to cross the placenta to your developing infant. Since this sweetner can remain in fetal tissues, it is not recommended during pregnancy. If you or your partner have phenylketonuria (PKU), a rare hereditary disease, it is best to avoid aspartame as you or your baby may not have the ability to break down the phenylalanine in the sweetener. Sucralose, acesulfame K and stevia are safe to consume in moderation during pregnancy. Non-nutritive sweeteners are much sweeter than sugar, so you may not need much! If you’d like to avoid sweeteners, fruits and whole grain desserts are great options.
Exercise daily
Exercising regularly helps to use up sugar circulating in your blood. So it naturally lowers your blood sugar levels. In addition to this short term benefit, regular exercise can have a long term benefit on blood sugars by improving insulin sensitivity. Insulin sensitivity is how well your body responds to insulin, the hormone that moves glucose from your blood into your cells for energy. Even a 30 minute walk every day can help achieve optimal glycemic control. If you are hoping to try out a new exercise routine, that’s a great idea and it’s best to talk to your doctor beforehand to make sure it’s safe for you.
Get support
Reach out to a trusted registered dietitian to discuss the kind of support you need. They may be able to help answer questions and customize your nutrition plan. If you aren’t currently working with a dietitian, you can find someone on the Academy of Nutrition and Dietetics website.
It’s also important to know that much of the common advice around gestational diabetes can be very triggering for those with a history of disordered eating or eating disorders. If you feel yourself slipping back into old patterns, please reach out to your provider and discuss this as soon as possible.
Reviewed by the Ovia Health Clinical Team
Sources
- “Gestational Diabetes.” American College of Obstetricians and Gynecologists (ACOG). ACOG. December 2020. https://www.acog.org/womens-health/faqs/gestational-diabetes.
- Carr DB, Gabbe SG. Gestational diabetes: detection, management, and implications. Clin Diabetes. 1998;16(1):4-11
- “Gestational Diabetes (GDM) Guideline (2016).” Academy of Nutrition and Dietetics Evidence Analysis Library. Available at www.andeal.org. Accessed on August 21, 2017.
