Gestational diabetes is a type of diabetes that develops during pregnancy in women who don't already have diabetes. It affects roughly 6% to 9% of pregnancies. The good news is that with proper prenatal management, the risk of complications can be reduced. Most women can control gestational diabetes with lifestyle changes alongside careful monitoring during prenatal visits.
Understanding Gestational Diabetes
During pregnancy, hormones can make insulin less effective or even cause it to stop processing glucose in food - insulin helps the body convert food into energy. These changes cause your body's cells to use insulin less well, a condition called insulin resistance. If insulin’s normal process is interrupted, the excess glucose in the mother’s blood can cross the placenta, causing problems for the baby. Children whose mothers had gestational diabetes are also at higher risk for developing type 2 diabetes later in life.
Recognizing the Symptoms
Gestational diabetes often doesn't have any noticeable symptoms. If you do have symptoms, they may be mild, such as:
- Increased urination-When glucose accumulates in the blood, it pulls water out of the body’s tissues and into the blood. The kidneys turn this extra water into urine and excrete it.
- Increased thirst-The increase in urine output causes your body to become dehydrated.
- Increased hunger-Your body’s cells are not getting enough glucose, which means your cells cannot get enough food.
- Recurring urinary tract infection or vaginal yeast infection -When glucose builds up in the blood, it can affect the functioning of your white blood cells.
- Fatigue-Because your cells are not getting glucose, they cannot get enough energy.
Unfortunately, the symptoms of diabetes are quite similar to other body changes that often occur during pregnancy. That’s why screening for gestational diabetes between your second to third trimester is so important. Gestational diabetes usually develops around the 24th week of pregnancy. If you're at higher risk for gestational diabetes, your doctor may test you earlier.
Risk Factors and Screening
Your doctor should assess your risk for gestational diabetes at your first prenatal visit. If you already have diabetes and you become pregnant, then you do not need to be screened for gestational diabetes. If you have risk factors for developing gestational diabetes (such as, obesity, family history for type 2 diabetes, or previous history of gestational diabetes), your doctor may recommend that you undergo glucose tolerance testing as soon as possible. If your initial test is negative, you will be retested between 24 and 28 weeks of gestation. If you are at average risk, your doctor will give you a screening test between 24-28 weeks of gestation.
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The Role of Weight Loss in Gestational Diabetes Management
Managing your weight with gestational diabetes is not about dieting or trying to lose weight. Your aim is to look after yourself and your unborn baby by eating healthy meals and staying active. Follow the recommended weight gain set out by your doctor. Don't try to lose weight if you're already pregnant. You'll need to gain some weight for your baby to be healthy.
Losing weight during pregnancy is not recommended to help manage gestational diabetes and could be harmful, especially after the first trimester. Nausea and food aversions can sometimes lead to first trimester weight loss, which is common and usually not concerning.
Healthy Eating for Gestational Diabetes
Eating a balanced, healthy diet can help you manage gestational diabetes. The diet recommendations that follow are for women with gestational diabetes who do NOT take insulin.
For a balanced diet, you need to eat a variety of healthy foods. Reading food labels can help you make healthy choices when you shop. If you are a vegetarian or on a special diet, talk with your health care provider to make sure you're getting a balanced diet.
In general, you should eat:
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- Plenty of whole fruits and vegetables
- Moderate amounts of lean proteins and healthy fats
- Moderate amounts of whole grains, such as bread, cereal, pasta, and rice, plus starchy vegetables, such as corn and peas
- Fewer foods that have a lot of sugar, such as soft drinks, fruit juices, and pastries
You should eat three small- to moderate-sized meals and one or more snacks each day. Do not skip meals and snacks. Keep the amount and types of food (carbohydrates, fats, and proteins) about the same from day to day. This can help you keep your blood sugar stable.
Carbohydrates
Less than half the calories you eat should come from carbohydrates. Most carbohydrates are found in starchy or sugary foods. They include bread, rice, pasta, cereal, potatoes, peas, corn, fruit, fruit juice, milk, yogurt, cookies, candy, soda, and other sweets.
High-fiber, whole-grain carbohydrates are healthy choices. These types of carbohydrates are called complex carbohydrates. Try to avoid eating simple carbohydrates, such as potatoes, french-fries, white rice, candy, soda, and other sweets. This is because they cause your blood sugar to rise quickly after you eat such foods. Vegetables are good for your health and your blood sugar. Enjoy lots of them.
Carbohydrates in food are measured in grams. You can learn to count the amount of carbohydrates in the foods that you eat.
Grains, Beans, and Starchy Vegetables
Eat 6 or more servings a day. One serving equals:
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- 1 slice bread
- 1 ounce (28 grams) ready-to-eat cereal
- 1/2 cup (105 grams) cooked rice or pasta
- 1 English muffin
Choose foods loaded with vitamins, minerals, fiber, and healthy carbohydrates. They include:
- Whole-grain breads and crackers
- Whole grain cereals
- Whole grains, such as barley or oats
- Beans
- Brown or wild rice
- Whole-wheat pasta
- Starchy vegetables, such as corn and peas
Use whole-wheat or other whole-grain flours in cooking and baking. Eat more low-fat breads, such as tortillas, English muffins, and pita bread.
Vegetables
Eat 3 to 5 servings a day.
Fruits
Eat 3 to 5 servings a day. One serving equals:
- 1 medium whole fruit (such as a banana, apple, or orange)
- 1/2 cup (170 grams) chopped, frozen, cooked, or canned fruit
- 3/4 cup (180 milliliters) fruit juice
Healthy fruit choices include:
- Whole fruits rather than juices. They have more fiber.
- Citrus fruits, such as oranges, grapefruits, and tangerines.
- Fruit juices without added sugar.
- Fresh fruits and juices. They are more nutritious than frozen or canned varieties.
Milk and Dairy
Eat 4 servings of low-fat or nonfat dairy products a day. One serving equals:
- 1 cup (240 milliliters) milk or yogurt
- 1 1/2 oz (42 grams) natural cheese
- 2 oz (56 grams) processed cheese
Healthy dairy choices include:
- Low-fat or nonfat milk or yogurt. Avoid yogurt with added sugar or artificial sweeteners. Dairy products are a great source of protein, calcium, and phosphorus.
Protein (Meat, Fish, Dry Beans, Eggs, and Nuts)
Eat 2 to 3 servings a day. One serving equals:
- 2 to 3 oz (55 to 84 grams) cooked meat, poultry, or fish
- 1/2 cup (170 grams) cooked beans
- 1 egg
- 2 tablespoons (30 grams) peanut butter
Healthy protein choices include:
- Fish and poultry. Remove the skin from chicken and turkey.
- Lean cuts of beef, veal, pork, or wild game.
- Trim all visible fat from meat. Bake, roast, broil, grill, or boil instead of frying.
Sweets
Sweets are high in fat and sugar, so limit how often you eat them. Keep portion sizes small. Even sugar-free sweets may not be the best choice. This is because they may not be free of carbohydrates or calories. You also may want to avoid artificial sweeteners, as they can negatively affect your gut bacteria. However, so far, no harm has been shown due to this change. Ask for extra spoons or forks and split your dessert with others.
Fats
In general, you should limit your intake of fatty foods. Go easy on butter, margarine, salad dressing, cooking oil, and desserts. Avoid fats high in saturated fat such as hamburger, cheese, bacon, and butter. Don't cut fats and oils from your diet entirely. They provide energy for growth and are essential for baby's brain development. Choose healthy oils, such as canola oil, olive oil, peanut oil, and safflower oil. Include nuts, avocados, and olives.
The Importance of Physical Activity
Gentle exercise can help to reduce your blood sugar levels and manage your gestational diabetes. Light physical activity, such as walking or swimming, can help manage gestational diabetes. However, speak to your doctor prior to engaging in any form of exercise. Walking, pregnancy yoga, swimming or aquanatal classes are all great ways to stay healthy and maintain a healthy pregnancy weight. Your body also needs at least 150 minutes of moderate-intensity exercise every week. Granted, it’s not always easy finding time to exercise, but this could be as simple as a quick 20-minute brisk walk every day.
Medical Intervention
In some cases, dietary changes and physical activity alone are not sufficient to control blood sugar levels. If this occurs, your doctor may recommend pregnancy-safe medications that you can take. It is important to always take medication as prescribed. Gestational diabetes that can’t be managed through diet and exercise alone requires medications, such as insulin.
Prenatal Care and Monitoring
The most important tool for maintaining your health and the health of your baby is to keep your regular prenatal appointments. Due to some of the increased risks to both you and your baby, you may need to attend a few more prenatal checkups. This will likely occur during the last three months of pregnancy. If you are diagnosed with gestational diabetes, those appointments will likely increase in frequency to at least every two weeks. You can also expect an extra ultrasound or two to monitor the size of your baby. In between appointments, you can take control of your health by watching what you eat and, with your doctor’s approval, getting regular exercise. Keep a food diary and track how you’re feeling after you eat.
Postpartum Care
Again, for many patients, gestational diabetes resolves shortly after childbirth. To determine the status of diabetes and whether you need medication to control it, your doctor will check your blood sugar after you give birth and again six to eight weeks later. Don’t postpone this follow-up care for your own health, even if you’re busy taking care of a new baby. Roughly half of patients who have gestational diabetes go on to develop Type 2 diabetes within 20 years. But you can reduce your risk of developing Type 2 by maintaining a healthy diet and weight.