Healthy eating for gestational diabetes

Gestational diabetes is a type of diabetes that arises during pregnancy. In a nutshell, diabetes is a condition in which blood glucose levels remain high. Although gestational diabetes usually disappears after the woman has given birth, it is a serious condition that can pose a threat to the mother’s health and her baby’s if not monitored closely. If you have been diagnosed with gestational diabetes, please contact a registered dietitian for dietary advice that matches your individual needs.

What happens during gestational diabetes?

When we eat carbohydrate foods (such as flour and sugar containing products, starchy vegetables, fruits and dairy), our body breaks them down into glucose which is released into the blood. Rises in blood glucose concentrations signal an organ, the pancreas, to release the hormone insulin. Insulin acts as a ‘key’ that ‘opens’ the ‘locked doors’ on our cell walls, allowing glucose entry into the cells where it can be used as energy.

The placenta produces hormones needed for the foetus to grow and develop. In gestational diabetes, these hormones also interfere with the mother’s insulin action. Moreover, fluctuating hormone levels in the body alter the body’s requirements for insulin in such a way that the pancreas cannot produce sufficient insulin. These two situations cause glucose levels to remain high.

After delivery, since the placenta is removed, the mother’s hormonal balance returns to normal and so do her needs for insulin: the diabetes usually disappears.

Risk factors for gestational diabetes

• Pre-pregnancy weight: Women who are overweight or obese (BMI over 25kg/m2) run a greater risk for gestational diabetes. You can calculate your BMI by dividing your pre-pregnancy weight in kilograms by the square of your height in metres.
• Age: Women over 30 years of age are at higher risks of developing gestational diabetes.
• Family history of type II diabetes.
• History of gestational diabetes in a previous pregnancy.
• Previous delivery of a heavy baby (over 4kg).
• Unexplained stillbirth.
• Ethnicity: Women of Asian, African or South-American origins are at higher risks.

Moreover, a 2010 study, published in the journal Obstetrics & Gynecology, linked excessive pregnancy weight gain — especially during the first trimester — to an increased risk of gestational diabetes.

How can gestational diabetes affect my baby?

• Excessive birth weight

  When your blood glucose levels are high, a larger amount crosses your placenta to your baby who needs glucose for proper development. However, extra glucose triggers the foetus’ pancreas to secrete extra insulin; this can cause excessive growth and fat accumulation in the baby. A C-section birth may be required as the baby may be too large to fit the birth canal.

• Respiratory distress syndrome

  If the mother’s blood glucose remains too high, she runs the risks of premature labour. The doctor may also request termination of pregnancy if the baby is growing too large. Lungs of babies born early may not be mature enough to support breathing.

• Increased risks of newborn jaundice.

• Increased risks of type 2 diabetes and obesity later in life.

How can gestational diabetes impair the mother’s health?

• High blood pressure

  Gestational diabetes increases your risks for high blood pressure, preeclampsia and eclampsia — two serious complications that endanger the lives of the mother and that of her baby.

• Future diabetes

  Uncontrolled gestational diabetes puts you at risk of developing type II diabetes later in life. However, achieving a healthy body weight after deliver reduces your risks by about 75 percent.

How can I manage my gestational diabetes?

Exercise

Studies suggest that moderate exercise improves the body’s ability to use insulin, thus helping to keep you blood glucose levels in check. Try to be active on most days of the week for at least 30 minutes. Choose physical activity of moderate intensity (your breathing and heart rate should increase only slightly); avoid strenuous exercise and consult with your doctor first.

Do not skip meals

Skipping meals causes fluctuations in blood glucose levels and may lead to sugar cravings which will cause spikes in blood glucose.

Eat regularly

Try to have breakfast within 1 to 2 hours of waking up and schedule your lunch, dinner and at least 2 snacks in such a way that you do not go more than 3 to 4 hours without eating. This will help stabilise your blood glucose levels.

Be carb-wise

Choose wholemeal products (wild and brown rice, wholegrain products, oats, quinoa) and avoid sugar-laden and refined foods (those made with white flour, cornflakes, soft drinks, honey). The high fibre content of wholemeal products helps flatten increases in blood glucose whereas sugars and refined products exacerbate insulin resistance.

Watch your carb portion-size

Use the Eatwell Guide as a guide.

Increase your vegetable consumption

Choose a variety of vegetables as these are high in fibre.

Do not eat fruits on an empty stomach

Fructose, the fruit sugar, is rapidly absorbed in the blood. To lessen its effects, consume fruits immediately before or immediately after eating a main meal.

Have a protein with each meal

Protein will help keep your blood sugar levels balanced and will decrease sugar frenzies. Fish can improve your body’s ability to utilise insulin. However, do not exceed two servings per week and steer clear of fish with high mercury contents (shark, swordfish, marlin, and king mackerel).

Watch your calorie intake

Overeating causes weight gain which will further impair your body’s ability to use insulin and process glucose. However, do not try to restrict your intake: this can potentially harm your baby’s health and can actually worsen your gestational diabetes. Research has shown that individuals who follow restrictive diets are more prone to binge on fatty and sugary foods and are thus, at risk of accumulating excessive body fat associated with increased insulin resistance.

Limit the fat you eat

Avoid consuming high fat foods as these have a propensity to induce sugar cravings. Choose low fat dairy products and avoid cream and sour cream. Choose lean cuts of meat and skinless chicken and turkey.

Drink enough water

Your urine should be clear (or pale yellow) and odourless. Avoid fruit juices — the fibre has been strained and, therefore, the fructose is absorbed in the blood even more rapidly. Say no to diet soft drinks as these are believed to increase sugar cravings.

Remember: Most women with gestational diabetes can go on to have a complication-free pregnancy and delivery and give birth to perfectly healthy babies if they manage their condition.

• References

  Hedderson MM, Gunderson EP and Ferrara A (2010) Gestational weight gain and risk of gestational diabetes mellitus. Obstet Gynecol. 115(3):597-604.

  NHS Choices (2012) Gestational Diabetes (Accessed August 2013).

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