By Nutritionist Megan Crockart
Gestational Diabetes (“GD”) is now a very common place term – between 5%-8% of pregnant women are developing GD between week 24-28. If you haven’t heard of it, it is a form of diabetes that can occur in pregnancy and usually resolves after pregnancy. The placenta can block the mother’s body from using insulin properly (insulin resistance) due to the high level of hormones it’s producing. This then results in high blood sugar levels being present in a similar way to Type 2 Diabetes (read my previous article here).
The risk factors during pregnancy of having GD is that the baby can be born premature, have a higher birth weight or at the worst end of the scale, miscarry or stillbirth risks.
The risk factors to the mother of having GD does increase her risk of developing Type 2 diabetes later in life. The baby, once it is born, has a higher risk factor of developing Type 1 or Type 2 diabetes as a child or as an adult.
At around week 26 of pregnancy it is now standard practice for your GP, Obstetrician or Midwife to refer you for a glucose tolerance test to diagnose if you have GD. This is done by taking a fasting blood sample, then you have to drink 75g of pure glucose within 8 minutes (300ml liquid), then wait an hour, have more blood taken, wait a further hour before having more blood taken. This 2 hour glucose test determines how well your body can process the sugar in your blood stream. If it doesn’t cope all that well and the 3 readings are higher than they should be, then you will be diagnosed with GD.
Managing GD
Making changes to your diet and to what physical activity you are/not doing are the main ways to manage GD. Blood sugar reducing medication such as Meformin is not generally used for GD. In some situations (10-20%) insulin injections can be required by the mother. But usually most mother’s-to-be can manage their GD quite well with some changes to what they are eating and making sure they are getting plenty of physical exercise. Blood sugar levels are required to be monitored the rest of the pregnancy if there is a GD diagnosis and if insulin is required, this is usually stopped as soon as the baby is born – it is recommended to retest within a couple of months of the birth.
Diet and Exercise Recommendations to prevent GD and to Manage GD
Exercise and movement is particularly important in managing any form of diabetes. Make sure if you have any concerns about exercise while pregnant you get the all clear from your health care practitioner. If all is good, a minimum of 30 minutes a day of exercise that gets your heart rate up a little is recommended. This exercise can be in the form of whatever is most comfortable for you at this stage. Suggestions are walking, swimming, tai chi, pregnancy yoga and/or pilates. Also trying to incorporate incidental exercise is great – walk instead of driving where you can, do gardening (if comfortable), walk around when you are the phone, play with pets/children as much as you can. Obviously stay within your own limits and how you feel.
What are you eating? Have you had problems with keeping foods down and have reached for some bad options during the morning sickness periods? Once diagnosed with GD, things will need to change. The main things to focus on include:
- Avoid processed foods and those high in saturated fat (eg cakes, biscuits, pastries, fried foods, sausages, junk foods, chips, soft drinks, too much fruit juice) or make your own healthy muffins/slices.
- Be wary of low fat products, they often contain too much sugar instead and small amounts of good fat can be beneficial.
- Avoid sugar and sugary products. Use natural sweeteners like stevia or xylitol instead or a little bit of honey, rice syrup, maple syrup, coconut syrup or coconut sugar (very minimal amounts).
- Eat plenty of protein, ensuring protein (mostly vegetable protein) at each meal and snack.
- Eat lots of vegetables/salads and not more fruit – 2 serves of fruit (including dried) is plenty – try home-made vegetable juices with one piece of fruit if necessary
Eating regularly can help keep blood sugar levels balanced – you don’t want big dips and crashes, but making sure you choose the right type of foods are crucial.
Protein, good fats and fibre are important here with some inclusion of whole grain carbohydrates, but don’t go overboard on carbohydrates as they will spike blood sugar levels, sometimes higher than sugar.
Low blood sugar levels
Are you finding that during pregnancy you seem to be suffering from low blood sugar levels from time to time, eg feeling shakiness, nervousness or weakness, or feeling anxious, dizzy, extreme hunger and slight nausea. This could be because you are not eating enough now you are pregnant. Making sure you eat regularly and not wait until these symptoms appear usually resolves these lows. Make sure your snacks between meals are a good mix of protein and good fats eg unsalted raw nuts, vegie sticks with hummus or nut butter.
Nutrients to help regulate blood sugar levels
Chromium is a trace mineral that can help balance blood sugar levels and is safe to use in pregnancy. Lipoic acid is another nutrient that can help the body metabolise glucose. There are other nutrients that can be of benefit if there is a diagnosis of GD or if you are experiencing low blood sugar levels.
Contact Megan, who is a qualified nutritionist specialising in pre-pregnancy planning and pregnancy advice, if you have any questions about how to manage GD or prevent it. Megan is currently pregnant and now in her third trimester of pregnancy with her first baby so is also experiencing this magical world first hand.
Contact her on megan@balancingnutrition.com.au for more information or click here to book an appointment with her.