Gestational diabetes is the most common complication of pregnancy, it affects anywhere from 5-20% of pregnancies. Around 24-28 weeks pregnancy you go in to drink a glucose drink. I'm sure you have heard about how awful it is, it's kind of like chugging a Mountain Dew or an extremely concentrated gatorade, on what may be an empty stomach. Walking into this test can feel a little scary maybe even overwhelming or if you get diagnosed you may feel guilty or ashamed, but the reality is it's not you...it's your placenta.
What is gestational diabetes?
Gestational diabetes is a form of diabetes that is diagnosed during pregnancy, usually the third trimester. Getting this diagnosis doesn't mean you will continue to have diabetes after pregnancy, but it may increase your risk of developing diabetes later in life.
It's caused by high blood sugar in the body which can be caused by insulin resistance. Meaning, if you eat a meal or drink the glucose drink for your gestational diabetes test, the sugars from the meal breakdown and are released into your blood. To deal with the sugar in your blood your pancreas sends out insulin to push the sugar into cells. If your blood sugar is constantly elevated then your pancreas is constantly working to push out insulin. When this scenario is happening in the body it can lead to the insulin release from your pancreas being less effective. More is not better in this scenario.
What happens if I am diagnosed with gestational diabetes?
If you take the 1 hour test and the results are inconclusive you will do the 3 hour test. If those results are positive you will likely meet with a registered dietitian and go over very basic guidelines on how many carbs per meal and a range for your blood sugars to be in. The provider will get you setup with a monitor so you can test your blood sugars. If you aren't able to maintain your blood sugars with nutrition and exercise alone, you will be given a medication like insulin or metformin to help manage your blood sugars.
These appointments usually leave pregnant people feeling overwhelmed and falling into habits that may not be truly benefiting them during their management of gestational diabetes. Meeting with a nutrition coach, like myself, can help you navigate this diagnosis with ease and confidence. Contact me today to get started with nutrition coaching.
What are the guidelines my provider may give me if I have GD?
Each provider will be in these lines, adjusting the carb intake per meal and snack as they prefer.
175 grams carbs/day (spread out over 3 meals and 3 snacks)
Main meals will likely be about 45-60g carbs
Snacks will likely have 30g carbs
Other Management Options
Your provider may not give you these other options, but know you have options. The third trimester is unique in that pregnant people often feel fuller sooner so adopting lower carb meals is beneficial when it comes to consuming more nutrients and actually staying full.
Lower carb, high protein + fat option
Low glycemic index foods
High protein, fat + fiber foods
Nutrient dense foods
Remember, one size does not fit all. Managing gestational diabetes has a period of trial and error in figuring out how your body reacts to your meals throughout the day. It's a learning process, so give yourself some grace.
To read more about diet and GD, this study gives more information on the conventional recommendations and other options in managing GD.
What are the risks for my baby and I if I have gestational diabetes?
It MAY increase the risk of having a large baby which can lead to a provider recommending induction, birth trauma from things like shoulder dystocia, which is where one shoulder gets stuck behind the pubic bone, birth defects, hypertensive disorders, and could potentially increase the risk of needing a c-section.
Reminder: suspecting a big baby is not a medically indicated reason for induction. Read the evidence here.
Your providers will be concerned about your baby's blood sugars after birth, so they will test them. It can sometimes require supplementation of formula, donor milk or you will have to express milk while you are at your birth place. You can start collecting colostrum in pregnancy, read more here.
Here are some nutrition things to keep in mind as it relates to blood pressure concerns, like pre-eclampsia:
we know that adding just 5g of fiber per day can reduces your risk of developing preeclampsia by 14%
Eating 5 or more servings of plants/day can reduce your risk by 55-75%
Research supports 1000mg of calcium/day from early pregnancy and through the third trimester
If you have low selenium your risk of pre-e is 4x higher. All you need to do is add 2 Brazil nuts to your daily intake to meet this goal (check your prenatal vitamin for this important nutrient too)
Can I use nutrition to help prevent developing GD?
During preconception, the 3-4 months leading up to actively trying to conceive you may consider your diet and lifestyle from a nutrition standpoint to help prevent gestational diabetes in pregnancy.
Through nutrition there is a link between gut health and the diagnosis of GD. If you are in the stages of trying to conceive or your first or potentially the very beginning of your second trimester consider adding fermented foods to your diet like kimchi, kefir, or a probiotic. To read more about the benefits of probiotics on the prevention and treatment of GD, click here.
There is some research that supports magnesium supporting better outcomes for pregnant people with GD as it relates to insulin and oxidative stress. Here is the meta-analysis.
There is newer research that shows a link between high supplemental folic acid and an increased risk in contracting GD. Folic acid is the synthetic version of folate and it serves a valuable purpose: eliminating neural tube defects like spina bifida. Supplementation is recommended about 12 weeks before pregnancy and through the first 12 weeks. There has been no proven benefit of continuing to take a folic acid supplement after the neural tubes have closed. Here is the cohort study that looked at 42k participants. It should be noted that this study was unable to differentiate between synthetic folic acid and folate from natural forms.
Research shows a potential link between low vitamin D levels in the blood and the development of GD.
If you are preparing to take your gestational diabetes test here are some tips to help you navigate the test, not to trick the test.
The night before your test have a bedtime snack. Examples include: dark chocolate and nuts, cheese and crackers, cottage cheese and fruit, or even chips and guac
A bedtime snack is important because your placenta sends out a surge of hormones in the early morning hours, between 4-6 AM, so you may automatically start your day with higher blood sugar.
Before your test make a savory breakfast like an egg scramble with at least 2 veggies plus a piece of whole grain toast with butter or avocado smeared on it. Try this tasty breakfast burrito recipe.
After your test, eat something high in protein and fat to avoid the crash and feeling extra icky
Continue to eat high protein, high fat, high fiber meals for the next few days to avoid feeling the ick
Let us know what questions you have about gestational diabetes in the comments!