If you are reading this, I’m guessing you have just been diagnosed with gestational diabetes or have been told you are at risk.
Let’s clear one thing up, it isn’t always your fault, there are many factors at play like genetics and hormonal effects that are out of control. I want to empower you to control what you can, your nutrition.
Gestational diabetes mellitus (GDM) is glucose intolerance that is first recognised in pregnancy. GDM is both a metabolic and endocrine disorder (2), that affects >20% pregnancies worldwide and approximately 1/7 pregnancies in Australia. Risk factors for developing GDM include a family history of DM2, hypothyroidism and being overweight or obese as well as underlying nutrient deficiencies like vitamin D.
Diagnostic criteria:
The diagnosis of GDM is made if one or more of the following criteria are met;
· A fasting blood glucose >5.1mmol/L,
· 1-hour post 75g glucose load >10.0mmol/L
· 2-hours post 75g glucose load >8.5mmol/L
How has this happened?
During early pregnancy, the body favours adipose tissue accumulation as a result of increased placental lactogen, progesterone, and prolactin. With increasing gestational age, insulin sensitivity is decreased which is an adaptive response of the mother to ensure sufficient nutrients to support the growing foetus and meet placental demands. Insulin secretion is increased to overcome the progressive insulin resistance. When pancreatic beta cell function is insufficient to meet the increased demands and hormonal effects of pregnancy coupled with reduced insulin sensitivity, hyperglycaemia may occur.
What are the risks for my baby?
Hyperglycaemia in pregnancy can lead to maternal, foetal and birth complications. For the mother, increased blood glucose levels can predispose to preeclampsia, maternal hypertension, caesarean section delivery, induction of labour or birth trauma. Complications for foetus include macrosomia (birth weight >4000g), small for gestational age, hypoglycaemia (low blood sugar), hyperbilirubinemia (high bilirubin potentially leading to jaundice), neonatal hyperinsulinemia (high insulin in baby), shoulder dystocia, and respiratory distress as well as a predisposition to metabolic diseases later in life.
But this doesn’t have to be the case. I will guide you to managing your blood sugar with wholefood nutrition. I also highly recommend using an at home blood sugar monitor to keep an eye on blood sugar levels. Interestingly, some women are more sensitive to certain carbohydrates than others. While this eBook provides a general guide to nutrition, if you find you are one of these women who are carbohydrate sensitive, please check in with me more tailored advice. I always tell my clients that GDM is a spectrum, and conventional approaches can be very one size fits all. I’m always curious to see where my one on one clients are on that spectrum eg. Are you borderline GDM, overtly or somewhere in between? If diet alone hasn’t been enough to manage blood sugar, please check back in with your doctor. You may need mediations, and there is no shame in that. It’s 1000x better that delivering a 5kg baby or having other complications.
What causes hyperglycaemia?
Put ultra-simply, carbohydrates, starches and sugars are what increase your blood glucose levels and insulin secreted by the pancreas is what helps to reduce levels by pushing glucose inside your cells. When your blood glucose levels are consistently or excessively elevated or you are “insulin resistant”, meaning your cells are resistant to the effects of insulin, and more insulin is secreted to compensate. When pancreatic function is insufficient in meet the increased demands of pregnancy, overt hyperglycaemia occurs.
If I cut carbs will that help?
This is effective for the management of type 2 diabetes but hasn’t been found to be effective for pregnant women with GDM. Carbohydrates are essential to support the demands of the foetus and possibly the placenta.
Consumption of carbs is important to prevent ketosis. During non-feeding hours, ketogenesis occurs which is a normal process in pregnancy (6). Ketone body synthesis also helps to meet the energy demands of the mother and preserve glucose for the foetus, while fasting. Ketone bodies can freely pass through to the placenta, though ketogenic diets with <10% total daily energy from carbohydrates may lead to ketonemia. Both ketonemia and higher B-hydroxybutyrate (a metabolite of ketosis) levels have been associated with growth abnormalities, reduced volume and distortion of organs including the brain, heart, thymus and spinal cord. Mothers with glucose intolerance have a predisposition to developing ketonemia. Management of blood glucose levels as well as preventing ketonemia is essential to ensure the health of offspring. Carbohydrate restriction in pregnancy could potentially put the developing foetus at risk of growth abnormalities.
What should I eat?
The Mediterranean-style diet has been shown to be the most effective in managing GDM. It’s important not to be tempted to mess with macronutrient distribution (the daily percentage of carbs, fat and protein) too much. Excessive protein intake and consuming the wrong type of fats e.g. Saturated or trans fats are all associated with an increased risk of GDM.
In a nutshell, consume the following each day;
A minimum 175g carbohydrate daily, strictly from wholegrains (e.g. faro, oats (?), sprouted bread, quinoa, brown rice), legumes (chickpeas, lentil), nuts, seeds, fruits and vegetables
1-1.2g per kg of body weight (no more than 25g per meal) but possibly up to 2g per kg of body weight daily if your are very active
5 serves of vegetable daily, 3 of these being low starch types (leafy greens mainly)
2 serves of fruit daily (always paired with protein like nuts or cheese)
Healthy fats, including a handful of nuts daily
2 serves of calcium rich foods daily (dairy, calcium fortified plant milks, fortified tofu or nut/seed butter)
No sugar (including honey or maple syrup, rice malt syrup), refined grains (anything white), anything made from flour (no cakes, crackers, conventional bread, pasta or pastries)
Avoid high starch foods (this may mean ditching oats) or limit portions of these foods
What else can you do?
Supplement with 300mg of elemental magnesium to improve insulin sensitivity
Take 4g myo-inositol daily
Exercise daily (at least 40-60 minutes as approved by your doctor)
Eat most of your carbs in the morning, a recent study showed that when consuming 50% of your daily carbs (~87.5g) in the morning (breakfast) improved fasting blood glucose and markers of insulin resistance. Notes this is a big carb load and my clinical experience is that it doesn’t work for everyone.
Track your dietary intake using cronometer
Continuous glucose monitor
What to know more? Book a free 10 minute into chat with me here .