Gestational Diabetes (GDM) is a form of glucose intolerance first diagnosed during pregnancy. Among the many changes that occur during pregnancy, there is shift in a women’s ability to metabolize carbohydrates. Most women are able to compensate with this shift by producing enough insulin to help cover the extra glucose and nutrient needs for their growing fetus.
When you consume carbohydrates, they get broken down and create glucose, glucose travels within your blood and gets shuttled by insulin to be metabolized and used as energy for the fetus and mother. When someone has GDM, their body isn’t able to digest the excess glucose needed during pregnancy by producing enough insulin to shuttle it to where it needs to go, therefore having excess glucose in your body. When this occurs your body is not utilizing the glucose for your fetus or yourself as a carbohydrate and thus affects both baby and mom.
The reason GDM occurs in the second and third trimester, is due to the fact that the embryo doesn’t require much energy from the mother in the first trimester and this is one reason why during the first trimester you aren’t required to increase your caloric intake. The embryo doesn’t need extra energy at this phase of life. As the pregnancy progresses, the placenta grows and as a result produces hormones. There are specific hormones released that are insulin antagonist (ANTI insulin). Due to these hormones that are against insulin and the need for women to consume more calories and thus produce enough glucose for the fetus, there is an increase of glucose demand and production. Most women can increase their insulin production to compensate for the extra glucose within their body, but when women can’t produce enough insulin or their insulin isn’t being used effectively then GDM occurs.
During pregnancy Gestational Diabetes affects approximately 7% of all pregnancies and woman who have GDM are 20-50% more likely to develop type 2 diabetes in the next 5- 10 years.
Women at risk for GDM have the following characteristics:
-Obesity (BMI >30.0)
– Personal history of GDM
– Glycosuria (excretion of glucose in the urine)
– Strong family history of diabetes (1st degree relative)
– Prior poor obstetrical outcome (stillbirth, birth defects, or baby >9lbs)
– Member of a high-risk ethnic group (Hispanic, African American, Native American, South or East Asian, Pacific Islander)
So what happens when you’re told you have GDM? I’m sure you start to panic, and stress and of course blame yourself. WELL STOP THAT! You aren’t the first and you won’t be the first woman in this situation and with a great clinical team around you, you will be able to manage your GDM and return to normal post pregnancy. Once diagnosed, the treatment goal is to prevent hyperglycemia ( high blood sugar levels). Which is defined as fasting blood glucose equal to or above 95 mg/dL, and either one-hour postprandial (after eating) blood glucose equal to or below 140 mg/dL, or two-hour postprandial blood glucose of 120mg/dL.
Diet manipulation is the treatment for most GDM. If diet and exercise alone aren’t able to keep blood glucose under control, medication needs to be considered.
A few helpful tips for management*:
Energy (Calories): Caloric intake should be sufficient to promote adequate but not excessive weight gain. Consume 3 small-medium sized meals and 2-4 snacks at least every 2 hours. A bedtime snack or even one in the middle of the night is recommended to diminish the number of hours fasting.
Carbohydrates: Recommendations are based on the effect of intake on blood glucose. Intake should be distributed throughout the day. Frequent feedings, smaller portions with intake enough to prevent ketonuria (excess ketones within the urine, which is a sign of poorly managed Diabetes). When dealing with Diabetes the word “exchange” is used to inform people how many carbohydrates should be consumed at that meal or snack. 1 exchange is equal to 15 grams of carbohydrates. Avoid all simple sugars, sweets and refined carbohydrates; limit carbohydrates at each meal; and emphasize complex carbohydrates and fiber.
Protein: The Recommnded Dietary Allowance (RDA) is (0.8g/kg x Body Weight) + 25 g/day or 1.1 grams/kg of ideal bodyweight. Protein consumption doesn’t affect post-meal blood glucose, but you should consume protein with your 3 moderate sized meals to help get adequate caloric intake and keep you satiated. Try choosing lean proteins to prevent excessive weight gain. If choosing a higher fat protein, salmon is your best choice due to the omega-3 content naturally found within.
Fat: Limit saturated fat, focus on leaner protein choices to not raise saturated fats and try to consume healthy fats such as DHA, Omega-3 and Omega-6 found in fish, nuts and seeds.
In order to properly manage GDM one must meet with a practitioner to create a nutrition plan that will meet the following goals:
- Individualize medical nutrition therapy based on pre pregnancy weight and height to provide adequate energy and nutrients to meet the needs of pregnancy and to be consistent with established blood glucose levels
- Avoid ketonemia from ketoacidosis or starvation
- Focus the medical therapy for GDM food choices for appropriate wight gain, normal blood glucose levels and absence of ketosis.
In addition to the above, women with GDM need to test their blood sugar (glucose) levels even if they are taking insulin.
For more detailed information on Gestational Diabetes click here.
*Please be advised that your physician will refer you to a Registered Dietitian or provide you with helpful resources. If you want help managing your GDM you can contact firstname.lastname@example.org for a meal plan created by Ali Lewis RD,LD.
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