7 Ways To Prevent and Manage Gestational Diabetes in Pregnancy
Gestational Diabetes Mellitus (GDM) is the development of diabetes during pregnancy. It is usually diagnosed by a blood glucose challenge test between 24-28 weeks of gestation.
Complications for Mom may include an increased risk of developing pre-eclampsia, preterm birth, dystocia (difficult, slow or obstructed labor) and the delivery of larger babies which may then require a c-section. Somewhere around 50% of women with GDM go on to develop type-2 diabetes if blood sugar is continually not well managed.
Complications for baby may include respiratory distress, low blood sugar upon birth (hypoglycaemia) and a predisposition to obesity, diabetes and metabolic syndrome later in life. Sadly, untreated gestational diabetes can even sometimes result in stillbirth.
Gestational diabetes is a complex disease with several contributing factors, including a disruption in glucose and lipid metabolism, inflammation and changes in the gut microbiata composition. The good news is, there is a lot that can be done to prevent and manage GDM to reduce the severity and risks for both mom and baby!
Photo courtesy of: https://www.womenfitness.net/gestational-diabetes-management/
1) Walk for at least 10 mins, 30 minutes after every meal.
Moderate-intensity walking after meals can reduce post-meal blood sugar spikes and improve overall blood glucose control in women with GDM. Some studies show that walking 30 minutes after meals may be the optimal time frame in order to optimally modify the glycemic (blood sugar) response. Timing your walks in this way may have a greater positive influence on GDM than simply walking for 30 minutes per day at a non-specific time.
Dinners tend to be carb heavy for most people and relaxation usually follows evening meals. The effect of blood sugar stabilization from walking after meals is most pronounced and beneficial after eating higher carbohydrate meals. Therefore, incorporating a 10 minute walk about 30 minutes after larger meals, especially carbohydrate rich meals like dinner, is an important step in managing GDM.
2) Focus on eating the right form and amount of carbohydrates. Aim for 25-30g of fibre/day in pregnancy.
Carbohydrates include both simple carbohydrates like white bread, pastries or baked goods, rice, pasta and sugary snacks but also include healthier options (complex carbohydrates) like starchy vegetables, whole grains, beans and lentils.
Carbohydrates in the first group almost get completely converted into sugar once in the body, spiking blood sugar more intensely and more quickly than healthier carbohydrate options.
Healthier complex carbohydrate options provide the body with essential fibre which is digested more slowly in the gastrointestinal tract and doesn’t get directly converted into sugar. These two factors explain why complex carbohydrates produce less significant post-meal blood sugar spikes and may lead to reductions in insulin resistance (an important factor in the development of GDM).
The fibre content of food items can be found listed under the carbohydrate section in the nutritional breakdown. Higher fibre contents reduce the total amount of carbohydrate that gets converted directly into sugar. For example, a food item with 20g of total carbohydrates and 2g of fibre is a poorer option for blood sugar control than a food item with 20g of total carbohydrates with 15g being from fibre.
Fibre passes through the digested tract undigested but plays many crucial roles, such as improving the gut microbiata, reducing cholesterol, removing waste products and removing excess glucose (sugar). Fibre also lowers the risk of obesity, heart disease and inflammatory illnesses. Ideally, pregnant women should consume around 28g of fibre/day. This may also improve pregnancy constipation and reduce hemorrhoids.
Downloading a Glycemic Index (GI) food guide may help you choose healthier carbohydrate options. Foods that are higher on the GI spike blood sugar more so than foods lower on the GI. For instance, a sweet potato raises the blood sugar less so and more slowly than a white potato since it is lower on the GI. You may download A Glycemic Index Food Guide, here: https://guidelines.diabetes.ca/docs/patient-resources/glycemic-index-food-guide.pdf.
3) Eat whole foods. Feed your microbiome to reduce inflammation.
Soluble and insoluble fibre may also help to reduce inflammation in the gut by producing important short-chain fatty acids, like butyrate, which can help improve the microbial balance in the gut. This is important as it is believed that women with GDM show changes in their microbial composition that may lower their levels of butyrate-producing flora (flora that help to decrease inflammation).
Interestingly, in late pregnancy the gut microbiata of pregnant women resemble the “bad bacteria” profile seen in those of adults with type-2 diabetes. Studies have shown that women with GDM may also have higher inflammatory markers in their blood stream than women without GDM, thus working towards reducing inflammation may help to possibly prevent and improve GDM parameters.
4) Eat smaller and more frequent meals throughout the day, spreading daily total carbohydrate intake over 5-7 smaller meals.
The Endocrine Society recommends limiting total carbohydrate intake to 35-45% of total calories/day for women with GDM. (Caloric needs differ amongst individuals but in general, it is recommended that pregnant women consume about 1800 calories/day in first trimester, 2200 in second trimester and around 2400 calories/day in third trimester. Proper nutrition, however, should be based on consuming well-balanced meals and eating whole foods as much as possible, rather than focussing on counting calories.)
The amount of carbohydrates eaten at one time can proportionately raise blood sugar higher. Therefore, the American College of Obstetrics and Gynecoloists recommends spacing your meals and carbohydrates out throughout the day, consuming three smaller meals and two-four snacks per day. Eating regularly and consuming smaller meals may help to decrease blood sugar spikes and improve glucose control in women with and without GDM. Eating smaller and more regular meals may also help to reduce nausea, dizziness, shakiness and other unpleasant pregnancy symptoms.
5) Pair carbohydrates with protein or healthy fats but limit saturated fats.
Protein requirements naturally increase in pregnancy. Eating adequate amounts of protein in pregnancy can also help to offset nausea and vomiting of pregnancy, too! Since protein and fats take much longer to digest than carbohydrates they can keep you full longer throughout the day and offset spikes in blood sugar. This is why I always recommend that snacks consisting of carbohydrates be paired with a protein or healthy fat. For example, an apple with a handful of nuts and seeds or a whole grain piece of toast with avocado.
When consuming fats, saturated fats should be avoided, especially for women with GDM. A high intake of saturated fats can interfere with insulin signalling and can increase inflammation and endothelial dysfunction which are both contributing factors in GDM. On the flip side, healthy fats, such as those derived from fish, seafood, some nuts and seeds can have anti-inflammatory properties and are associated with a reduced risk of GDM!
6) Eat a snack before bed!
Eating a snack before bed can help stabilize your blood sugar over night, which can actually also reduce night time wakings. One reason for night wakings in pregnant and non-pregnant people is due to dips in blood sugar.
Some examples of healthy night time snacks include greek yogurt, a handful of pumpkin seeds, a fruit paired with a healthy fat or protein such as cheese or almond butter or high fibre seed-based crackers with hummus.
In addition, blood sugar levels tend to naturally be higher in the mornings. So, it may be a good idea to eat lower carbohydrate meals in the morning and more carbohydrate-rich meals or snacks in the afternoon or evening (as long as you don’t forget your post-meal walk!) When having a small breakfast upon waking, you may want to consume your second small meal of the day about two hours later.
7) Supplements to consider:
Vitamin D. Multiple studies have shown that vitamin D deficiency is associated with an increased risk of developing gestational diabetes. Vitamin D supplementation has been shown to have beneficial effects on fasting blood glucose and serum insulin levels when taken by women with GDM. Having sufficient levels of vitamin D prior to 20 weeks of pregnancy may be protective and reduce the risk of developing gestational diabetes. In addition, vitamin D can help reduce inflammation, improve maternal mood and energy, may reduce the risk of postpartum mental health disorders and is essential for optimal fetal development.
Inositol. Inositol is an emerging therapy in the treatment of Type-2 Diabetes Mellitus and insulin resistance associated with PCOS. It is also a potential therapeutic agent in the treatment of gestational diabetes as it has insulin-like effects and plays a crucial role in blood sugar regulation. Inositol may be especially useful for overweight pregnant women, pregnant women with PCOS and a history of insulin resistance or for women with a family history of type-2 diabetes. Five randomized controlled trials concluded that myo-inositol is safe for use during pregnancy and can improve insulin resistance and blood sugar control in women diagnosed with gestational diabetes. It may also be used in some cases as a preventative measure to reduce the risk of GDM in susceptible women.
Probiotics. Considering the microbial changes in the gut (discussed above) associated with the development of GDM, it makes sense that “good bacteria” may help to reduce the risk of GDM. Probiotics are generally safe for most women to take in pregnancy and may significantly reduce insulin resistance, fasting serum insulin and blood sugar levels in women with gestational diabetes. Probiotics are not all created equally, they have different amounts and strains of beneficial bacteria. It is important to always speak with your Doctor and ND about supplementation.
If you are looking for help in preventing and managing diabetes or gestational diabetes, a Naturopathic Doctor can help you! Fill out a contact form here and we will reach out to you.
Warmly,
Dr. Sam
(Please note that more large scale, randomized controlled trials need to be performed with regards to some of these supplements with respect to various conditions in pregnancy. Always speak to your Doctor and ND before introducing new supplements into your regimen during pregnancy. In addition, always check the non-medicinal ingredients of supplements to ensure all ingredients are safe in pregnancy. Using professional-grade brands is recommended as well for the potency and purity of supplements).
REFERENCES:
https://pubmed.ncbi.nlm.nih.gov/29272606/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6267507/
https://link.springer.com/article/10.1007/s00125-016-4085-2
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7071246/
https://yalehealth.yale.edu/gestational-diabetes-treatment-plan
https://nutritionandmetabolism.biomedcentral.com/articles/10.1186/s12986-020-00509-0