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Managing Gestation Diabetes: What to Know about Diet, Exercise, Blood Sugar Checks and Meds

Protect your baby and yourself with research-proven strategies for controlling high blood sugar in pregnancy. Part 3 in a series

wicker bassinet Most women with gestational diabetes can control it with a healthy diet, regular doctor-recommended exercise and regular blood-checks. (Photo: Unsplash, Nynne Schroder)

Gestational diabetes (GD)—high blood sugar that develops during pregnancy and almost always resolves itself shortly after birth—is in the news more than ever. And for good reason. GD increases a pregnant woman’s risk for dangerous high blood sugar called preeclampsia and for a large birth-weight baby—boosting odds for a caesarean section and for birth-related shoulder, bone and nerve injuries for your baby. In the long-term, GD raises a mom’s risk for type 2 diabetes and heart disease and boosts a baby’s risk for obesity and type 2 diabetes in the years ahead.

The good news? Most women with GD can control it with a healthy diet, regular doctor-recommended exercise and regular blood-sugar checks. And most women with GD can deliver their baby via vaginal birth. And research is also proving that taking charge of GD lowers risk for health problems for women and their babies. A healthy lifestyle and regular blood-sugar checks are the cornerstones of smart, effective GD self-care. If your blood sugar stays high, insulin is the preferred drug treatment but doctors may recommend other medications for some women.  

If you’ve been diagnosed with GD, here’s what you should know about what works best—and why it matters.

Health Benefits for Both of You

Research proves it: Following a doctor-recommended plan for managing GD—healthy eating, activity, blood sugar checks and medications such as insulin if prescribed—is good for your baby and for you. A landmark Australian study of 1,000 women with GD—the first big study testing the results of GD treatments—uncovered the benefits. It compared usual pregnancy care to more intensive GD treatment with all the steps mentioned above. Women who got treatment lowered their risk for preeclampsia (dangerously high blood pressure during pregnancy) by 30%—to 12% compared to 18% for the control group. Just 13% of babies born to moms in the treatment group had a high birth weight, compared to 22% in the control group. Newborns were also 75% less likely to endure serious birth complications such as shoulder injuries, bone fractures and nerve damage.1

Taking care of GD has benefits after birth, too. Women in the treatment group in the Australian study were half as likely to have depression or anxiety in the first three months after having their baby. In a 2017 review of 15 GD treatment studies involving 4,501 women, those who made healthy diet and exercise changes during pregnancy were more likely to be at a healthy weight a year later than those who didn’t. That could help lower the extra risk for type 2 diabetes and heart disease faced by women with a history of GD.2

The Best Diet for Gestational Diabetes

Between 70 and 85% of women with GD can control their high blood sugar effectively with a healthy diet and regular, doctor-recommended physical activity, according to the American Diabetes Association.3 A healthy eating plan packed with the nutrients that you need to maintain a healthy pregnancy and that your baby needs for healthy growth and development—while keeping your blood sugar in a healthy range—is one of the cornerstones of caring for your GD. There’s no one-size-fits-all menu for women with GD. When researchers from Australia compared 19 different GD diets in studies involving 1,308 women for a 2017 study,4 no clear winner emerged. Diabetes and pregnancy experts say a healthy GD diet features:

Menus tailored to your needs by your doctor or a registered dietitian/nutritionist.
Your eating plan should be customized so it’s right for your current health, stage of pregnancy and activity level. Work with your doctor or a dietitian to come up with a personalized plan—in a 2018 Kaiser Permanente study of more than 2,000 pregnant women with GD, those who got personalized recommendations for weight gain were more likely to hit their targets than those who didn’t.5 Write down what you eat each day. This will help you stay on track and show you how food choices affect your blood sugar. Review your diet journal with your dietitian or doctor.

Three meals plus 2-3 snacks.
Eating frequently—and staying within your recommended calorie and carbohydrate levels—spreads carbohydrates out through the day to prevent blood sugar spikes. Don’t skip meals. Your baby needs a steady supply of energy and building blocks for growth. If you’re using insulin, missing a meal could lead to low blood sugar. Include some satisfying protein every time you eat—such as eggs, cheese, low-fat or fat-free yogurt, lean meat and poultry, fish or beans.

“Complex” carbs help control blood sugar.
Fiber and other nutrients in produce and whole grains help control your blood sugar and deliver important vitamins, minerals and other must-have components to your baby. Don’t skimp on carbs in pregnancy—you and your baby need carbs for growth and energy and they’re essential for healthy brain development. Eat the amount recommended by your doctor or registered dietitian/nutritionist. Include plenty of vegetables in meals and snacks. Choose whole grains (whole-wheat bread, brown rice, whole-grain pasta and side dishes like barley, quinoa and bulgur) instead of refined grains and starches (like white bread, white rice, white potatoes). Have fresh fruit as recommended, in place of fruit juice. Skip sugar-sweetened soft drinks, which can boost blood sugar levels without providing nutrients.

Eat enough calories for healthy weight gain.
Follow your doctor’s guidance on how much weight you should gain during your pregnancy. Don’t try to lose weight. According to ACOG, insufficient weight gain can raise your risk for an early delivery.  

Physical Activity

Discuss with your healthcare practitioner the kinds of physical activity that are best for you. The National Institutes of Health recommends women with GD aim for 30 minutes of activity five days a week. Walking is a great option. Start slowly if you haven’t been active before.6  A 10- to 15-minute stroll after meals can be especially helpful for controlling blood sugar.

If you were active before your pregnancy, talk with your doctor about which high-intensity activities and exercises you can keep doing. Making movement a part of your pregnancy self-care can also soothe stress, strengthen your muscles, bones and heart and could help lower your odds for developing type 2 diabetes later in life.

Regular Blood-Sugar Checks

Your doctor will likely recommend that you test your blood sugar several times a day once you’ve been diagnosed with GD. Testing first thing in the morning and then one to two hours after each meal is common. Frequent tests will show you and your doctor how well your diet and exercise plan are controlling your blood sugar. You and your healthcare practitioner will review your readings regularly. If your readings stay within the healthy range recommended by your doctor, she may suggest testing less often each day or even every other day, according to the American Diabetes Association.7 If readings are high despite healthy lifestyle changes, your doctor may recommend insulin or another medications.

According to the ADA8 and ACOG, healthy blood sugar readings during pregnancy are:

  • Fasting blood sugar: Below 95 mg/dL
  • 1 hour after you started a meal: Below 140 mg/dL
  • 2 hours after you started a meal: Below 120/mg/dL  

Medications for Gestational Diabetes

If your blood sugar is high despite lifestyle changes, your healthcare practitioner will likely recommend treating your GD with insulin. This injectable hormone tells your cells to absorb blood sugar. According to the ADA, insulin is the preferred drug for GD because it will bring your blood sugar levels down to a healthy range but doesn’t cross the placenta at measurable levels. Depending on your unique blood sugar patterns, you may need several injections a day or just a few.9  Some women with GD also use an insulin pump. 

What about pills that lower blood sugar? Your doctor or healthcare practitioner may prescribe metformin if she feels it is a better option for you. Some women have difficulty using injectable drugs like insulin or it may cost too much, for instance. Metformin can be effective. But according to the ADA, research suggests half of the women with GD who try it may eventually need insulin anyway to control their blood sugar. And metformin crosses the placenta—levels in umbilical cord blood have been shown to be higher than levels in the mother’s own blood, the ADA notes. So far researchers haven’t found any adverse side effects for babies, however.

Another pill, glyburide, is frequently given to women for gestational diabetes. But it can have downsides. It crosses the placenta. And in a 2018 French study10 in the Journal of the American Medical Association of 914 women with GD, the babies of the women who took glyburide were more likely than those using insulin to have high birth-weights and to experience low blood sugar and jaundice after birth babies.

Do Babies Need Extra Tests during Pregnancy?

Talk with your doctor. Women with GD may have to visit their healthcare practitioner or a clinic more often as their pregnancy progresses, to monitor the health of their developing baby. According to ACOG, tests for your baby may include a “kick count” to be sure your baby is active, a “nonstress test” to monitor your baby’s heart rate as she or he moves around in your uterus and a biophysical profile that includes a nonstress test and ultrasound to assess levels of amniotic fluid and sometimes, your baby’s breathing, movement and muscle tone.11 Most women with GD can deliver their baby vaginally, but your doctor may discuss the possible need for a caesarean section as your pregnancy progresses.

Updated on: May 20, 2019
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