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Gestational Diabetes

Written by nutrition student Millie Rose

Introduction

Diabetes week is here bringing awareness to the chronic health condition. There are 3 types of diabetes, including Type 1, Type 2 and Gestational. However, this blog will focus on gestational diabetes and how diet can help manage your blood sugar levels. Read until the end for recipes for women with Gestational Diabetes.

Why is this relevant?

Gestational Diabetes affects 1 in 20 pregnancies in the UK (Diabetes, 2023). Gestational diabetes can make it difficult to manage blood sugar levels, which may lead to symptoms such as increased thirst and urination, a dry mouth, and tiredness (NHS, 2022). It is important that you learn to manage your blood sugar levels if you have gestational diabetes, for the health of you and your baby.

What is gestational diabetes?

Gestational diabetes is when blood sugar levels are high during pregnancy. It occurs because the body cannot produce enough insulin to reduce blood sugar levels after eating, leading to spikes in blood sugar that don’t settle. Blood sugar levels usually level out after birth.

Who is more likely to get gestational diabetes?
  • 40+ years of age
  • BMI above 30
  • A baby weighing 4.5kg or more in previous birth
  • Gestational diabetes in previous birth
  • A parent or sibling has diabetes
  • Your ethnic background- South Asian, Black, African-Caribbean or Middle Eastern
  • You have had a gastric bypass or weight-loss surgery

(NHS, 2022)

Why?

These risk factors have a correlation with insulin resistance.

A healthy individual will produce insulin when blood sugar rises after eating. The insulin will be responded to, and the blood sugar levels will reduce to a pre-eating level.

Insulin resistance is where insulin is produced when blood sugar rises after eating. However, the insulin is not responded to, and the blood sugar levels remain high.

Often in gestational diabetes, insulin is produced in response to increasing blood sugar levels; however, it is not responded to, so blood sugar levels remain high. This can be due to placental hormones making insulin less efficient.

How is gestational diabetes diagnosed?

If you have one or more risk factors for Gestational Diabetes (see list above), you will be screened for Gestational Diabetes earlier in your pregnancy. This is done by an oral glucose test, where a blood test is taken in a fasted state and 2 hours after a glucose drink. However, some women may have high blood sugar levels, which are indicated by symptoms including increased thirst, increased urination, a dry mouth, tiredness or blurred eyesight, which may also prompt earlier testing (NHS, 2022). Gestational Diabetes may also be detected later in your pregnancy.

What happens after diagnosis, during pregnancy?

You will be given a blood sugar testing kit to measure your blood sugar levels throughout the day, especially after eating. This requires a small finger prick for a drop of blood, allowing you to get a blood sugar reading.

Controlling blood sugar levels is vital to reduce the effects of Gestational Diabetes, meaning diet is an important factor to monitor. Continue reading to learn how to manage your blood glucose through your diet.

Additionally, being more active can help reduce blood sugar levels. Walking, swimming, and prenatal yoga may be more suitable options during your pregnancy.

However, in severe cases insulin injections may be necessary to reduce blood glucose.

Additionally, your midwife will talk to you about monitoring what is needed throughout pregnancy and birth. It is recommended to give birth before 41 weeks with gestational diabetes to reduce the risk of complications to you and your baby, so an induction or caesarean section may be considered.

(NHS, 2022)

What can I do?

1. Swap to wholegrain options

  • Lower Glycemic index in comparison to refined grains, such as white flour.
    • This prevents spikes in blood glucose.
  • Higher in fiber
    • Fiber slows down digestion, meaning glucose is absorbed into the blood slower, stabilising blood glucose.

How to apply this:

  • Opt for whole grain bread, brown rice, whole grain pasta, quinoa and oats instead of white bread, white rice and white pasta
  • Check labels, look for 100% whole grain
  • Eat at least 5 portions of fruit and vegetables every day

2. Reduce refined sugar

  • Refined sugars are absorbed into the bloodstream quicker than unrefined sugars, leading to blood sugar spikes
  • Unrefined sugars provide more consistent energy levels, which may also reduce snacking

How to apply this:

  • Limit refined sugar products, such as cake, sweets, juices and sweetened drinks
  • Opt for unrefined sugar products when you have a sweet craving, such as dates and whole fruits

3. Check portion sizes

  • Regulate blood sugar
    • Larger portions can lead to spikes in blood glucose
  • Support weight maintenance
    • Excessive weight gain can increase the risk of complications for mother and baby

How to apply this:

  • Check food labels – see blog on label reading
  • General portion sizes: two fists of rice, pasta, a handful of potato, 1 slice of bread, 1 handful of nuts, 1 small matchbox of cheese

4. Choose and plan healthier snacks

  • Snacking can promote high sugar or carbohydrate intake
    • Leads to a spike in blood sugar
  • One large snack may spike blood sugar
    • Blood sugar will remain high

How to apply this:

  • More frequent, smaller snacks will promote steadier blood sugar levels
  • Snacks which are whole foods and low in refined sugar and carbohydrates will cause smaller spikes in blood sugar, for example Greek yoghurt with fruit or carrot sticks and hummus

5. Opt for lower Glycaemic Index foods

  • The Glycaemic Index indicates how quickly carbohydrate foods cause an increase in blood sugar levels after eaten
    • Foods with a high GI will cause a quick spike in blood sugar and provide only temporary energy, whereas low GI foods will cause longer peaks in blood sugar, providing longer-lasting energy
  • However, it is also important to consider the cooking methods
    • For example, foods cooked in fat have a lower GI because the fat slows down the absorption of carbohydrates. Use your intuition to choose healthier low GI foods, which are typically in their natural state or minimally processed. For example, minimise milk chocolate or crisps.

How to apply this:

  • Low GI products include bananas, apples, milk, seeds and nuts
  • High GI products include potatoes, white bread, sugary cereals

(Diabetes UK)

(Diabetes UK, 2023)

Exemplar Meal Guide

Breakfast: Overnight oats with figs and honey

Lunch: Tahini goddess lunch bowl

Dinner: Chorizo and bean stew

Snack option 1: Crunchy chocolate quinoa bites

Snack option 2: Creamy smooth hummus with cucumber or carrot sticks

Snack option 3: Dark chocolate dipped strawberries/fruit

What is the impact of Gestational Diabetes after birth?

Having Gestational Diabetes during your pregnancy increases the risk of having Type 2 Diabetes, which is lifelong. Women who have had gestational diabetes have their blood sugar levels tested every year to detect whether they are pre-diabetic or diabetic. It is especially important that women who have had gestational diabetes maintain a healthy weight by eating a balanced diet and exercising regularly to prevent development of type 2 diabetes after pregnancy.

Continuing the habits in the ‘What Can I do?’ section after birth will also reduce the risk of type 2 diabetes, in which mothers who have had Gestational Diabetes are at a greater risk of developing.

References:

Buchanan, T.A., Xiang, A.H., & Page, K.A. (2019). Gestational diabetes mellitus. Nature Reviews Disease Primers, 5, Article 47. https://doi.org/10.1038/s41572-019-0098-8

Diabetes UK. Glycaemic Index and Diabetes. [online] Available at: https://www.diabetes.org.uk/living-with-diabetes/eating/carbohydrates-and-diabetes/glycaemic-index-and-diabetes

Diabetes UK (2023). Causes of Gestational Diabetes. [online] Diabetes UK. Available at: https://www.diabetes.org.uk/about-diabetes/gestational-diabetes/causes.

Diabetes UK (2023). What can I eat with Gestational Diabetes? [online] Diabetes UK. Available at: https://www.diabetes.org.uk/living-with-diabetes/eating/gestational-diabetes

Hillier, T.A., Pedula, K.L., Ogasawara, K.K., et al. (2021). A Pragmatic, Randomized Clinical Trial of Gestational Diabetes Screening. New England Journal of Medicine, 384(10), 895–904. doi:10.1056/NEJMoa2026028.

NHS (2022). Gestational Diabetes. [online] NHS. Available at: https://www.nhs.uk/conditions/gestational-diabetes/.

Simmons, D., Immanuel, J., Hague, W.M., et al. (2023). Treatment of Gestational Diabetes Mellitus Diagnosed Early in Pregnancy. New England Journal of Medicine, 388(22), 2132–2144. doi:10.1056/NEJMoa2214956.

Zhang, C., Rawal, S., & Chong, Y.S. (2016). Risk factors for gestational diabetes: is prevention possible? Diabetologia, 59(7), 1385–1390. https://doi.org/10.1007/s00125-016-3979-3

Zhu, Y., & Zhang, C. (2016). Prevalence of Gestational Diabetes and Risk of Progression to Type 2 Diabetes: a Global Perspective. Current Diabetes Reports, 16(7), 7. https://doi.org/10.1007/s11892-015-0699-x