How to Treat and Prevent Gestational Diabetes
Registered dietitian Lily Nichols joins the Nutrition Diva with expert advice on how to deal with this common condition and how to prevent it from happening in the first place.
Monica Reinagel, MS, LD/N, CNS
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How to Treat and Prevent Gestational Diabetes
If you are expecting a baby, you can also expect to be tested for gestational diabetes somewhere around your 24th week of pregancy. About 1 in 5 women develop high blood sugar during their pregnancies, a complication that—if it arises—needs to be carefully managed, both for your sake and for the baby’s.
See also: Foods to Avoid During Pregnancy
Lily Nichols is a registered dietitian who specializes in the treatment and prevention of gestational diabetes. She is the author of a new book called Real Food for Gestational Diabetes and I’ve asked her to share some of her tips on how to handle this increasingly common diagnosis—and even how to prevent it from happening in the first place!
Nutrition Diva: First, Lily, will you tell us what gestational diabetes means?
Lily Nichols: Gestational diabetes (GD) is usually defined as diabetes that develops or is first diagnosed during pregnancy. However, it can also be defined as “insulin resistance” or “carbohydrate intolerance” during pregnancy.
I prefer to rely on the latter description because, at the end of the day, gestational diabetes is the result of insulin resistance, which means a woman is unable to tolerate large amounts of carbohydrates without experiencing high blood sugar.
ND: Being diagnosed with GD causes a lot of anxiety, but you suggest that this is not cause for panic or despair. Can you explain?
LN: Getting gestational diabetes is often scary and overwhelming for women as there are risks to both mom and baby if it’s not well controlled. However, moms that learn to control their blood sugar (the majority of which can be done with simple diet, lifestyle, and exercise changes) have no higher risks of complications.
We need to re-frame how we look at gestational diabetes. It’s a unique opportunity for moms to focus on self-care and make healthy lifestyle changes they can continue for life. GD is now the most common complication of pregnancy, affecting up to 18% of pregnant women, so it’s time we lose the stigma and focus on what we can do.
See also: What Is High Glucose?
ND: How do women with GD go wrong in their dietary approaches?
LN: Many women are told to eat a fairly high carbohydrate diet, which is perplexing given that GD is “carbohydrate intolerance” and carbohydrates are the primary macronutrient that raises the blood sugar. So often, it’s not the moms that go wrong, but the advice they receive that’s misguided and outdated.
ND: What makes your diet plan different than the conventional gestational diabetes diets?
LN: Well, first off, the carbohydrate recommendations are different. I don’t believe there’s a one-size-fits-all diet for pregnancy, and that includes the whole notion that there’s an “ideal” level of carbohydrates for all women to consume. It should be personalized to the woman and to her blood sugar & activity levels. Often, that will mean a lower carbohydrate diet compared to conventional guidelines, but not always.
Second, I emphasize the importance of quality fats in a prenatal diet, rather than a low-fat diet. There are numerous nutrients found in fatty foods that are key for fetal development. This whole notion that “fat is bad” is extremely outdated. It inadvertently leaves women deficient in a variety of nutrients, including choline, glycine, and fat-soluble vitamins. I cover why these nutrients, and others, are key to a developing baby in Chapter 5 of my book and in more detail in Module 2 of my online gestational diabetes course.
Third, I emphasize a real food approach that embraces nutrient-dense foods, including animal foods (from properly-raised animals). It’s not just about eating fewer processed carbohydrates, it’s about replacing those foods with the right things. Inadequate micronutrients can lead to blood sugar issues as well, so we have to focus on food quality.
See also: How Much Fat Should You Eat?
ND: What’s the most important thing to focus on when managing GD?
LN: The most important thing is to focus on is how your blood sugar responds to any changes in diet, exercise, or lifestyle. In general, consuming meals and snacks that include a balance of protein, fat, and carbohydrates will naturally help balance blood sugar levels.
ND: What materials are available for women concerned about GD?
LN: I have a book, Real Food for Gestational Diabetes, and an online course of the same name, which both explore the nutrition, exercise, and lifestyle changes women can make to manage their gestational diabetes, naturally. Course participants are also part of an online community, so they can connect with and get support from other moms who are also dealing with GD.
There’s also information on real foods to emphasize for a healthy baby, blood sugar-lowering medications, and research into low-carbohydrate diets and the controversy surrounding ketosis. The nutrition approach I share has been shown to reduce the likelihood a woman with GD will require insulin by 50%.
ND: Finally, is there anything women can do to LOWER their risk of being diagnosed with GD—especially if they’ve had it with previous pregnancies?
LN: Yes. The single most important factor in lowering the risk of GD is attaining a normal weight preconception. Being overweight at conception doubles the risk of getting GD during pregnancy. For women with a body mass index (BMI) greater than 35, the risk of gestational diabetes is five times greater than a woman at a healthy weight, most likely because insulin resistance tends to go up at higher body weight.
Weight is not the only factor, though. One study found that the combination of not smoking, exercising 150 minutes or more per week, and healthy eating reduced the risk of gestational diabetes by 41%.
Another showed that women who regularly exercised prior to conception and through 20 weeks gestation had a 49-78% reduced risk of developing gestational diabetes.
Newer research is looking at other factors that can affect GD risk. These include consuming adequate protein during the first trimester, avoiding exposure to toxins, maintaining normal vitamin D levels before and during pregnancy, and minimizing intake of processed carbohydrates during pregnancy (from foods like juice and cereal).
See also: Pregnant and Overweight? How to Minimize Your Risks
ND: That actually sounds like great advice for all of us!
My thanks to Lily Nichols for her expert advice. You can find out more about Lily’s book and online course at https://realfoodforGD.com and connect with her on Facebook and Twitter as well.
References:
Dempsey JC, Butler CL, et al. A case-control study of maternal recreational physical activity and risk of gestational diabetes mellitus. Diabetes Res Clin Pract. 2004 Nov;66(2):203-15.
Kim SY, England L, et al. Percentage of gestational diabetes mellitus attributable to overweight and obesity. Am J Public Health. 2010 Jun;100(6):1047-52.
Zhang C, Tobias DK, et al. Adherence to healthy lifestyle and risk of gestational diabetes mellitus: prospective cohort study. BMJ. 2014 Sep 30;349:g5450.
Image courtesy of Shutterstock.
About the Author
Monica Reinagel is a board-certified licensed nutritionist, author, and the creator of one of iTunes’ most highly ranked health and fitness podcasts. Her advice is regularly featured on the TODAY show, Dr. Oz, NPR, and in the nation’s leading newspapers, magazines, and websites. Do you have a nutrition question? Call the Nutrition Diva listener line at 443-961-6206. Your question could be featured on the show.