A diagnosis of gestational diabetes can hit hard. Its not how you imagined your pregnancy journey. Many emotions arise: guilt, shame, sadness, worry, overwhelm and anger…You will have so many questions in your head and tempted to hit google for the answers. But online medical information needs to be carefully selected. The best way to tackle Gestational Diabetes is to arm yourself with evidence-based knowledge.

You would usually be referred to a diabetes team which may include any of the following health professionals: an endocrinologist, midwife, diabetes educator and dietitian, depending on your type of obstetric care.

Your team will offer diabetes education, individualised management, and ongoing support.

To help you start gathering evidence-based information, in this article I will outline my 5 key messages to take home for your Gestational Diabetes journey.

Message 1: GD IS NOT YOUR FAULT.

Understanding this point is a game changer.

Gestational diabetes mellitus, or GD is a type of diabetes that occurs in pregnancy, due to the placental hormones compromising normal insulin action.

Normally our blood glucose levels are controlled by our hormone insulin. Insulin lowers blood glucose levels (BGLs). However, the placental hormones raise BGLs. In some women, usually later in pregnancy, the placental hormones override your insulin action, causing insulin resistance. This results in high blood glucose.

Excess glucose can cross the placenta and impact your baby’s health in the short and long term. And there are increased risks for the mother’s health as well.

However, if GD is diagnosed promptly and treated appropriately, these risks are low.

GD is not due to eating too much sugar or carbs in early pregnancy.

Many women blame themselves but it’s important to know that GD is due to a complex mixture of factors, triggering increased insulin resistance.

Many of these factors are out of your control such as:

Family history of diabetes
Older age >40 yrs
History of PCOS
Certain cultural backgrounds are more at risk, including Asian, Indian, Middle Eastern & Indigenous groups.

Expecting twins or triplets

GD can also occur in women with no known risk factors, eating very healthy diets and exercising regularly.

We clearly don’t know all the causes of GD!

Studies are looking into other factors that modulate insulin resistance, like the Microbiome, Vitamin D and Magnesium status along with other hormones.

GD is not caused by diet but treated by diet and exercise, so if you are already eating a healthy diet be assured that you won’t need to make many changes.

Message 2: EAT ADEQUATELY FOR PREGNANCY IN TERMS OF CARB, PROTEIN, FATS, FIBRE AND MICRONUTRIENTS.

The dietary management of GD is a balancing act.

On one hand the eating plan is designed to help keep blood glucose levels within the tight range.

But on the other hand, the diet needs to be nutritionally adequate for pregnancy to support mother’s health as well as the growth and development of their baby.

It’s not meant to be a “keto boot camp weight reduction diet”.

Pregnant women need energy and meal satisfaction.

CARBS

Its important to include the right type and amount of carbs and

to pair them in a balanced meal for a slower rise in BGLs.

Don’t cut out all carbs.

Choose Low GIycemic Index or low GI carbs, which are digested more slowly and lead to a lower gradual rise in BGLs. They are more likely to keep post meal BGLs within the target range.

The low GI carbs are generally less processed, high fibre and nutritious options like:

Bread –multigrain, sourdough.

Cereal – oats, high fibre flakes.

Pasta and noodles – pasta, soba, udon or egg noodles, vermicelli.

Rice- long grain basmati, Doongara, wild/red/black rice.

Other Grains- quinoa, buckwheat, pearl couscous, barley, semolina.

Starchy veggies - Carisma potatoes, orange sweet potato, corn

Most Whole fruit -except melons, juice.

Whole Milk and natural Greek yoghurt.

Wholegrain and seeded crackers.

There is a correlation between maternal carb intake and BGLs.

By measuring carb serves at meals, it can assist with keeping BGLs within the recommended range. It is recommended to see a dietitian who can help to assess your carb requirements, based on many factors including appetite, activity, cultural background, food preferences, health goals and individual glucose tolerance. What works for one woman may not work for another.

Eating 3 small meals and 3 regular snacks, and spreading carbs over the day, also helps with your glucose tolerance.

PAIRING CARBS WITH PROTEIN, GOOD FAT & FIBRE AT THE MEAL.

The food containing protein, good fats and fibre take longer to be digested, so if you pair your carbs with these foods, the carbs in the meal are digested more slowly, leading to a lower rise in post meal BGLs.

Protein foods include meat fish chicken eggs tofu and cheese.

Good fats include olive oil, avocado, olives, nuts and nut butters

High fibre foods include all the non-starchy veggies containing minimal carbs.

For example, If you ate just toast at breakfast you’d get a higher BGL than if you ate toast with protein like eggs and added in good fats like avo as well as veggies like say, mushrooms.

This balanced meal is slowly digested, resulting in a lower post meal BGL. It also helps you to feel satisfied, whilst supplying important nutrients and calories for pregnancy.

THE HEALTHY PLATE TEMPLATE

Aim for a plate with ¼ carbs, ¼ protein & good fats and ½ plate veggies Design your meals based on that formula. Its easy and it works.

AND REMEMBER PREGNANCY NUTRITION

Be sure to include the key micro-nutrients for pregnancy including, iron, calcium, folic acid, iodine, vitamin B12, Vitamin D, Zinc, Magnesium and Choline.

Your dietitian can help you with an individualised meal plan.

Message 3: FOOD IS NOT THE ONLY FACTOR THAT IMPACTS BGLS

BGLs are also influenced by many other factors other than diet, such as:

Activity: Being active as appropriate in pregnancy, leads to glucose uptake by the muscles for energy.

A short walk for 10 mins after meals can lower post meal readings.

A longer walk in the evening for 20-30 min may help lower fasting levels.

Stress, Illness or pain: Increases cortisol which pushes up BGLs.

Sleep. Poor sleep increases the stress hormones.

Hydration. Dehydration can concentrate glucose levels.

Time of Day. Due to changes in hormone profiles over the day.

And stage of pregnancy- As your pregnancy progresses, the placenta grows and more placental hormones are produced, increasing insulin resistance. The same meal can give higher BGLs later in pregnancy.

Bottomline: It not just about your diet

Your diabetes team will look at the big picture when interpreting your BGLs.

Message 4: MEDICATION MAY BE REQUIRED

GD is generally managed by a healthy eating plan and exercise.

However, for some women, lifestyle measures are not enough.

Due to genetics and the hormones of pregnancy, such women are very insulin resistant, and levels remain elevated, through no fault of their own.

At that stage your Diabetes team may suggest medication.

It may be for fasting levels or post meal levels or both.

It depends on your doctor, hospital, and individual situation as to the type of medication prescribed. In Australia the options generally used are Metformin or Insulin. The main message is if you need medication, it is not your fault. It is NOT a fail. Medication is safe and effective in managing BGLs and ceases at birth.

Discuss further with your diabetes team. Understand the pros and cons of medication. Your team will guide you.

Message 5: NO ONE SIZE SUITS ALL

My final message is that there is “no one size fits all” when it comes to managing GD.

Every woman has her own unique glucose tolerance and nutritional needs.

What works for one woman might not for another.

Your personal eating plan needs to be worked out based on the many factors just discussed.

There will be a certain amount of trial and error too as you trial certain types and amounts of carbs in certain meal combinations.

Some meals will work well but others not so. You learn and modify.

Pregnancy is a moving target. What worked earlier, may not work later.

Exercise can help but is not appropriate for everyone.

Some women will require medication and other women won’t.

Best tip:

See an accredited practising dietitian with experience in GD, early in your journey, to assist with education about food choices, serving sizes, food shopping and organisation, meal and snack ideas, meal prep, recipes, eating out, and other challenges.

Your diabetes team will guide you with testing and medical management of blood glucose throughout your pregnancy.

Remember you are unique and so is your GD journey.

Knowledge is power. Gather evidence-based information.

Ask lots of questions. Reach out for support along the way.

Wishing you well in your GD journey

Robyn has been working as an APD, with a special interest in women’s health for many years. She started her career as a clinical dietitian in the wards at Royal Women Hospital in Melbourne before becoming Dietitian in Charge. She moved into private practice when she started her own family. She has worked as the Consultant Dietitian for Diabetes Australia & Royal Melbourne Hospital Diabetes Centre and later assisted with Diabetes Research within the Endocrinology unit. At her private practice, based at Royal Womens Hospital, Robyn specialises in providing nutritional information and support to women in pregnancy and in particular, with gestational diabetes. She is married with 2 beautiful children and loves escaping to the family coastal home on weekends.

Enquiries and appointments can be made by email: Rob.compton@bigpond.com

For more information: www.robyncomptondietitian.com

Follow Robyn on her socials :

Instagram: @gestationaldiabetes_dietitian X - @robcomrant

REFERENCES :

Diabetes Australia: Position Statement August 2020, Gestational Diabetes in Australia.

Meloncelli N et al. The challenge of Standardised MNT Prescription in GDM Management. Seminars in Reproductive Medicine 2021.

Rasmussen L et al. Diet and Healthy Lifestyle in the Management of Gestational Diabetes Mellitus. Nutrients 2020; 12: 3050.

Meloncelli N et al. Preventing Gestational Diabetes with a Healthy Gut Diet : Protocol for a Pilot Feasibility Randomised Controlled Trial Nutrients 2023;15 (21): 4653.

Fatima,K et al. Association between vitamin D levels in early pregnancy and gestational diabetes mellitus: A systematic review and meta-analysis. J Family Med Prim Care. 2022 ; 11 ( 90 : 5569-5580.

Yilmaz E et al. Gestational Diabetes Diet: Alternative Approaches. Series Endo Diab Met 2023; 5 (2): 92-99.

Wong M et al. Impact of carbohydrate quantity and quality on maternal and pregnancy outcomes in GDM: A systematic review and meta-analysis. Diabetes & Metabolic Syndrome: Clinical Research and reviews 2024; 18: 102941

Luo, L et al. The efficacy of Magnesium Supplementation for Gestational Diabetes: A meta-analysis of Randomised controlled trials. Eur J Obstet Gynecol Reprod Biol 2024 ; 293: 84-90.

Nichols, Lily. Real Food for Gestational Diabetes. 2015.

wwwRealFoodforGD.com

Gestational Diabetes- 5 Take Home Messages By Robyn Compton APD