Twenty-six weeks into my pregnancy, my OB informed me that I might have gestational diabetes. I was shocked. Other than my age—I was 35—I had zero risk factors. I exercised regularly. In fact, I had once been a dancer and yoga teacher. I was fit and healthy. I figured it was all a big mistake. I’d do the glucose tolerance test and all would be fine. Sometime between 24 and 28 weeks, most healthcare providers recommend pregnant women be screened for gestational diabetes. The glucose challenge test is relatively painless: You drink a syrupy sweet drink and wait an hour. Your blood and urine levels are tested, and if they fall within a certain range, you’re fine. If they spike outside that range, however, you go for a follow-up glucose tolerance test. This test, which is slightly more involved, necessitates fasting overnight (no fun). The following morning, having forgone breakfast, I went in to have my blood and urine tested. Then I consumed an even sweeter drink, and my levels were tested every hour for the next three hours—all while I continued to fast. (Bring a good book and a few podcasts. You’ll be starving.) When the test came back positive for gestational diabetes, I panicked. Was my baby okay? Had I done something wrong? Was it all those croissants I’d eaten in the first trimester? What should I do now? There was no need to panic. My baby was fine. I was fine. I had a mild case, which meant I didn’t have to take insulin. But even if I had, it’s an entirely manageable and relatively common condition, as anywhere from 2 to 10 percent of pregnant women experience gestational diabetes. The trick is learning to test your blood sugar at regular intervals, sticking to a balanced diet, and prioritizing exercise. Beyond that, we’ve got all the details you need to know to manage gestational diabetes or put your mind at ease if you think you might be at risk.
What is gestational diabetes?
Gestational diabetes is not the same as type 1 or type 2 diabetes. It is a condition that develops during pregnancy, almost always ends with the birth of the baby, and has nothing to do with whether you have type 1 or type 2. Typically diagnosed between weeks 24 and 28, gestational diabetes causes high blood sugar levels that affect how your cells break down sugar or glucose. If managed well, gestational diabetes isn’t a problem, but it can be dangerous for mother and baby if the condition is not addressed. Although gestational diabetes has little to do with types 1 or 2, “[Doctors] sometimes diagnose type 2 diabetes or type 1 diabetes during pregnancy that had previously been missed,” according Rebecca Weiss, MD, an endocrinologist at Kaiser Permanente in Woodland Hills, California. “This can be apparent based on a woman’s blood sugar control during pregnancy.”
Am I at risk?
“Gestational diabetes is caused by hormones produced by the placenta that increase insulin resistance in the mother,” explains Weiss. “The main causative hormones are growth hormone, placental lactogen, corticotropin releasing hormone, and progesterone. These hormones increase the body’s insulin resistance, leading to higher sugars, and in some cases, gestational diabetes.” Weiss explains that this is why all women are screened because even thin, healthy, fit women can develop the condition. No one really knows how what causes gestational diabetes, but there are some risk factors:
- Age—if you are over 25
- Overweight or obese pre-pregnancy
- Excessive weight gain during pregnancy
- A history of diabetes in your family
- Hypertension or preeclampsia in this pregnancy
There is also an increased risk for expecting women in certain ethnic groups, including African American women, Latinas, South and East Asian women, and Native American women. A woman can lessen her risk of developing gestational diabetes by adopting healthy eating and exercise habits before and during pregnancy, explains Julie Peacock, RDN, a registered dietician nutritionist and integrative whole-health wellness counselor in New York City. “Before getting pregnant, talk to your doctor to establish if you have any risk factors—family history, overweight, history of polycystic ovarian syndrome, and history of irregular blood sugars.” You can then target your food and exercise plan to specifically watch carbohydrate intake and get the recommended amount of exercise daily. Peacock emphasizes, however, that this holds true for all women, pregnant or not. “The goal is always to move your body frequently and load up on whole foods while decreasing or eliminating processed foods and foods high in sugar, salt, and [linkbuilder id=”5310″ text=”artificial ingredients”].” “The saying ‘eating for two’ is not accurate at all,” adds Weiss. “Pregnant women actually only require about 250 extra calories a day during pregnancy. I always recommend to pregnant patients to maintain a healthy diet and to continue to exercise as they did prior to pregnancy.”
How do I know whether I have gestational diabetes?
There are no symptoms of gestational diabetes, so unlike other conditions during pregnancy, it is virtually impossible to tell without a test. After testing, your OB will be the one to deliver the news.
Will gestational diabetes affect my baby?
If your gestational diabetes is well managed, you baby will be totally fine. It’s when gestational diabetes is mismanaged—or not treated at all—that the baby might face one or more of the following risks.
Increased Birth Weight
According to the Mayo Clinic, an excess of glucose in mom’s bloodstream may prompt baby’s pancreas to make too much insulin. This can make the baby grow too big to be birthed vaginally, and will necessitate a C-section.
If a baby seems to be growing too big, your doctor might induce before the your due date to ensure a safe delivery.
Low Blood Sugar (Hypoglycemia)
Occasionally, babies of moms with gestational diabetes develop low blood sugar shortly after birth because their insulin production is too elevated. In extreme cases, this can cause seizures in the baby, which may necessitate intravenous glucose solution treatment to help the baby’s blood sugar level return to normal.
Type 2 Diabetes
The baby could be at a slightly greater risk of developing diabetes later in life.
Will this affect me after my baby is born?
The short answer is no. The longer answer is that there is a very, very small chance that it could. “Ninety percent of the time, gestational diabetes goes away after birth,” explains Peacock. “But if a woman had gestational diabetes, she is at a higher risk for developing type 2 diabetes.” It’s very important to continue eating and exercising healthfully throughout the pregnancy and after delivery. Stick to the same dietary guidelines you followed during pregnancy (eat whole foods and limit processed and refined foods), maintain a healthy weight, and be sure to get at least 30 minutes of exercise daily.
Tips for Managing Gestational Diabetes: You are what you eat.
“What a woman eats is just as important as how much and when she eats,” explains Peacock. “Keeping her blood sugar levels stable is the goal.”
Key Foods to Incorporate Into Your Diet:
- An abundance of vegetables—leafy greens, cabbage, broccoli, cauliflower
- Protein-rich foods—hormone-free meats, beans, and legumes (black beans, split peas, lentils, etc.), eggs, and pregnancy-safe fish
- Fiber-rich complex carbohydrates—oats, quinoa, barley, buckwheat, and brown rice
- Dairy—milk, cheese, and plain yogurt are good sources of protein and can be a healthy part of any diet
What to Avoid:
- Soda, juices, and candy
- Most coffee drinks and purchased smoothies
- Donuts and baked goods
- Deep-fried foods
- Flavored water, milk shakes, certain nut milks
“These foods are high in refined sugar and/or flour,” Peacock explains. “When you order these foods at a restaurant or buy them at the store, they contain more sugar, fat, and sodium than what you would make at home.” That said, this isn’t advice that only goes for diabetics—this is Peacock’s advice for anyone trying to eat in a healthful way.
Two Tips to Keep in Mind:
- Protein with each meal can help keep blood sugar levels stable.
- When you have a carbohydrate source, make sure it’s a whole food. This will ensure that it’s fiber rich, and therefore healthier. Eat the apple instead of drinking an apple juice.
A Typical Menu
For a lot of women, the most challenging aspect of gestational diabetes is developing different eating habits and sticking to them. If you’re used to inhaling a bowl of sugary cereal before running out the door, you’ll have to make some major amendments to your diet. Here are some basic guidelines:
- Someone with diabetes can have two to four carbohydrate servings with each meal and one to two per snack.
- One serving is equal to one piece of bread, one small apple, half a banana, ¾ cup berries, one cup of milk or yogurt, ⅓ cup beans, or ⅓ to ½ cup rice, pasta, or cooked grain.
Looking for inspiration? Try the following sample menu on for size.
Prepare and enjoy a small portion of a cooked grain like oats along with an egg or high protein yogurt to help the body absorb the carbohydrates more efficiently. Opt for natural, no-sugar-added peanut or almond butter on whole grain toast.
For Lunch and Dinner
The bulk of these meals should be leafy greens. Add 4 ounces of chicken (or another protein) and 1 cup of a cooked grain, a piece of fruit, or a roasted root vegetable like sweet potatoes, beets, or squash.
Enjoy two to four snacks a day, keeping in mind the goal of spacing them out evenly, every two to three hours, to keep your blood sugar levels from spiking or falling. Having a snack before bed also helps keep levels from plummeting overnight. Examples of good snacks include:
- A hardboiled egg, a few whole grain crackers, and a handful of carrots
- ¾ cup blueberries and 6 ounces of Greek yogurt
- One rice cake with ½ avocado, mashed
- Two slices of cheese, a few crackers, and 1 cup of raw vegetables
- A pear and a handful of almonds
Move your body.
“Regular exercise helps the body use insulin better and can lower blood sugar,” Peacock explains. She suggests that women get at least 30 minutes of moderate exercise daily. “Think of moderate exercise as the kind that leaves you slightly out of breath, with a faster heart rate, and makes you sweat.” If you’re unsure about what kind of exercise to pursue, Peacock advises continuing to do what you did before you were pregnant. A few good options include brisk walking, stationary cycling, swimming, and yoga. Consult with your doctor about what forms of exercise are appropriate for you. Since it does affect blood sugar levels, eating a snack or meal one to two hours before exercise is important. A snack could be half a banana and a scoop of almond butter, or a plain rice cake and spoonful of hummus or smashed avocado. Remember to always have a form of quickly accessible sugar with you when you exercise, such as glucose tablets or hard candy just in case you experience a blood sugar low.
Don’t give up carbs—really.
Carbohydrates are the sugars, starches, and fibers found in fruits, grains, vegetables, and dairy products. Though trendy diets often treat carbohydrates as something to avoid, Peacock says they are one of the basic food groups and are important to a healthy life. Carbohydrates are macronutrients, meaning they are one of the three main sources of energy for the body. In fact, they are the body’s main source of energy and provide imperative fuel for the central nervous system and energy for working muscles. When thinking about carbs, remember that they’re classified as either simple or complex. The difference between the two types is their chemical structure and how quickly the sugar they break down into is absorbed and digested. “Generally speaking, simple carbs are digested and absorbed more quickly and easily than complex carbs,” Peacock explains. “Simple carbs are found in candy, soda, and syrups. These foods are made with processed and refined sugars and do not have vitamins, minerals, or fiber. They are considered ‘empty calories’ and can lead to weight gain and uncontrolled blood sugars. Complex carbohydrates include beans, peas, lentils, nuts, potatoes, root vegetables, corn, whole-grain breads, grains, and cereals.” Carbs affect blood sugar levels, and when blood sugar levels are too high, they’re harmful to both the woman and the growing fetus. To help manage blood sugar levels, it is important to monitor carbohydrates in terms of how many, what type, and how often you’re consuming them. When too many carbs are eaten at once, the blood sugar levels in a woman with gestational diabetes will get too high. To keep blood sugar levels in check:
- Avoid eating too many carbohydrates at one time.
- Choose complex carbohydrates that are high in fiber and low on the glycemic index .
- Avoid skipping meals.
- Combine carbohydrates with protein or healthy fats to help slow down digestion.
- Eat a protein-rich breakfast that includes fibrous carbohydrates.
“Although it’s easy to look at carbs as the villain here,” Peacock says, “they’re important for energy and foods with carbs have nutrients that are necessary for a healthy pregnancy, so it’s important to learn how to incorporate them smartly as opposed to avoiding them altogether.”