Gestational diabetes is a type of diabetes that some patients develop during pregnancy due to changing hormone levels in the placenta. During pregnancy, it can be harder for your body to make enough insulin—insulin is the hormone that helps your body regulate blood sugar levels. Without enough insulin, blood sugars will rise, which is not good for the pregnant individual or baby.
A pregnant individual cannot pass diabetes onto her baby directly, but high blood sugar levels can cause your baby to put on too much weight, and it can impact the baby's delivery and health later on in life (obesity and chronic health conditions associated with obesity). There’s also there an increased risk for your baby becoming obese or developing type 2 diabetes later in their life.
Usually, there are no symptoms of gestational diabetes. This is why all women are screened for diabetes between 24 and 28 weeks or sooner if there are risk factors. Screening prevents complications from happening later in pregnancy.
Risk factors for gestational diabetes
Gestational diabetes occurs in about 9% of pregnancies in Nova Scotia. You’re more likely to be at risk of gestational diabetes if you:
- are over 35 years old
- have a family history of type 2 diabetes
- are overweight or gained more than recommended weight for weeks of pregnancy
- had gestational diabetes in a previous pregnancy
- had a large baby (greater than 9 lbs) at full term
- have polycystic ovarian syndrome
- are from Aboriginal, South Asian, Asian, African, Middle Eastern or Mediterranean background
Managing gestational diabetes during pregnancy
It’s important to work with your healthcare team to manage blood sugar levels and keep them in the normal range during pregnancy. To best manage gestational diabetes so that you and baby are healthy, choose a healthy diet for you and your family, achieve a normal pregnancy weight gain, be physically active, if possible, test your blood sugars, and take insulin, if needed.
Managing your gestational diabetes can reduce the need for treatment of your baby at birth. Sometimes your baby may have low blood sugars and need to be given intravenous fluids or feeding to normalize their blood sugars. They may also have problems with jaundice. Speak with your doctor or midwife about these conditions before delivery.
After you give birth
After your baby is born, gestational diabetes usually goes away, but you’ll have a higher risk of developing type 2 diabetes in your next pregnancy and later in life. Your health care provider will give you a lab slip to screen for diabetes about six weeks after delivery. It's important to get this test done. The best way to avoid getting type 2 diabetes is to follow the advice given by your team on diet, lifestyle, and controlling your weight.
Having gestational diabetes will not impact your ability to breastfeed. Breastfeeding can help avoid low blood sugars in your baby at birth and may also help reduce your baby’s risk of being overweight and developing diabetes later in life.
If you follow a healthy eating plan, you’ll be more able to keep your blood sugars within target, provide proper nutrition for you and your baby, and achieve proper weight gain during your pregnancy. Choose foods that are low in fat and high in fibre; are healthy sources of carbohydrates (grains, cereals, pasta, rice, fruit), and provide what you need during pregnancy: calcium, iron, and folic acid.
Patients with gestational diabetes are encouraged to:
- eat three balanced meals at consistent times
- eat small amounts often (for example, every two to four hours)
- satisfy hunger
- include some healthy carbohydrates in every meal and snack
- choose foods that are varied and enjoyable
Carbohydrates are broken down into glucose and used by the body for energy, and they are very important for you and your baby. To help manage your blood sugars, it’s important to spread your carbohydrates over three small meals and two or three snacks each day. Consistency and moderation of carbohydrates is the key to helping your blood sugars.
Foods containing carbohydrates include multigrain or whole grain breads and breakfast cereals; whole wheat, whole grain pasta, noodles and rice; potato, sweet potato and corn; legumes such as baked beans, red kidney beans and lentils; fruits, yogurts and milk. Carbohydrates that you should avoid because they contain little nutritional value include sugar or sucrose, soft drinks, fruit juices (even 100 % fruit juice), cakes (and muffins) and cookies.
Fats do not affect blood sugars directly but too much can cause extra weight gain which can cause problems with blood sugars. Use healthier fats like olive oils, avocados, and unsalted nuts. Select lean meats, skinless chicken, and low-fat dairy foods, and try to avoid takeout foods and processed foods.
Include protein with all meals to help keep your body healthy and for the growth and health of your baby, and because protein can help you feel full longer. High protein foods include lean meat, skinless chicken, fish, eggs and cheese, milk, yogurt, custards, and legumes (beans, lentils, chickpeas)
Water, plain mineral water or soda water is best—you can add a small bite size piece of fruit (lemon, lime, orange, melon, cherry) to add some flavour. Avoid juices, pop, and energy drinks since they’re high in sugar.
There are some treat options you can include as a substitute into your meal plan. Your dietitian can help with this. Having a treat at a time of day when blood sugar runs in the target range may be an option, and being active after a small treat may help keep your blood sugars in target.
Exercise and activity
Exercise and activity are important parts of managing your gestational diabetes as long as your doctor is okay with you being active. Moving around or going for a short walk (10 minutes) after a meal can really help your blood sugars after a meal. It’s recommended to include 30 minutes of daily physical activity. If you were exercising before, you should be able to continue your usual level of exercise and activity. If interested in beginning an activity program, be sure to consult with a physiotherapist or health care professional about how to safely start and progress throughout pregnancy.
Testing your blood sugars
Testing blood sugars can help determine whether your meal plan and exercise plan is working well for you. Your health team will provide you with a blood sugar meter and teach you how to use it. Testing involves a small finger poke and logging the result in a book. The timing of your test is important: test before meals noting the time, then test one hour after your meal.
Blood sugar target values are for people who are pregnant and have diabetes are:
- Before meals (fasting): 3.8 to 5.2 mmol/L
- One hour after meals: 5.5 to 7.7 mmol/L
- Two hours after meals: 5.0 to 6.6 mmol/L
To ensure your meter is working properly and giving accurate results, you will be asked to take your meter to the lab and compare blood sugar readings from your meter to the labs meter. Your dietitian will review your blood sugars and determine whether changes can be made to diet and exercise to bring the readings closer to target. If your blood sugars are sometimes high, there is no need to panic. Continue to test and watch for trends.
If diet and exercise cannot keep blood sugars in target you may need insulin by injection. Currently diabetes pills are not recommended during pregnancy therefore insulin injection is the only option. Arrangements will be made by your health team for education if insulin is needed. The number of insulin injections and doses you will need will depend on records of what you are eating so the health team can suggest the proper insulin dose. You will be keeping in close contact with your health team and may have more appointments and tests to ensure you and your baby are healthy. The idea of insulin can be very worrisome for some patients but remember it is safer to be on insulin than to have high blood sugars. Your health team can answer all your questions about insulin if and when it is needed.