I have gestational diabetes. What type of diet should I follow?

Expert: Jill Stovsky, M.A. [See Biography]

Question: I have gestational diabetes. What type of diet should I follow?
Jill Stovsky: Good nutrition is an important part of any pregnancy. That's even more true if you've developed gestational diabetes, which means the glucose, or sugar, in your blood is elevated. Diabetes develops when the body can't efficiently produce or process insulin, a hormone made by the pancreas that allows cells to turn glucose into usable fuel. Large amounts of glucose in the blood can be harmful for a developing baby as well as a pregnant woman, which is why controlling blood sugar levels is crucial.

Following a meal plan designed specifically for you is one way to do this. Some general guidance follows, but I strongly recommend you see a registered dietitian who can create a diet for you. She'll determine the amount of calories you'll require each day based on your weight, height, and physical activity. She'll also take into account the needs of your growing baby.

Next, the dietitian will determine how much carbohydrate you need. She'll teach you how to count and distribute carbohydrates appropriately, how to determine portion sizes, and how to balance your meals with protein, carbohydrates, and fat. She'll also assess your current eating habits to make sure you're getting enough vitamins and minerals.

More tips to help you control blood sugar levels:

• Eat a variety of foods, distributing calories and carbohydrates evenly throughout the day. Make sure both your meals and your snacks are balanced.

• Don't skip meals. Be consistent in the amount of food you eat at each meal and when you eat them. Your blood sugar will remain more stable if your food is distributed evenly throughout the day and consistently from day to day.

• Include high-fiber foods. Foods high in fiber include fresh fruits and vegetables, whole grain breads and cereals, dried peas, beans, and legumes. These foods are broken down and absorbed more slowly than carbohydrates, which helps keep blood sugar levels from going too high after meals. * Eat a good breakfast. Blood glucose levels during pregnancy are most likely to be out of whack in the morning. To keep your level below 120 milligrams per deciliter, you may need to modify your morning menu. You may have to limit carbohydrates (breads, cereal, fruit, and milk), boost protein, and possibly avoid fruit altogether.

Overall, a diet for gestational diabetes is balanced and healthy.

What's below:
• What is gestational diabetes?

• How will having diabetes affect my pregnancy?

• How common is gestational diabetes?

• What are the risk factors?

• How do I know I have it?

• How is it treated?

• I've heard exercise can help. Is that true?

• Will I continue to have diabetes after my baby is born?

• See also | Other Sources
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What is gestational diabetes?
Gestational diabetes is a high-blood sugar condition that some women get during pregnancy. Usually it goes away after the baby is born — unlike other types of diabetes.
Diabetes develops when the body can't efficiently produce or process insulin, a hormone the pancreas makes that allows cells to turn glucose, or sugar, into usable fuel.

Your body has to produce extra insulin because increasing levels of pregnancy hormones interfere with insulin function and make your body a little more resistant to it. If your body can't process that additional insulin sufficiently, you'll most likely develop gestational diabetes.

Your prenatal caregiver will probably give you a blood test called a glucose screening test. You'll most likely have this test done as a routine part of your prenatal care.



How will having diabetes affect my pregnancy?
That depends on how well you care for yourself. If your diabetes goes untreated, there are consequences for your pregnancy. If your diabetes is well controlled throughout your pregnancy, there's much less reason to worry.
The main risk in having extra glucose in your blood is that it crosses over to the baby, which means he can become abnormally large. A big baby obviously makes labor and delivery more difficult. It increases the risk of a delivery by cesarean section, and means your baby could end up with jaundice or breathing problems.

Some researchers believe large babies are more prone to obesity later in life. As adults, they're also more apt to develop Type 2 diabetes (known as non-insulin dependent diabetes or adult-onset diabetes).

Babies born to women with pre-pregnancy diabetes — especially women with poor control over the condition — also face greater risk of having a child with birth defects.

How common is gestational diabetes?
Quite common, considering it's a rather serious medical condition — 2 to 5 percent of all pregnant women in the United States have diabetes. Of course, some women had it before they became pregnant. But others with no history of the condition can develop gestational diabetes.

What are the risk factors?
Those most at risk are women who have had diabetes, or gestational diabetes, or previously had one or more large babies. Obese women are at risk, as are those who've had pregnancy-related problems, such as a miscarriage or preeclampsia. Others at risk:

• Older mothers (everyone's tendency to develop diabetes increases with age)

• Women with hypertension (high blood pressure)

• Women who were large babies themselves (more than nine pounds at birth)

• Women with a parent or sibling who is an insulin-dependent diabetic

How do I know I have it?
Usually women have no warning, which is why all pregnant women are routinely tested. Some women may feel extreme thirst or fatigue.

Since many women who get gestational diabetes have no risk factors, doctors routinely give women a glucose screening test between the 24th and 28th weeks. About an hour after you drink a syrupy soft drink, a blood sample is drawn and then analyzed. If the test is positive, you'll undergo an even more detailed screening.

How is it treated?
The first step is to control your glucose levels by adhering to a special diet. Most doctors recommend you follow the nutrition guidelines set by the American Diabetes Association, which encourage you to eat healthy foods in the right amounts and limit fats and sugars. A lot of women struggle with their diet during pregnancy, but if you have diabetes, eating a balanced diet and controlling weight gain are critical.

If a nutritional approach doesn't work — which is the case for about one in 10 women — your provider may prescribe insulin shots for you to give yourself. Whether or not you take insulin, you'll need to monitor your glucose levels if you have gestational diabetes. You'll learn how to do this using a home glucose meter or strips. Your unborn baby's weight and heart rate will be regularly checked as well.

If you have diabetes and are planning to become pregnant, try to get it under control in the months before you conceive; high blood-glucose levels in the first trimester increase the risk of birth defects. Your pregnancy will probably be considered high-risk, but that doesn't necessarily mean you'll encounter problems during your pregnancy, particularly if blood glucose levels are normalized.

I've heard exercise can help. Is that true?
Yes. Studies show physical activity helps keep glucose levels in check. Other evidence suggests that exercising before you get pregnant can help prevent you from ever getting gestational diabetes.

Will I continue to have diabetes after my baby is born?
You'll be checked for it postpartum, but the good news is that it disappears after delivery in most women. Nonetheless, if you had gestational diabetes you increase your risk of developing diabetes later in life. And women who were obese before and during pregnancy are much more more likely to remain diabetic after pregnancy

Could I have gestational diabetes?

Expert: Ann Linden, Certified Nurse-Midwife [See Biography]

Question: I'm 27 weeks pregnant and just had a glucose test. The hospital called me the next day to let me know my blood sugar level was above normal, so now I have to go back for a more intensive test. What does having an above-average sugar level mean?
Answer: You were given a glucose screening test, also called the glucose challenge test or GCT, to test for gestational diabetes mellitus (GDM). Diabetes is the most common medical complication of pregnancy, affecting about 4 percent of expectant mothers.

The hormone insulin, made by your pancreas, regulates glucose (blood sugar) levels. During pregnancy, the placenta also produces hormones. Three of these hormones--human placental lactogen, estrogen, and cortisol--also counter the effect of insulin. You were tested at 27 weeks (and not at your first prenatal visit when other bloodwork was done) because this effect begins in mid-pregnancy and becomes more pronounced as your pregnancy progresses. In most women, the pancreas responds to this insulin resistance by making additional insulin to keep the blood sugar at a normal level. GDM develops when the pancreas cannot keep up with demand, and blood glucose levels rise too much. Unlike those with pre-existing diabetes, women with gestational diabetes do produce insulin, but not enough to meet their body's needs during pregnancy.

Women who are obese or older, have a family history of diabetes, or have had a large baby, a malformed infant, a stillbirth, or gestational diabetes in a previous pregnancy are at risk for GDM in their current pregnancy. They are tested earlier and more often for diabetes. However, since about 40 percent of women who develop GDM have no risk factors at all, the American Diabetes Association recommends that all pregnant women be screened for abnormal glucose tolerance between 24 and 28 weeks' gestation.

You may be worried, but remember that the one-hour GCT you had was a screening test, and a positive (abnormal) result does not mean that you have gestational diabetes. Many women who don't turn out to have GDM test positive on the initial screen. To make sure midwives and doctors identify all (or at least most) women with gestational diabetes, the screening tests err on the side of caution. Only after they do further tests on each woman who has an above-normal result can they narrow the field. Only 20 percent of women who test positive initally end up having GDM. An actual diagnosis of GDM is made on the basis of a more cumbersome three-hour test called a glucose tolerance test (GTT). Most likely this is the 'more intensive test' you were told you'll need to have.

You'll fast the night before the test, and then your blood will be drawn to check the sugar level. You will then be given a 100-gram glucose drink and redraw blood one, two, and three hours later. If two or more of the four blood glucose values are elevated, you will be diagnosed as having gestational diabetes.

Be reassured, though, that most women with GDM are generally able to manage or prevent complications by controlling blood sugar levels. You will follow a special diet, monitor your glucose levels frequently, and may be encouraged to exercise. Less frequently, you may have to use insulin to better control the amount of glucose in your blood. Your healthcare provider will also want to check how your baby is doing.

Glucose screening and glucose tolerance test
Approved by the BabyCenter Medical Advisory Board

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What's below:
• My practitioner says I need a glucose screen. Why?

• What causes gestational diabetes?

• Can gestational diabetes harm my baby?

• How can I tell if I'm at high risk for gestational diabetes?

• How is the screen test done?

• Will this test make me sick?

• What is an abnormal blood glucose level?

• What is the glucose tolerance test like?

• Does having gestational diabetes put me at higher risk for diabetes in the future?

• See also | Other Sources
--------------------------------------------------------------------------------


My practitioner says I need a glucose screen. Why?
You need to take a glucose screening test (also called a glucose challenge test or GCT) between 24 and 28 weeks of pregnancy to check for gestational diabetes, a high blood sugar condition that some women get during pregnancy. Like any screening test, this one is designed to cast a wide net and identify as many women as possible that may have a problem. A positive result doesn't mean that you have gestational diabetes; in fact, only about 15 percent of women who test positive on the glucose screen actually have this condition. To find out if you're one of them, you'll have to undergo a longer, more definitive exam called a glucose tolerance test
Though only about 2 to 5 percent of expectant mothers develop gestational diabetes, it's still the most common pregnancy complication. Your practitioner may want you to be screened earlier than 24 weeks if a routine urine test showed a high amount of sugar in the urine or if you're considered to be at high risk. If the results are normal, you'll be screened again at 24 to 28 weeks and possibly at 32 weeks as well. If you've already been diagnosed with diabetes, you won't need to take the glucose screening test. Instead, your practitioner will talk to you about the best ways to manage your condition during your pregnancy.



What causes gestational diabetes?
Diabetes develops when the body can't efficiently produce or use insulin, a hormone the pancreas makes that allows cells to turn glucose, or sugar, from foods into usable fuel. At around 5 months of pregnancy, your placenta starts to secrete hormones that block the normal action of insulin in your body so that there's more glucose available for the baby. If you have gestational diabetes, your blood sugar processing system goes awry and you become insulin resistant — that is, unable to use insulin to process glucose efficiently. You may notice that you're more thirsty than usual or that you have to urinate more frequently, but there are often no symptoms. Unlike other types of diabetes, this condition usually goes away once the baby is born. (However, women with gestational diabetes are at higher risk for becoming diabetics later in life.)

Can gestational diabetes harm my baby?
Most women who develop diabetes during pregnancy go on to have normal, healthy babies. Your practitioner will monitor you closely and you'll most likely be able to keep your blood sugar level under control with diet and exercise and by getting insulin shots if you need them. The problem with having high blood sugar during pregnancy is that too much of it may end up in the baby's blood. That means the baby's pancreas also needs to produce more insulin to process the extra glucose. All this excess blood glucose and insulin cause the baby to make more fat and put on extra weight, a condition known as macrosomia.
What's wrong with extra weight? An overly large baby makes labor and delivery more difficult and is at an increased risk for a birth injury from a shoulder 'dystocia': If the baby's shoulders are too broad to pass through the birth canal, his neck may be stretched as the practitioner attempts delivery, which can sometimes result in nerve damage. (In very rare cases, the baby may fracture his collarbone or suffer brain damage from lack of oxygen during this process.) Because of these risks, if your practitioner suspects that your baby may be overly large, you may have to deliver by cesarean section. She may do an ultrasound to see if she can determine the baby's size, but ultrasound is not usually very accurate late in pregnancy and it can be hard to tell how big the baby is.

Gestational diabetes can also cause jaundice and temporary breathing problems (because the lungs don't mature as quickly) in newborns. And if you're unable to keep your diabetes under good control, your baby may have low blood sugar at birth because his body will still be producing extra insulin in response to receiving extra glucose from you. Your delivery team will test his blood sugar at birth (by taking some blood from his heel). If it's low, you'll want to feed him as soon as possible, either by breastfeeding or by formula. Poor diabetes control can also put your baby at an increased risk for stillbirth.

The good news is that with the proper treatment to control your diabetes, these problems are rare. And in spite of what you may have heard, having gestational diabetes doesn't increase your baby's risk of birth defects.

How can I tell if I'm at high risk for gestational diabetes?
You're at a higher risk for this condition if:

• you've had gestational diabetes before

• you've previously had a very large baby (over 9 1/2 pounds)

• you're obese (your body mass index — a ratio of height to weight — is 29 or higher)

• you have a family history of diabetes (especially if a parent or sibling has the disease)

If you fall into any of these categories, you may be screened earlier and more often. Your chances of having gestational diabetes increase as you age. You may also be somewhat more likely to develop the condition if you are Hispanic, African American, Native American, Asian American, or Pacific Islander. But half of all women who develop gestational diabetes don't have any risk factors; that's why the American College of Obstetricians and Gynecologists (ACOG) recommends that all pregnant women be screened.

How is the screen test done?
You may be told not to eat anything within an hour or two of the test (or during the test) because it can throw off the results. Once you arrive for the test, you'll have to drink a sugar solution that tastes like a flat, syrupy soda pop. This is the worst part of the test: The stuff tastes awful and you have to get all 4 ounces (half a cup) down in five minutes. It may come in cola, orange, or lime flavor, but they're all pretty unpleasant. Some centers let you pour it over ice and drink it cold. An hour later, your practitioner or a technician will take a blood sample from your arm to check your blood sugar level. Bring a book or some other way to distract yourself while you wait. The results should be available in a few days. If the reading is abnormal (too high), which happens about 15 to 20 percent of the time, your practitioner will have you come back for a three-hour glucose tolerance test to see if you really do have gestational diabetes. The good news is that approximately 85 percent of women whose screening test shows elevated blood turn out to have normal blood sugar levels in the glucose tolerance test.

Will this test make me sick?
Many women find that drinking the glucose solution makes them feel nauseated and a few even throw up. Some find that it helps to have eaten something a few hours before the test, but this doesn't work for everyone. If you vomit soon after you've gotten the stuff down, you may have to come back another day and repeat the test.

What is an abnormal blood glucose level?
Different practitioners use different standards for determining whether your level is too high. Some will say that if your one-hour level is 140 milligrams of glucose per deciliter of blood (mg/dl) or more, you need to have the glucose tolerance test. Others put the cut-off at 130 mg/dl to make sure that they've caught every woman who may have gestational diabetes, even though there are likely to be more false positives this way. If your blood glucose level for this test is higher than 190 mg/dl, most practitioners will consider you diabetic and you won't be required to take the glucose tolerance test. But any score between 130 and 190 means that you'll have to take the tolerance test for a definite diagnosis.

What is the glucose tolerance test like?
For 10 to 14 hours before the test, you can't eat or drink anything but water, so you'll want to schedule it for first thing in the morning. (Some practitioners suggest eating a high carbohydrate diet for a few days before the exam, but it's not clear whether this makes any difference.) When you arrive for the test, the doctor or technician will measure your fasting blood glucose level and then ask you to drink a double dose of the same glucose solution that you were given for the screen test. If you can manage to keep that down, brace yourself for three more arm pricks as they test your blood every hour for the next three hours. The technician should alternate arms each time she draws your blood. If one of the readings is abnormal, you may have to repeat the test later in your pregnancy or go on a diabetic diet. If two or more of your readings are abnormal, you'll be diagnosed with gestational diabetes and you'll need to talk to your practitioner about a treatment plan. This chart shows the levels that are considered abnormal at each interval of the test:

Interval Abnormal reading
Fasting 95 mg/dl or higher
One-hour 180 mg/dl or higher
Two-hour 155 mg/dl or higher
Three-hour 140 mg/dl or higher


Does having gestational diabetes put me at higher risk for diabetes in the future?
Once you've had gestational diabetes, you're at high risk for getting it again: About two-thirds of women who have the condition will go on to have it in future pregnancies.

And 50 percent of women who get gestational diabetes will ultimately develop full-fledged type 2 diabetes within the next 20 years. Your practitioner will let you know how often you'll need your blood sugar level tested. Keeping your weight down, making healthy food choices, and exercising regularly can help you ward off the disease.

Finally, a small number of women who develop diabetes during pregnancy will continue to have diabetes after delivery. So if you have any of the high risk factors mentioned above, you might need to have your blood sugar level tested within the first few days after you give birth. (This is just a blood test, though; you don't have to drink the glucose solution.) Depending on your circumstances, you may also have another glucose screening test after six weeks postpartum.