I was a big baby.  My mom had gestational diabetes when she was pregnant with me, and as a result I was nearly 11 pounds at birth! During my own pregnancy with Madi, I worried frequently that I was going to have gestational diabetes since my mom had it.  Gestational diabetes is when a woman without diabetes prior to pregnancy develops abnormal blood sugars resulting in abnormal sugar (glucose) tolerance during pregnancy. Pregnancy can change the way our bodies process sugars to ensure that the baby has plenty supply of food and nutrients.  Unfortunately, these changes during pregnancy can also result in insulin resistance, which can lead to diabetes symptoms and gestational diabetes. 

Gestational Diabetes can lead to pregnancy and birth complications

Gestational diabetes is important to diagnose and treat in pregnancy because it can result in birth complications requiring early delivery or caesarean sections.  It can also result in the baby growing too large, termed macrosomia (like me!)

The current medical evidence suggests that the only effective way to prevent gestational diabetes in early pregnancy is to implement a healthy diet and prevent excessive weight gain. In women who were diagnosed with gestational diabetes, implementing a healthy diet resulted in improved glucose levels, reduced the need for medication, and also reduced the rates of macrosomia babies. 

Healthy lifestyle changes in pregnancy can help prevent gestational diabetes

Some tips for implementing a healthy diet during pregnancy to avoid diabetes symptoms and gestational diabetes include:

• Reduce animal meat, particularly red-meat consumption.
• Try to get protein from vegetables and nuts.
• Eat 3 small-to-moderate sized meals per day, and 2-4 snacks per day.
• Meal plans should be adjusted throughout pregnancy based on appetite, weight gain, and glucose levels. 
• Monitor your weight gain with your physician to make sure you are not gaining too much, or too little weight during pregnancy.
• Consultation with your doctor and nutritionist is highly recommended.

Some women are at higher risk than others. 

These risks include:

• Having impaired blood sugars in the past.
• Gestational diabetes in a previous pregnancy.
• Asian, Hispanic, African, or Indigenous ethnicity.
• A family history of diabetes, especially if it is a sibling or parent.
• Obesity, a BMI over 30 prior to pregnancy.
• Having excessive weight gain in the first 18-24 weeks of your pregnancy. 
• Advanced age during pregnancy – most notably over 35 years old .
• Having a previous unexplained pregnancy loss.
• Having a baby with birth defects previously.
• Given birth to a baby that was over 9 pounds (4kg) previously
• Abnormal blood cholesterols (low HDL and high triglycerides)
• Having a pre-existing medical condition including: Polycystic ovary syndrome, hypertension, or cardiovascular disease
• Having multiple gestations (twins, triplets, etc).
• Use of steroid (glucocorticoid) medications
• Consuming too much animal meat (especially red meat) prior to pregnancy.

This post was co-authored by  Stephanie Liu, MD, MSc, CCFP, BHSc and Suzanne Black, MD, BSc.

References

1. Moyer VA, U.S. Preventive Services Task Force. Screening for gestational diabetes mellitus: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med 2014; 160:414.
2. Solomon CG, Willett WC, Carey VJ, et al. A prospective study of pregravid determinants of gestational diabetes mellitus. JAMA 1997; 278:1078.
3. Retnakaran R, Shah BR. Impact of Twin Gestation and Fetal Sex on Maternal Risk of Diabetes During and After Pregnancy. Diabetes Care 2016; 39:e110.
4. Avalos GE, Owens LA, Dunne F, ATLANTIC DIP Collaborators. Applying current screening tools for gestational diabetes mellitus to a European population: is it time for change? Diabetes Care 2013; 36:3040.
5. American Diabetes Association. 2. Classification and Diagnosis of Diabetes. Diabetes Care 2017; 40:S11.
6. Kiani F, Naz MS, et al. The Risk Factors of Gestational Diabetes Mellitus: A. Int J Womens Health 2017; 5:253.
7. Bao W, Bowers K, Tobias DK, et al. Prepregnancy dietary protein intake, major dietary protein sources, and the risk of gestational diabetes mellitus: A prospective cohort study. Diabetes Care 2013;36:2001–8.
8. American Diabetes Association. 14. Management of Diabetes in Pregnancy: Standards of Medical Care in Diabetes-2019. Diabetes Care 2019; 42:S165.
9. American Diabetes Association, Bantle JP, Wylie-Rosett J, et al. Nutrition recommendations and interventions for diabetes: a position statement of the American Diabetes Association. Diabetes Care 2008; 31 Suppl 1:S61.
10. Hernandez TL, Brand-Miller JC. Nutrition Therapy in Gestational Diabetes Mellitus: Time to Move Forward. Diabetes Care 2018; 41:1343.
11. Yamamoto JM, Kellett JE, Balsells M, et al. Gestational Diabetes Mellitus and Diet: A Systematic Review and Meta-analysis of Randomized Controlled Trials Examining the Impact of Modified Dietary Interventions on Maternal Glucose Control and Neonatal Birth
12. American Diabetes Association. Gestational diabetes mellitus. Diabetes Care 2004; 27 Suppl 1:S88.

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