5 Ways to Prevent & Manage Gestational Diabetes Mellitus

Written by: Dr. Samantha Zahavi

​Yoga Mamas Naturopathic Doctor

​Gestational diabetes (GDM) is the development of diabetes (blood sugar dysregulation) during pregnancy. It is usually diagnosed by a blood glucose challenge test between 24-28 weeks of gestation. It is important to prevent GDM because it can cause complications for mama and baby like pre-eclampsia and predisposition to diabetes after birth. The good news is, there is a lot that can be done to prevent and manage GDM to reduce the severity and risks for mama and baby!

GDM is a complex disease with several contributing factors, including a disruption in glucose and lipid metabolism, inflammation and changes in the gut health. Yoga Mamas Naturopathic Doctor, Samantha Zahavi lists 5 tips to help prevent and manage gestational diabetes.

1) Walk for at least 10 mins, 30 mins after every meal

​Moderate-intensity walking after meals can reduce post-meal blood sugar spikes and improve overall blood glucose control in women with GDM. Some studies show that walking 30 minutes after meals may be the optimal time frame in order to optimally modify the glycemic (blood sugar) response. Timing your walks in this way may have a greater positive influence on GDM than simply walking for 30 minutes per day at a non-specific time.

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2) Eat complex carbohydrates high in fiber

Prenatal mamas should aim for 25-30g of fibre/day in pregnancy. Unlike simpler carbohydrates (ie white bread), healthier complex carbohydrate options provide the body with essential fibre which is digested more slowly in the gastrointestinal tract and doesn’t get directly converted into sugar. These two factors explain why complex carbohydrates produce less significant post-meal blood sugar spikes and may lead to reductions in insulin resistance (an important factor in the development of GDM). Fibre also lowers the risk of obesity, heart disease and inflammatory illnesses.

The fibre content of food items can be found listed under the carbohydrate section in the nutritional breakdown. Higher fibre contents reduce the total amount of carbohydrate that gets converted directly into sugar. For example, a food item with 20g of total carbohydrates and 2g of fibre is a poorer option for blood sugar control than a food item with 20g of total carbohydrates with 15g being from fibre.

Downloading a Glycemic Index (GI) food guide may help you choose healthier carbohydrate options. You may download A Glycemic Index Food Guide, here: https://guidelines.diabetes.ca/docs/patient-resources/glycemic-index-food-guide.pdf

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​3) Eat smaller and more frequent meals throughout the day, spreading daily total carbohydrate intake over 5-7 small meals

The Endocrine Society recommends limiting total carbohydrate intake to 35-45% of total calories/day for women with GDM. (Caloric needs differ amongst individuals but in general, it is recommended that pregnant women consume about 1,800 calories/day in first trimester, 2,200 in second trimester and around 2,400 calories/day in third trimester. Proper nutrition, however, should be based on consuming well-balanced meals and eating whole foods as much as possible, rather than focussing on counting calories.)

The amount of carbohydrates eaten at one time can proportionately raise blood sugar higher. Therefore, the American College of Obstetrics and Gynecologists recommends spacing your meals and carbohydrates out throughout the day, consuming three smaller meals and 2-4 snacks per day. Eating regularly and consuming smaller meals may help to decrease blood sugar spikes and improve glucose control in women with and without GDM.

Eating smaller and more regular meals may also help to reduce nausea, dizziness, shakiness and other unpleasant pregnancy symptoms.

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4) Pair carbohydrates with protein or healthy fats but limit saturated fats

Protein requirements naturally increase in pregnancy. Eating adequate amounts of protein in pregnancy can also help to offset nausea and vomiting of pregnancy, too! Since protein and fats take much longer to digest than carbohydrates they can keep you full longer throughout the day and offset spikes in blood sugar. This is why I always recommend that snacks consisting of carbohydrates be paired with a protein or healthy fat. For example, an apple with a handful of nuts and seeds or a whole grain piece of toast with avocado. 

When consuming fats, saturated fats should be avoided, especially for women with GDM. A high intake of saturated fats can interfere with insulin signalling and can increase inflammation and endothelial dysfunction which are both contributing factors in GDM. On the flip side, healthy fats, such as those derived from fish, seafood, some nuts and seeds can have anti-inflammatory properties and are associated with a reduced risk of GDM.

5) Eat a snack before bed

​Eating a snack before bed can help stabilize your blood sugar overnight, which can actually also reduce night time wakings. One reason for night wakings in pregnant and non-pregnant people is due to dips in blood sugar. 

Some examples of healthy night time snacks include greek yogurt, a handful of pumpkin seeds, a fruit paired with a healthy fat or protein such as cheese or almond butter or high fibre seed-based crackers with hummus.

In addition, blood sugar levels tend to naturally be higher in the mornings. So, it may be a good idea to eat lower carbohydrate meals in the morning and more carbohydrate-rich meals or snacks in the afternoon or evening (as long as you don’t forget your post-meal walk!) When having a small breakfast upon waking, you may want to consume your second small meal of the day about two hours later.

Need more healthy lifestyle advice? Book a consultation with a Yoga Mamas Naturopathic Doctor.

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REFERENCES:
https://pubmed.ncbi.nlm.nih.gov/29272606/
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https://link.springer.com/article/10.1007/s00125-016-4085-2
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7071246/
https://yalehealth.yale.edu/gestational-diabetes-treatment-plan
https://www.karger.com/Article/Fulltext/486810#:~:text=Multiple%20studies%20have%20reported%20that,levels%20%5B14%2C%2015%5D
https://nutritionandmetabolism.biomedcentral.com/articles/10.1186/s12986-020-00509-0
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6823013/
https://pubmed.ncbi.nlm.nih.gov/28927313/#:~:text=Conclusions%3A%20Compared%20with%20control%20intervention,gestational%20age%20and%20gestational%20weight
https://www.nature.com/articles/s41598-020-74773-8
https://www.cdc.gov/diabetes/basics/gestational.html#:~:text=However%2C%20about%2050%25%20of%20women,your%20levels%20are%20on%20target