​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.

​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.

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

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.

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.

Posture Check!
Maintaining a healthy posture during pregnancy is important to help keep mama and baby healthy. Proper posture can decrease neck, mid-back, low back, pelvic, and feet pain. These guidelines will help you maintain a healthy posture throughout your pregnancy when standing, sitting and lying down. 

Lying Down
 
Lying on your side is a recommended position to take off tension from the lower back. During the third trimester, it is not recommended for pregnant women to lie on their back for long periods of time. The weight of the baby can press on large blood vessels and reduce blood flow to the placenta and baby. 

1. When on your side, keep your body in line, with your knees slightly bent and avoid twisting.
   
2. Place a pillow between your legs to relieve pressure from the top leg.
   
3. Situate a pillow under your belly to support the weight of the baby.
   
4. Tuck a pillow behind your back for support. 
   
5. Alternate sides to achieve the most comfort possible. 

​Good posture can make you look and feel better, as well as help you avoid some of the discomforts that can occur later in pregnancy.

Have you been experiencing constipation, nausea, or heartburn since becoming pregnant? During pregnancy mamas often experience digestive issues. Thankfully, there are ways to mitigate a troubled tummy. Yoga Mamas' Holistic Nutritionist, Sarah Robinson has listed 6 of her go-to tips:

1. Eat smaller, more frequent meals 
Instead of eating three big meals a day, try eating smaller amounts frequently. This can help prevent you from being overly full at each meal, which can exacerbate nausea. This is especially important for mamas dealing with heartburn as well, since eating large quantities at once is a common trigger for heartburn. 

2. Prioritize movement
Movement is important during pregnancy for many reasons, but it can also be really helpful in managing constipation. Walking in particular helps improve digestion and increase transit time (aka the total time that it takes for your food to be digested, from start to finish). Doing a couple of brisk walks a day, even for just 20 minutes or so can help improve your digestion. Instead of laying down after meals, getting up and going for walks can also help reduce heartburn. This is because being upright during the initial stages of digestion means that gravity is helping your food move south where it should be going, instead of back up. 

3. Focus on fiber-rich foods
It can be tempting during pregnancy (especially when you’re nauseous) to mostly eat refined carbohydrates such as crackers, white bread, and pasta. These are okay in moderation, but they are quite low in dietary fiber and can make constipation worse. If you’re struggling with constipation during pregnancy, try including fiber-rich sources of carbohydrates such as oats, quinoa, whole grain crackers, brown rice, sweet potatoes, and fresh fruit. 

4. Sip on ginger tea 
Many people find that ginger is helpful in relieving nausea, and it’s a great option for pregnancy-induced nausea because fresh ginger is completely safe for mom and baby. You can easily make ginger tea by grating fresh ginger into hot water with a bit of lemon and honey. You can also purchase ginger lozenges to suck on when you’re out and about and the nausea hits. 


5. Swap leafy greens for root vegetables
For many pregnant women with nausea and food aversions, leafy greens and raw vegetables are no longer appealing - especially during the first trimester. Instead of trying to force these foods down, opt for root vegetables instead, as these are generally easier to tolerate when nauseous. Root vegetables are also high in insoluble fiber, which helps speed up digestion and prevent constipation. 

6. Slow down at meal time 
Slowing down at meals and thoroughly chewing your food can help your food digest more efficiently. Most people assume that digestion begins in the stomach, but it actually begins in your mouth. When you chew your food, digestive enzymes are released into your saliva that starts to break down your food before it even hits your stomach. Chewing slowly and thoroughly ensures that these enzymes are able to do their job. Plus, breaking your food down into smaller pieces means that there is less work for your stomach to do. This will start the digestive process off on the right foot and can help ease pregnancy-related digestive issues.   

Experiencing digestive issues or other pregnancy concerns? Book a complimentary session with Sarah, Yoga Mamas' Holistic Nutritionist. 

There are so many options out there for prenatal vitamins, all the choices can be overwhelming! Prenatal vitamins help keep you and your baby healthy. It’s recommended that you take prenatal vitamins 3 months prior to trying to conceive, for the duration of your pregnancy and three months postpartum to help you recover. Taking prenatal vitamins while you’re pumping or breast/chestfeeding is also recommended.

Yoga Mamas' Naturopathic Doctor, Dr. Shannon Vander Doelen made a short list of things she recommends her clients to be mindful of when making the decision. Below are three things to consider when choosing a prenatal:
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1. Make sure you’re able to take it for a year or longer. If your body is not responding to it well (ie it makes you nauseous,) you should try a different one because you won’t be able to tolerate it for an extended period of time. 
   
   
2. Be weary of prenatal vitamins that claim to include all of your daily needs in one pill. It’s usually very difficult to pack everything into one. Typically you need to take more than one pill a day.
   
   
3. Take your prenatal vitamins with food. It helps with the absorption of nutrients and decreases the chance of nausea.
   
   
4. A good way to tell if your prenatal vitamin is of good quality is by checking which type of vitamin B9 (also known as folate) it has. Folic acid is the synthetic and inactive version of vitamin B9. Our bodies have to convert it into the active form of folate so that your body can use it. The other form of folate is 5-methyltetrahydrofolate (5-MTHF), which is the active form. 50% of the population is not able to convert folic acid into folate, so choosing a prenatal vitamin with 5-MTHF is a better option. Folate supports a baby’s brain and nervous system development.

Speak with your health practitioner when deciding on which prenatal vitamin to take. If you’re looking for a naturopathic doctor, Dr. Shannon Vander Doelen is accepting new patients! She’s available online and can treat anyone who resides in Ontario.