Managing Gestational Diabetes: What To Know

Excitement, anxiety, and hope are all emotions that you may feel throughout your pregnancy. But add a diagnosis of gestational diabetes, and you may feel overwhelmed, confused, and worried about the future health of you and your baby. First, take a deep breath and know you did not “cause” it. Second, know that you are not alone. And third, know that you can learn how to manage gestational diabetes while having a healthy and happy pregnancy.

By following the steps in this guide, understanding how to track your blood sugars, and working closely with your healthcare provider and registered dietitian, you will feel confident about how to manage gestational diabetes.

What is Gestational Diabetes?

Gestational diabetes is a type of diabetes that first presents itself during pregnancy. With all the ongoing changes, every pregnant woman’s body becomes slightly insulin resistant. That means our bodies do not respond to insulin as well as they should. Insulin is a hormone that helps to regulate our blood sugar.¹

Every year, 2-10% of pregnant women become so insulin resistant that their body can’t compensate for the resistance, leading to elevated blood sugar levels (also known as hyperglycemia), and a gestational diabetes diagnosis.^1,2

Who is at Risk for Gestational Diabetes?

Any pregnant woman is at risk for developing gestational diabetes. While certain risk factors increase your chance of developing gestational diabetes, there are many instances when women have none of these risk factors and end up developing it.¹

Known risk factors for gestational diabetes include the following:³

• Being overweight or obese pre-pregnancy
• Not being physically active
• Being older than 25
• Having gestational diabetes in a previous pregnancy
• Having polycystic ovarian syndrome (PCOS)
• Having a close relative with type 2 diabetes
• Being of a certain race or ethnicity, including African American, Pacific Islander, American Indian, Asian American, Hispanic

Now that you know the risk factors, you may wonder whether you can prevent gestational diabetes.

Gestational Diabetes Diagnosis

Most pregnant women will undergo a glucose tolerance test between 24 and 28 weeks gestation. If you have an increased risk of developing gestational diabetes or had gestational diabetes in a previous pregnancy, your healthcare provider may recommend testing sooner.¹

A glucose tolerance test measures how well your body processes sugar. It involves drinking a high-sugar drink within a short period and then taking a blood glucose test to measure your blood sugar level(s). Most women will take an initial one-hour glucose tolerance test where they will consume a 50-gram drink and have their blood drawn an hour later. If your levels are within the normal range, you are in the clear and most likely won’t have to test again. If your levels are higher than normal, you will be asked to return for a three-hour test.⁴

During the three-hour glucose tolerance test, you will have your fasting blood level drawn, then drink a 100-gram drink, followed by a blood draw one, two, and three hours after. If one level is higher than normal, your healthcare provider may suggest small diet and lifestyle changes while keeping a close eye on your blood sugar levels or have you come back and retake the test. If more than one result is higher than normal, you will receive an official diagnosis of gestational diabetes.⁴

Gestational Diabetes Treatments

Most pregnant women can manage gestational diabetes through diet and lifestyle alone while monitoring their blood glucose levels. In some circumstances, medication may be necessary. Let’s dive into how to help manage your gestational diabetes.¹

Lifestyle Changes

Healthy diet and lifestyle changes are the best way to manage gestational diabetes and decrease the likelihood of going on medication.⁵

Eat a Healthy Diet

Some foods raise or don’t raise your blood sugar. Foods containing carbohydrates, including fruits, starchy vegetables, grains, dairy products, and sweets (cookies, cake, ice cream, etc.), will raise blood sugar. Foods that do not contain carbohydrates, including poultry, red meat, fish and seafood, eggs, cheese, tofu, oils, and butter, will not raise blood sugar. Now, this is not to say you should eliminate carbohydrates altogether and only eat foods that do not contain carbohydrates. Your body needs carbohydrates as a fuel source to provide you with energy throughout your pregnancy. Finding a balance to supply you and your baby with a well-rounded variety of carbohydrates, protein, fat, vitamins, and minerals is vital.⁶

Eating a healthy diet rich in fruits, vegetables, whole grains, nuts, seeds, protein, and healthy fats will ultimately help you to achieve optimal blood sugar levels. However, every woman’s body may respond differently to varying amounts of carbohydrates and may need more assistance finding the optimal number of carbohydrates per meal and snack. Working with a registered dietitian or certified diabetes educator will help you learn how to control your blood sugar through diet while pregnant.

Exercise Regularly

Engaging in regular exercise is another way to help keep your blood sugar under control. Even 5-10 minutes of brisk walking after a meal can help reduce your post-meal blood sugar levels. After obtaining clearance from your healthcare provider, aim for at least 30 minutes of moderate exercise daily. Go for a brisk walk or swim, do some gardening, or attend a prenatal yoga class.⁷

Blood Sugar Monitoring

When it comes to managing your blood sugar, checking your blood sugar is critical! Now, you may be nervous about poking yourself, worry it may hurt, or that you will see a high number. But the more knowledge you have, the more control you can take. Tracking trends and noticing which foods affect your blood sugar allows you to make changes to optimize your levels best. You should check your blood sugar level four times daily: fasting in the morning before eating or drinking anything, and then again 1-2 hours after every meal.

Below I have highlighted the numbers you should aim for. The information here is intended solely for educational purposes and should not be taken as personal medical advice. Always discuss your optimal levels and guidance with your healthcare provider.⁸

Blood Glucose Target Levels for Gestational Diabetes During Pregnancy

• Fasting/upon waking before breakfast: Less than 95 mg/dL. Your fasting level should be checked first thing in the morning before you have had anything to eat or drink (except water).
• One hour post meal: Less than 140 mg/dL. Check your blood sugar 1-2 hours after each meal (this does not include snacks), so three times per day.
• Two hours post-meal: Less than 120 mg/dL. Check your blood sugar 1-2 hours after each meal (this does not include snacks), so three times per day.

Medication

Medication management may be necessary if you cannot meet your target blood glucose levels through diet and lifestyle alone.

Insulin is typically the first line of treatment for gestational diabetes uncontrolled by diet and lifestyle. Depending on your blood sugar level, you may only need one daily intermediate or long-acting insulin injection before bed or in the morning. If your post-meal blood sugar levels are out of range, you may need multiple injections of short-acting insulin with meals. Insulin is an effective and safe management tool for gestational diabetes and does not cross the placenta to your baby.⁹

Your healthcare provider may recommend or prescribe oral medication in addition to, or as an alternative to, insulin injections such as glyburide or metformin. However, it should be noted that the Food and Drug Administration does not approve these drugs for gestational diabetes management. Many healthcare providers believe more research is needed to confirm the safety and effectiveness of these oral medications to manage gestational diabetes.^10,11

Tips for Managing Gestational Diabetes

Check Your Blood Sugar

The more knowledge and information you have, the more power and control you can take. Checking your blood sugar regularly allows you to notice trends and how your body responds to specific foods.

Eat Balanced Meals with a Carb + Protein + Fat

Carbohydrates affect our blood sugars the most, but we don’t want to exclude them from our diet because they supply our bodies with energy and other essential nutrients. Pairing a carb with protein and fat decreases blood sugar spikes and higher numbers.¹²

Aim for 2-3 carbohydrate servings with a protein source and fat for meals and about one carbohydrate serving with a protein source or fat for snacks. As you begin to track your numbers, you will notice whether you can increase your carbohydrate load or need to decrease it.

Include High Fiber Foods; Decrease Simple Sugars

Fiber helps to slow the release of blood glucose, leading to lower numbers, whereas simple carbs are more likely to raise your blood sugar. Incorporate a variety of fruits, vegetables, whole grains, nuts, and seeds to increase your fiber intake while limiting sweets such as cakes, cookies, brownies, and ice cream.¹³

Eat Consistently Throughout the Day

Eating smaller, more frequent meals helps stabilize blood sugar fluctuations while providing consistent nutrition throughout the day for your body (and your baby). You want to ensure you supply your body and baby with adequate energy and good nutrition all day.⁶

Get Up and Move

Yep, that’s right, more than just your diet plays a role in managing your blood sugar. When you move and exercise, your body uses glucose as fuel for energy, helping to stabilize your blood sugar levels. Even a 5–10-minute walk after every meal can make a difference.⁷

How Does Gestational Diabetes Affect Your Baby?

Uncontrolled gestational diabetes (poor blood glucose control) poses risks to you and your baby. So, it is essential to get your blood sugar under control. Risks associated with uncontrolled gestational diabetes include the following:¹⁴

• Preterm birth
• Hypoglycemia (low blood sugar) in your baby
• Jaundice
• Larger baby, which increases the chances of a C-section
• Preeclampsia
• Developing diabetes or heart disease later in life for mom
• Developing obesity or diabetes later in life for the child

Fortunately, gestational diabetes often resolves itself after birth. However, having gestational diabetes increases your risk of type 2 diabetes and your baby’s risk of developing obesity as a child or teen and type 2 diabetes later in life.^1,14

Achieving optimal blood sugar control throughout your pregnancy is in your, and your baby’s, best interest to prevent further complications. Work with your healthcare provider to determine the best management for you and your blood sugar.

Sources

1. https://www.cdc.gov/1

2. https://www.cdc.gov/nchs/nvsr/nvsr71/nvsr71-03.pdf

3. https://www.cdc.gov/2

4. https://www.mayoclinic.org/pac-20394296

5. https://www.cdc.gov/3

6. https://www.cdc.gov/4

7. https://www.cdc.gov/5

8. https://diabetes.org/1

9. https://diabetes.org/2

10. https://www.webmd.com/3917/

11. https://www.webmd.com/11285-7061/

12. https://www.cdc.gov/6

13. https://www.hsph.harvard.edu

14. https://www.cdc.gov/7