Avoid Gestational Diabetes

Gestational diabetes mellitus, sometimes also referred to as (GDM), is a potentially serious condition that develops during pregnancy. Basically defined, gestational diabetes affects how the mother's body produces and uses insulin to control her blood sugar levels which can be harmful to both her and the baby. The good news is that GDM is can be prevented, or your risk for developing it at least minimized. There are no guarantees, but the more healthy habits you adopt before and during your pregnancy, the better you and baby will be.

Steps

Determining Your Risk Factors

1. Get a family history. The first step in preventing GDM is determining your risk factors for developing it. If it turns out that you are at high risk, then you and your doctor take steps towards lowering your risk and keeping you and the baby healthy.
   • Before talking with your immediate relatives about their diabetic history, it might help to know the differences between type 1 and type 2 diabetes. Type 1 diabetes, is an autoimmune disorder, whereas type 2 diabetes is closely tied to lifestyle and eating habits.
   • Your risk of developing gestational diabetes increases if a close family member, such as a parent or sibling, has type 2 diabetes. Talk to your family to see if this applies to you.
2. Determine your other risk factors. Besides heredity, there are a number of other risk factors in that you should think about and bring to your doctor’s attention. These include:
   • Being Hispanic, African-American, Native American, Asian American, or Pacific Islander.
   • Being overweight before your pregnancy.
   • Being 25 years of age or older.
   • If you developed GDM in a previous pregnancy.
   • If you previously had large baby (9 pounds or more) or a stillbirth.
   • If you had abnormal blood sugar tests before, including glycosuria (sugar in your urine).
   • A history of polycystic ovarian syndrome.
3. Make a pregnancy plan. There are steps you can take even before you become pregnant to manage your risk for developing GDM. Consult with your doctor before you get pregnant and ask them to help you put together a pregnancy plan to help prepare your physically, mentally, and emotionally.
   • Have your blood sugar tested as early as 3 months before you plan to become pregnant in order to establish your baseline levels and to if you fall in a normal range.
   • Plan to lose any excess weight before pregnancy. Weight loss is not advised during pregnancy, so if you are overweight and concerned about this increasing your risk for GDM, try to lose the extra weight (between 5% to 7% of your body weight if you are overweight) before you become pregnant.

Lowering Your Risk Through Medical Screening

1. Make a doctor appointment. Meet with your Ob-Gyn early on in your pregnancy, and frequently throughout, in order to ensure the health of you and your baby
   • It is recommended that those at average risk for GDM have a screening performed during their second trimester -- between 24 and 28 weeks.
   • If you are at high risk, your doctor may elect to test for diabetes during your first prenatal visit.
2. Prepare for your doctor visit. Being a proactive and informed patient can help you effectively communicate your concerns to your doctor.
   • When you make your appointment, ask if the doctor will order any tests, including a blood sugar screening, and if you should follow any food restrictions or fasting before your appointment.
   • Go to your appointment with a list of any medications or supplements you are currently taking, as well as a list of any symptoms, concerns, or questions that you would like the doctor to address.
   • Let your doctor know that you are particularly concerned about GDM, either because of your family history or other personal risk factors. Ask if they recommend any special diet, exercise, or testing plans for you to follow during your pregnancy.
3. Get tested. During your doctor’s visit, you will likely be tested for GDM through an “initial glucose challenge test” and/or a follow-up “glucose tolerance testing.”
   • In the “initial glucose challenge test,” you’ll be asked to drink a syrupy, sugar solution and then, after an hour has passed, your blood will be tested to measure your sugar levels.
   • If your blood sugar level is higher than normal, it only means that you are now considered at higher risk for developing GDM, and will need a follow-up glucose tolerance test to determine if you have GDM. However, if the value is above 200mg/dl. Then gestational diabetes is presumed. If the diagnosis is made early in pregnancy, then you probably have pre-existing diabetes, not gestational diabetes.
   • In the “glucose tolerance test,” you’ll fast overnight and then have your blood sugar levels checked. Then, you’ll drink a sweet solution (this time with a higher level of sugar in it) and your blood will be checked every hour for three hours. If at least two of the three sugar readings come back as higher than normal, your doctor will very likely diagnose you with GDM.
4. Continue to monitor your blood sugar and make lifestyle changes. Consult with your doctor to find a regular testing schedule and method that works best for you. Ask your doctor about what you should do to change your diet and exercise routines to help mitigate GDM during your pregnancy.

Lowering Your Risk Through Diet

1. Eat more fiber. It is important to maintain steady blood sugar levels if you are at risk of gestational diabetes. Fiber will help you stabilize your sugar levels. In a study of the diets of women before they got pregnant, those who increased their daily fiber intake by 10 grams reduced their risk of GDM by 26%. Try to include more high-fiber foods to lower your risk.
   • High-fiber foods include whole grains, bran, fruits (especially prunes), and vegetables (especially green leafy vegetables).
2. Increase your protein intake. Protein is an essential part of a healthy diet, and also provides a lot of B vitamins which can help prevent birth defects. Make sure that you are getting plenty of protein from lean sources.
   • Lean meats, such as chicken, are good sources of protein and safe for pregnant women to consume. Avoid fish as a lean protein source, as its high mercury levels can be dangerous for pregnant women
   • Very dark green leafy vegetables such as broccoli and spinach are good sources of protein as well as iron.
3. Enjoy fresh fruit in moderation. Fruits are good for you, but sugary fruit juices should be avoided. Fruits are high in natural sugars which in and of itself is not a bad thing, but one small glass of orange juice can contain the juice of as many as 10 oranges and there may also be added artificial sweeteners.
4. Avoid “white” foods. This means items such as sugar, flour, as well as starchy potatoes and pasta. These items are more likely to spike your blood sugar, so it is best to limit your intake of these items to small quantities.
5. Watch when and how much you eat. Your body releases insulin in response to high blood sugar, and eating large meals or having lots of time in between meals can cause a spike in blood sugar. That is why it is best to have a steady level of insulin in your system instead of extreme spikes and low points throughout the day.
   • Keep an eye on portion sizes and try to eat several small meals frequently throughout the day to maintain your blood sugar levels. For example, you could eat a 300 to 400 calorie meal once every three hours during the day so that you consume a total of five meals totaling between 1,500 to 2,000 calories.

Lowering Your Risk Through Exercise

1. Start exercising before you become pregnant. Exercising before and during pregnancy can help protect you from developing gestational diabetes.
   • Research has shown that women who were physically active for 4 hours a week or 30 minutes a day, before and during pregnancy can reduce their risk of GDM by about 70%.
   • Always ask your doctor about how much and what type of physical activity are right for you.
2. Stick with safe exercises while pregnant. Safe exercises to participate in during pregnancy typically include low impact exercises, such as walking and swimming. Avoid doing any type of exercise that is high impact or that has a higher potential for injuries, such as contact sports.
   • Parking your car at the far end of the parking lot as you run your daily errands is one way to squeeze in extra activity.
3. Aim for 30 minutes per day. Most doctors will approve of up to 30 minutes of exercise per day, for most or several days a week, for pregnant women.
   • You can incorporate several short exercise activities into your day to keep the stress on your body low while still reaping the same benefits as 30-minutes of straight activity.
   • Make sure to monitor your heart rate while exercising and never exceed the recommended target heart rate for your age and weight.

Tips

• Keep your exercise and healthy eating habits up after you deliver. This will help you can also lower your overall risk for diabetes as well as future development of GDM.

Warnings

• Always discuss any exercise program with your doctor, especially if you were not exercising prior to becoming pregnant. Never start a new diet or begin a new physical activity without first consulting with your doctor.

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Sources and Citations

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