Gestational Diabetes Mellitus is defined as glucose intolerance diagnosed during pregnancy. It is recommended that pregnant women with any risk factors be screened at the first prenatal visit. For women at high risk not found to have GDM at the first visit, repeat testing is indicated between 24 and 28 weeks. If 2 or more values are abnormal then the patient has a positive diagnosis of gestational diabetes. It has been found that women diagnosed with gestational diabetes already have insulin resistance at baseline with a higher level of plasma insulin levels.
Women diagnosed with GDM need training about daily self monitoring of glucose 6-7 times a day with a minimum of 4 times.
All women diagnosed with GDM require nutritional counseling for the appropriate amount of weight gain during pregnancy as well as dietary control. It is a critical point in time for changing the lifestyles of these women since they are at a high risk for development of type 2 diabetes.
The use of oral medications is considered when diet and exercise do not adequately control blood sugars. Some studies have recently evaluated the safety and efficacy of Glyburide [sulphonylurea] after the first trimester for treatment of GDM. There is inadequate data in regards to the safety and efficacy of other oral antidiabetic medications such as Metformin, thiazolidinediones and Acarbose.
The diagnosis and treatment of gestational diabetes is critical because elevated blood sugars adversely affect both the mother and the baby. Approximately 50% women will develop type 2 diabetes within 5 years of development of gestational diabetes. A1C chart on this page has A1C to BS conversion chart and calculator using the DCCT formula. The hemoglobin A1C result is an important value for long-term glucose monitoring; about three months mean value of glucose level. DCCT (The Diabetes Control and Complications Trial) Formula: Below is the a1c chart to show a relation between A1C and BS equivalent.
This could either be newly diagnosed type 1 or type 2 Diabetes Mellitus or this could be a new onset of hyperglycemia secondary to metabolic changes related to pregnancy. One can either take a two step approach, starting with the 50 gm glucose challenge test, followed by an oral glucose tolerance test if the results of the former test are abnormal.
During the early part of pregnancy there is increase in insulin secretion and beta cell hyperplasia. It is recommended that pregnant women exercise for about 20-30 minutes everyday or at least most days of the week.
The older sulphonylureas were not recommended for use in pregnancy because they crossed the placenta. The fetus is at increased risk of macrosomia, hypoglycemia, hypocalcemia, hypomagnesaemia, jaundice, polycythemia, respiratory complications, congenital malformations and fetal loss including abortion, still births and neonatal deaths.
The greatest risk factor for early-onset type 2 diabetes after pregnancy was early gestational age at the time of diagnosis and elevated fasting glucose.
This A1C chart is based on the DCCT formula, a randomized clinical trial designed to compare intensive and conventional therapies and their relative effects on the development and progression of diabetic complications in patients with type 1. This leads to an increase in insulin sensitivity with low fasting blood sugar levels, increased glucose uptake by peripheral tissue and glycogen storage as well as decreased hepatic gluconeogenesis. The pancreas however, is unable to cope with this additional stress of elevated level of insulin resistance. Testing for the presence of ketones in a fasting urine sample is a valuable tool to assess the adequacy of caloric intake in these patients. These patients should restrict fat intake and substitute simple or refined sugars in their diet to more complex carbohydrates.


Seven-point capillary blood-glucose profiles (pre-meal, post-meal, and bedtime) obtained in the DCCT were analyzed to define the relationship between HbA1c and BG.
This process is crucial for the build-up of maternal adipose tissue, to be used in the later part of pregnancy. Positive urine for ketones indicates a state of starvation and the patients should be advised to increase their daily caloric consumption.
There isn’t enough data regarding the safety of the long acting insulin glargine in pregnancy. It has been shown that it is as effective as insulin, more cost effective than insulin and safe for use in pregnancy. Women with normal pregravid glucose tolerance who develop gestational diabetes in late gestation have no increased risk of fetal congenital anomalies beyond the population risk for women with normal glucose metabolism. If you or someone you know is looking for information on managing GD with real food, I highly recommend it!Gestational diabetes is never part of any mom’s plan . Converting A1C to equivalent blood-glucose level (as shown by the glucometer) can be easier interpreting the result. He recommends DCCT's formula to convert A1C to BS than the formula by ADAG recommended by ADA. During the late phase, there is an increase in hormones such as cortisol, prolactin, progesterone and human placental lactogen which leads to a state of relative insulin resistance, possibly via a post receptor defect in the cells. Both American Diabetic Association [ADA] and American college of Obstetricians and Gynecologists [ACOG] await more research related to the effect of glyburide on maternal and perinatal outcomes before approving its use. The children of women diagnosed with GDM are at increased risk of obesity and abnormal glucose metabolism during childhood, adolescence and adulthood.
Goldstein, MD "Defining the Relationship Between Plasma Glucose and HbA1c, Analysis of glucose profiles and HbA1c in the Diabetes Control and Complications Trial," Diabetes Care 25:275-278, 2002.
Women diagnosed with gestational diabetes are at increased risk of gestational hypertension including preecclempsia, caesarian section and assisted deliveries.
One of the mechanisms thought to be contributing to the long term complications in these babies is ‘early onset hyperinsulinimia’. Yet there are many misconceptions about this diagnosis, both in conventional health care and the integrative medicine world. Ia€™ll also be sharing why the typicalA gestational diabetes diet fails and why a real food, nutrient-dense, lower carbohydrate approach is ideal for managing gestational diabetes.What is Gestational Diabetes?Gestational diabetes is usually defined as diabetes that develops or is first diagnosed during pregnancy. However, it can also be defined as a€?insulin resistancea€? or a€?carbohydrate intolerancea€? during pregnancy.I prefer to rely on the latter description because, at the end of the day, gestational diabetes is the result of insulin resistance, which means a woman is unable to tolerate large amounts of carbohydrates without experiencing high blood sugar. However, in our modern world where food is rarely scarce and refined carbohydrates are everywhere, this adaptation can work against us. This is especially true if a woman already has some level of insulin resistance before becoming pregnant, which is becoming more common.[2]Why Early Screening for Gestational Diabetes is HelpfulIn years past, it was thought that the elevated blood sugar levels seen with gestational diabetes only begin to occur in the second and third trimester, when placental hormones are at their peak and insulin resistance spikes.
This is why gestational diabetes is classically screened for around 24-28 weeks of pregnancy.However, researchers have now found that gestational diabetes can be predicted earlier, by relying on a blood test called hemoglobin A1c (for short, A1c).
As their pregnancies progressed, their insulin resistance got more severe, as a natural result of placental hormones and weight gain, resulting in elevated blood sugar.Moreover, gestational diabetes is increasingly believed to be an early indicator for the later development of diabetes, which means a womana€™s insulin resistance continues or worsens years after they give birth. Women who have gestational diabetes have a 7-fold higher risk of developing type 2 diabetes later in life.[4]Can Gestational Diabetes be Prevented?Not all women with gestational diabetes have preexisting issues with glucose tolerance or insulin resistance, but research does show that wise preconception practices may prevent some cases of gestational diabetes. For women with a body mass index (BMI) greater than 35, the risk of gestational diabetes is five times greater than a woman at a healthy weight, most likely because insulin resistance tends to go up at higher body weight.[8]Vitamin D deficiency has also been associated with gestational diabetes (and, not surprisingly, insulin resistance). When those two arena€™t enough to bring the blood sugar levels down to normal, a woman may need insulin or medication.Many women would rather make dietary changes to control their gestational diabetes, than jump right to medicine (and most doctors feel the same way). Often, much to their disappointment, my patients had to start medication or insulin in order to control their blood sugar. Carbohydrates are the primary macronutrient that raises the blood sugar, so why are we suggesting they eat lots of carbohydrates?The primary reason clinicians are afraid to endorse a lower carbohydrate diet for pregnancy is that theya€™ve been given outdated information regarding ketosis. This topic is so complex that I devote an entire chapter to in my book,A Real Food for Gestational Diabetes.


But the short answer is that low-level nutritional ketosis is common during pregnancy, does not carry the same risks as starvation ketosis or diabetic ketoacidosis, and does not negatively impact the brain development of a baby.[19]What Level of Carbohydrates is Best?There will likely always be controversy around the ideal level of carbohydrates a woman should consume during pregnancy and frankly, I believe it will vary woman-to-woman based on her blood sugar control.
But, in general, I find most women with gestational diabetes benefit from a diet that has less than 175g of carbohydrates per day.My approach is to have a woman monitor her blood sugar while eating her usual diet (using a home glucose monitor) to get a baseline of how food affects her blood sugar. Below are some simple tips you can implement.Request getting your HbA1c (hemoglobin A1c) measured with your first trimester labs to get a better idea of your baseline blood sugar control. That way, you can take action earlier in your pregnancy if you need to.Ask to have your vitamin D levels measured (25-hydroxy vitamin D), so you can correct deficiency if ita€™s present.
Depending on where you live, time of year, and time spent outdoors in sunlight, you may need to add a vitamin D supplement to meet target levels.[22]If you have gestational diabetes, monitor your blood sugar in the morning (fasting) and after each meal to learn your bodya€™s unique pattern and response to different foods (and combinations of food). Adjust your diet and exercise levels accordingly, knowing that carbohydrates tend to raise your blood sugar the most, fat and protein tend to stabilize your blood sugar, and exercise tends to lower your blood sugar.Emphasize foods with plenty of fat and protein, both of which stabilize, rather than directly raise, the blood sugar. Pasture-raised meat (including organ meat), poultry, eggs, wild-caught fish, full-fat cheese, heavy cream, nuts, seeds, avocados, olives, butter, and some coconut products fit into this category.Embrace low-glycemic sources of carbohydrates, like non-starchy vegetables (lots of these!), nuts, seeds, and low-sugar fruit (like berries). For example, ita€™s better for your blood sugar levels to have a servings of sweet potatoes alongside grass-fed beef, sauteed spinach, and butter rather than by itself.Avoid large portions of carbohydrates at one time to prevent blood sugar spikes.
Ita€™s far better to have fruit as a snack twice per day than to have a large fruit salad in one sitting.Exercise regularly. A real food approach is ideal for gestational diabetes, because it emphasizes nutrient-dense foods that provide a baby with all the critical nutrients for growth, while also minimizing blood sugar spikes.Knowledge is power.
2Real Food On A Budget Pregnancy 10 Comments About Lily Nichols, RDN, CDE, CLTLily Nichols, RDN, CDE, CLT is one of the countrya€™s most sought after a€?real food for pregnancya€™ experts whose approach to nutrition embraces real food, integrative medicine, and mindful eating.She is a regular speaker at medical conferences on gestational diabetes and prenatal nutrition.
I had gestational diabetes during my pregnancy and it was one of the most frustrating and depressing seasons of my life. I had no traditional risk factors other than maternal age over 30, although since then I’ve done a lot of research and discovered there is a link between autoimmune disease and gestational diabetes. I could talk on and on about my experience, what I learned, what I will do differently next time, etc (supplements, exercise, diet).
I felt like the focus was on birthing a baby of a certain size rather than on our day-to-day health and well-being.
In the end my son was born healthy at 39 weeks with barely any sign that his mom had gestational diabetes. Our great frustration is that he is now allergic to all the foods I was required to eat in large quantities for that diet- dairy, eggs, chicken, blueberries.
Brewer’s Pregnancy Diet is an excellent resource that eliminates many pregnancy complications.
The whole diagnosis of gestational diabetes can be a real pain to deal with without the right kind of help. Protein, vegetables, a little fruit (low on the glycemic index), higher fat dairy…Thanks for this post! Instead of hearing snarky comments like, “You do know that *half* a banana is one serving, right?” Yeah, maybe not eating bananas at all would have been easier!
I have been gluten free for several years and I feel that I should have been gluten free when I was pregnant.
My fasting levels are checked every year or so because of my high risk of developing Type 2 diabetes. I was able to get my blood sugars under tight control basically how you suggested- monitoring and adjusting my diet accordingly.
I’m so nauseous and all I can tolerate (barely) is crackers, bread, rice, and watered down juice or broth. On the other hand, I think I am actually glad I was diagnosed with GD, because it certainly gave me a huge kick in the butt down the path of healthy living, good nutrition, and label reading!



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Comments

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