Gestational Diabetes

What is Gestational Diabetes (GD)?

Gestational Diabetes is when your blood glucose elevates above a recommended range. Diagnostic test for gestational diabetes is the Oral Glucose Tolerance Test. This test is given between 24-28 weeks in the third trimester of pregnancy. For women with a family history of diabetes, the test can be performed in the first trimester.

The patient is given a 100grams of a sugary drink. The health care worker will draw blood three times to measure:

  • Faster level  > 5.3mmol/L
  • After 1 hour > 10.0mmol/L
  • After 2 hours > 8.6mmol/L

If the patient has 2 blood draws that exceed these given ranges, then the diagnose of gestational diabetes is given.

Who are at risks?

It is estimated around 6% of all pregnancies result in GD. High risks populations include:

  • Family with a history of diabetes
  • Previous pregnancy with gestational diabetes
  • Older than 35
  • Non-Caucasian populations

What are the treatments for gestational diabetes?

The first line of treatment is to change eating habits and increase physical activities. Around 75% of expectant mothers can control their gestational diabetes through these methods. Around 25% requires insulin therapy.

When should you get tested?

  • Testing is typically done around 24 weeks of pregnancy since that is the period that blood glucose tends to rise in pregnant women
  • However, if you have a family history with diabetes for previous pregnancy with GMD, then your doctor could test you within the first trimester.

Why do expectant mothers have higher risks during the third trimester?

During the late stages of pregnancy, the mother’s body naturally comes more insulin resistant. Glucose is a form of energy currency for the body to grow and function.  In short, the food you eat gets converted into glucose which provides the energy for the mother to function. The baby in order to grow absorbs the glucose from the mother’s food. In the late stage of pregnancy, the mother’s body does not absorb as much glucose to preferentially given the glucose to the baby.  The baby can use glucose as energy to grow. Since the mother does not absorb as much glucose, the glucose remains longer in the blood and hence raising the measurement of blood glucose.

Once diagnosed with Gestational Diabetes, what is the targeted range of blood glucose?

American Diabetes Association recommends to keep the blood sugar in these ranges:

  • Fasting < 5.3mmol/L (95/mg/dl)
  • 1 hour after eating  <  7.75mmol/L (140mg/dl)
  • 2 hours after eating < 6.65mmol/L (120 mg/dl)

What are the health risks for the baby?

Short-term risks:

  • Large baby. Due to an elevated level of glucose in the blood, the baby’s pancreas will release extra insulin. Insulin is an energy storage hormone. As such, the baby runs the risk of gaining weight and be a large baby.
  • Complications during the birthing process. Having a large baby could lead to complications during birth. For example, the baby’s shoulder could get a fracture. In rare cases, the baby is too large which delays the birth process and suffer from the lack of oxygen. For these reasons, the doctors typically recommend having a scheduled C-section around the 38th weeks to reduce the complication risks.
  • Hypoglycemia, having low blood sugar. This is because the baby’s pancreas was releasing extra insulin to deal with the mother’s high blood sugar. But after birth, the baby is no longer supplied with the mother’s blood. The baby’s extra insulin causes his/her own blood sugar to drop. This is not as dangerous as long as the baby is being monitored by the doctors.

Long-term risks:

  • Obesity
  • Type 2 diabetes

What are the health risks for the mother?

  • Type 2 diabetes. According to the CDC, 50% of mothers with gestational diabetes go on to develop type 2 diabetes.
  • In addition, these mothers also run the risk of having GD again in future pregnancies. Type 2 diabetes is a chronic illness that lowers our quality of lives, lead to other deadly serious complications, and shorten our lifespans. By changing lifestyle habits in diet and exercise, we have a good chance to live a long and healthy life.

What to eat?

Since the biochemistry of each person is different, it is recommended that you pay close attention to the food you eat and adjust in accordance with your blood sugar level. Even if a food is on the suggested list but it raises your blood sugar too much, then eliminate it.

5 low-carb principles of healthy eating for gestation diabetes

  1. Limit the number of carbohydrates to 30-45grams per meal. See the list of the low-carb list. To keep it simple, keep the portion of rice, pasta, noodle, tubers to 1/2 cup or bread to 1 slice per meal. This is about 20 gram of carbs.  Protein, vegetable, and good fats have a very limited amount of carbohydrate, so to keep it simple, you don’t have to track them. Keep the snack to under 15 grams of carbs.

  2. Eat at least 3 cups of vegetables per day. Limit fruits. 1/2 of your plate should be vegetable.

  3. 1/4 of your plate should be good fats. 1/4 of your plate should be protein.

  4. Avoid sugary drinks, soda, and fruit juices. Drink water, herbal tea, unsweetened soymilk, almond milk.

  5. Avoid fried food.

5 low-carb principles simplified:

Red - avoid_ (1)

Which food has the highest carbohydrate amount and which food has the lowest?

  • Processed foods are high in carbohydrate due to the added sugar. As such, you should pay close attention to the food label for these and avoid them if you can.
  • Refined carbs: rice, pasta, noodle, bread typically have the highest carbohydrate amount, around 20 grams per 1/2 cup. This is the type of food that you should pay the attention to.

When I cut down carbohydrate, I am always hungry. What to eat?

When you first cut down carbohydrate and reducing sweet, you will go through a period of craving. This is because your body and your brain have been used to eating these refined carbohydrates and sugar for most of your life. After 2-3 weeks of reducing these foods, you will get used to the new food. To help you with the food craving:

  • You can eat more protein and good fats. These foods will help you feel fuller longer.
  • You can also eat more fiber since it will help you feel fuller longer as well. Vegetables that are high in fibers include: green peas, green beans, broccoli, cauliflower, turnip, and carrots.

If I eat brown rice, can I eat more than white rice?

Brown rice has more fiber than white rice and slightly less carbohydrate content.  A cup of cooked brown rice has 42 grams net carb, while a cup of white rice has 52 grams of net carb. So brown rice does have less carbohydrate than white rice, but only slightly.

Since you should keep your carbohydrate intake per meal under 30 grams, you should eat around 1/2 cup only, regardless if it is brown rice or white rice. Instead, you should explore recipes that have higher protein, good fats, and vegetable content.

Can I eat all the vegetable that I want?

In short, the answer is yes. Vegetables are low in carb (see the list below). As such, you don’t have to count the amount of carbohydrate when eating them. They are also high in fiber, which is good for your digestive system and help you feel fuller longer. They are also full of essential minerals and vitamins that can help your baby to grow.

Vegetables (raw). 1 cup
Net carb in grams
Spinach 0
Celery 1
Cucumber 2
Mushroom – white 2
Eggplant 2
Bean sprout 3
Cabbage 3
Brocolli 4
Green beans 4
Tomato 5
Pumpkin 7
Carrot 9

What fruit can I eat?

Fruits can be high in both carbohydrates. If you are eating fruit as a snack, then you should limit to 15 grams of carb per snack. Each person is different, make sure you measure your blood sugar and see how your body reacts to the fruits.

Fruits that are low in carb: strawberries, blueberries, guava, watermelon. Avoid fruits high in carbohydrates like mango, grapes, and banana.

Fruits (1 cup)
Net carb in grams
Avocado 3
Blackberries 5
Strawberries 9
Watermelon 11
Blueberries 12
Apple 12
Cantaloupe 13
Guava 15
Orange 17
Pear 17
Pineapple 20
Kiwi 21
Mango 22
Grape 26
Banana 29
Jackfruit 35
Durian 57

What are the good fats?

During pregnancy, the body needs more fat. UCSF recommends expectant mothers to consume 25-35% of calories in term of fat.

Healthy fats Portion
Net carbs (grams)
Fish – sardine 100 gram 0
Fish – salmon 100 gram 0
Olive oil 2 tablespoons 0
Flaxseed 2 tablespoons 0
Avocado 1 cup 3
Sunflower seed 1 cup 5
Walnut 1 cup 8
Coconut cream 1 cup 12
Milk – whole 1 cup 13
Almond 1 cup 13

How much protein should I eat?

Consume protein. UCSF recommends expectant mothers to consume at least 60 grams of protein per day. Fill up around 1/4 your plate with protein.

Protein. 100 grams of food
Net carbs in grams
Egg 0
Beef 0
Pork 0
Chicken 0
Fish – salmon 0
Fish – sardine 0
Tofu 2
Beans – fava 31

What should I drink?

Drink water, herbal tea, unsweetened soymilk, almond milk.

Avoid sugary drinks, soda, and fruit juices.

Drinks Portion Net carbs in grams
Soymilk – unsweetened 1 cup (8 oz) 2
Almond milk – unsweetened 1 cup (8 oz) 2
Coconut juice 1 cup (8 oz) 11
Milk – whole 1 cup (8 oz) 13
Fresh orange juice 1 cup (8 oz) 26
7-up 1 can (12 oz) 38
Coke 1 can (12 oz) 39

Why should I avoid fried food?

When oil is heated to a high temperature, it becomes oxidized. Oxidized oils become free radicals in the bodies and have been linked to the risks of developing cancer.

General rules about fried food:

  • Limit as much as you can
  • Especially avoid eating fried food at restaurants since many restaurants re-use the oil to save money.
  • If you cook as home, don’t use extra virgin oil since they have a low smoke point. Look for oil with a higher smoke point like coconut oil, avocado oil. You can also use butter or ghee to cook in a limited amount.

What type of foods have essential vitamins and minerals for the baby?

Omega 3 Folate Iron Vit D Calcium Zinc
Help your baby develop brain and eyes Reduce the risk of the baby’s neural tube defects Helps produce red blood cells to transport oxygen; reduce the risk of low birth weight and premature birth Development of bones and teeth Development of bones and teeth

Help the mother’s bones not weaken at old age

Help the baby’s cells grow

Increase immunity  to fight of infection

Salmon, tuna, sardines, anchovies and herring Varieties of green vegetables, spinach, broccoli, cauliflower, peas, beans, cashews, walnuts Beef, pork, chicken liver or beef liver, pea, spinach, Oyster, Clam, tuna, egg, shrimp Salmon, mackerel, mushrooms, tuna, sardines, milk, yogurt, eggs Yogurt, milk, dark green leafy vegetables, canned fish with bones Oysters and other types of seafood, red meat, poultry, dairy products, beans

What are some low-carb recipes for meals?

The American Diabetes Associations has a good recipe website with low-carb menus and easy to prepare food: https://www.diabetesfoodhub.org/

Spinach Seafood soup:

  • Protein: shrimp, scallop, fish, squid, and/or egg
  • Vegetable: spinach, tomato, green onion, mushroom
  • Sauce: a little bit of salt, soy sauce, fish sauce

Seafood Soup (3)

Screen Shot 2019-07-10 at 8.10.47 PM

Homemade spring rolls

1 cup of lettuce
1/2 cup of cilantro
1 cup of cucumber
1/2 cup coleslaw
1 cup of seafood
2 tablespoons sesame dressing
8 small rice papers

Net carbs_ 32 gramsScreen Shot 2019-07-10 at 9.30.31 PM

What are some low-carb ideas for snacks?

Blueberries nuts snack:

1/8 cup of walnut

1/8 cup of cashew

1/8 cup of frozen blueberries (taste like ice cream)

.5 oz of cacao nibs

1 cup of unsweetened almond milk

Seafood Soup (4).png

Screen Shot 2019-07-10 at 8.30.41 PM

 

How does exercise help with managing blood sugar?

When you exercise, the blood sugar in your blood goes down because the muscle cells are using up the glucose for energy. Exercise also has a long-last effect beyound the time you exercise. After you exercise, your cells will remain more effective at uptaking glucose (more insulin sensitive) and keep your blood sugar remain stable even after you exercise.

The American Pregnancy Association recommends 30 minutes of exercise per day. The general rule of thumb is that you should do the exercise that you are comfortable with (or have done before). Some ideas include walking, yoga, swimming.

There are additional benefits besides lowering blood sugar. Benefits include coping during labor. In addition, it can help you to get back in shape after pregnancy.

Why some people have a higher fasting blood glucose level?

There could be 2 reasons why you have a higher fasting blood glucose in the morning: (1) the dawn phenomenon, or the (2) Somoygi effect. To find out which one, it is recommended that you set an alarm for 2am, for a few nights in a row, and test your blood sugar. If the blood sugar is high at 2am, then it is likely dawn phenomenon. If your blood sugar is low in at 2 am, then you likely have the Somogyi effect.

  1. Dawn phenomenon is a natural phenomenon that happens to everyone. In the morning, your body releases hormones (cortisol, glucagon, norephedrine) to help you get up and get out of bed. These hormones cause your blood sugar to raise so that you have more energy to get out of bed. In normal people, the body naturally releases insulin and insulin will work to lower the blood glucose to a normal level. Women with GMD have a harder time to lower this surge in blood sugar and hence the blood sugar remains high. The dawn phenomenon is more common than Somogyi effect. In type 2 diabetes, it is estimated that 50% of the population have the dawn phenomenon. What to do:
    • Eat an earlier dinner
    • Excercise after dinner
    • If you eat a snack before bed, limit the amount of carbohydrate
    • Eat a lighter breakfast
    • If you are using insulin: use it at bedtime instead of dinner time.
  2. Somogyi effect is when your blood sugar drops during the night. The blood sugar drops either because the person takes too much diabetes medication/or insulin injections. As a response:
    • Have a snack before bed to keep your blood sugar level balance throughout the night.
    • If you exercise at night, do it earlier and not close to bedtime

How much weight to gain during pregnancy for the mother?

As long as you are within the recommended weight gain for the pregnancy, you should eat as much as you feel you need.

According to the American Pregnancy Association, normal weight ranges are dependent on BMI levels. You can use a BMI calculator to find your BMI number.

  • BMI < 18.5.  This is considered to be underweight. Weight gain during pregnancy should be between 28-40 pounds.
  • BMI 18.6-24.5. This is considered to be the normal weight. Weight gain during pregnancy should be between 25-35 pounds.
  • BMI 25-29.  This is considered to be overweight. Weight gain during pregnancy should be between 15-25 pounds.
  • BMI >30.  This is considered to be obese level. Weight gain during pregnancy should be between 11-20 pounds.

How much to gain for the fetus?

These data show the average length and weight for the fetus.

Gestational Age Length (inches) Weight (oz/lb)
8 weeks 0.63 0.04 oz
9 weeks 0.9 0.07 oz
10 weeks 1.22 0.14 oz
11 weeks 1.61 0.25 oz
12 weeks 2.13 0.49 oz
13 weeks 2.19 0.81 oz
14 weeks 3.42 1.52 oz
15 weeks 3.98 2.47 oz
16 weeks 4.57 3.53 oz
17 weeks 5.12 4.94 oz
18 weeks 5.59 6.70 oz
19 weeks 6.02 8.47 oz
20 weeks 6.46 10.58 oz
21 weeks 10.51 12.70 oz
22 weeks 10.94 15.17 oz
23 weeks 11.38 1.10 lb
24 weeks 11.81 1.32 lb
25 weeks 13.62 1.46 lb
26 weeks 14.02 1.68 lb
27 weeks 14.41 1.93 lb
28 weeks 14.8 2.22 lb
29 weeks 15.2 2.54 lb
30 weeks 15.71 2.91 lb
31 weeks 16.18 3.31 lb
32 weeks 16.19 3.75 lb
33 weeks 17.2 4.23 lb
34 weeks 17.72 4.73 lb
35 weeks 18.19 5.25 lb
36 weeks 18.66 5.78 lb
37 weeks 19.13 6.30 lb
38 weeks 19.61 6.80 lb
39 weeks 19.96 7.25 lb
40 weeks 20.16 7.63 lb
41 weeks 20.35 7.93 lb
42 weeks 20.28 8.12 lb
43 weeks 20.2 8.19 lb

What if my baby is under weight, what can I eat?

If your baby is underweight, it is still important to follow a low-carb diet to control your blood sugar. You can increase the amount of protein, good fats and vegetables.

What to eat if my baby is overweight?

If your baby is overweight, it is important that you restrict the amount of carbohydrate even further to slow down the weight gain. You should focus on eating protein, good fats and vegetables. In addition, increase physical exercise so that you can lower the blood sugar level, which will help to reduce the weight gain.

If my baby is underweight, should I drink grain powder to supplement?

You should avoid drinking grain powder as a supplement. Typically, these grain powder are high in carbohydrate and low in fiber. They can raise your blood glucose without having enough nutrients for you and your baby.

You should get nutrients from real food. Real food such as high-quality proteins, good fats, and vegetables have the essential minerals and vitamins that are needed for your baby to grow.

After giving birth

When will you be tested again after birth?

Typically, the doctors will test you again between 6-8 weeks after pregnancy. About 5-10% of women with gestational diabetes develop Type 2 Diabetes right after giving birth. If the blood sugar level is within range (fasting < 95mg/dL, 1hour <140mg/dL, and 2 hour < 120mg/dL), then the doctors will test you again after 1 year. After that, it is recommended that you get tested every 3 years.

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