Diabetes is one of the most common diseases in the U.S., affecting more than 30 million people. When it develops during pregnancy, the condition is called gestational diabetes –and the rates of gestational diabetes are increasing. Research published in JAMA Network shows that gestational diabetes rates increased from 4.8% to 6.4% between 2011 and 2019. The study included more than 12.6 million women ages 15-44 women who were having their first baby.
This is alarming, because gestational diabetes used to be more prevalent in older pregnant women—now we are seeing it more frequently in younger patients.
Gestational diabetes develops when the placenta secretes a hormone called human placental lactogen (HPL). This hormone is important for fetal growth as it causes an increase in maternal glucose (sugar) levels that then pass to the baby.
When women with gestational diabetes don’t get the care they need, expectant mothers and their babies are exposed to health problems. Women with gestational diabetes are at an increased risk of developing Type 2 diabetes later in life, needing a C-section, or developing high blood pressure in pregnancy (preeclampsia).
Potential effects on the baby include an increased risk of:
- Birth trauma: The most common type is nerve injury from shoulder dystocia, or when the baby’s head delivers but the shoulders remain lodged behind the mother’s pubic bone
- Jaundice: An excess of bilirubin (a yellow pigment released by red blood cells) in the baby’s blood
- Neonatal hypoglycemia: Low blood sugar at birth
Women who are at risk for diabetes – or those whose blood sugar levels are higher than the average person prior to pregnancy – are most likely to develop gestational diabetes. This often includes women with obesity, as well as those with a strong family history of diabetes.
Maintaining a healthy weight and lifestyle, including regular exercise, will help control your blood sugar before pregnancy, and is the best way to reduce the risk of gestational diabetes. Because we do not generally recommend weight loss during pregnancy, treatment typically focuses on eating nutritious foods and use of medications to lower blood sugar as needed.
I had a patient in her early 40s who, after two decades of trying to conceive, was having her first baby. She had pre-diabetes before pregnancy and developed gestational diabetes during. Because she diligently followed a diabetes-friendly eating plan during pregnancy, she ended up having a beautiful, healthy baby. It takes commitment, but it is very doable.
Lowering your blood sugar
Before pregnancy, nutrition and weight management play a key role in reducing gestational diabetes risk. Data from the Centers for Disease Control and Prevention show that in 2000, approximately 30% of U.S. adults had obesity. In 2018, the number jumped to 42%, including 40% of people age 20 to 39. The increase in gestational diabetes cases is, in part, a symptom of our country’s overarching obesity epidemic.
During pregnancy, follow a diabetes-friendly eating plan that emphasizes protein and avoids carbohydrates and sugar. Eating three small to moderate-sized meals and two to four healthy snacks per day can help stave off cravings and keep you feeling full.
Women who follow this regimen generally experience a drop in their blood sugar levels and, ultimately, healthy deliveries. You don’t have to make separate meals for yourself – encourage your whole family to start eating healthier.
Diet Tips
Blood sugar control during pregnancy is important for your health and the health of your baby. The following tips will help you control your blood sugar levels during pregnancy. Carbohydrates in food turn into sugar (also called glucose) when digested. Glucose is important for you and your baby, but too much glucose in your blood can lead to problems. It is important to eat the right amount of carbohydrate and to choose healthy foods. Carbohydrates are found in starches, fruits, vegetables, milk and yogurt so these food portions should be measured. Sweets and desserts should be avoided as they may lead to high blood sugar levels.
1. Eat 3 meals and 2–3 snacks per day
Eating too much at one time can cause your blood sugar to go too high. Eat smaller meals and have snacks. You have increased nutritional needs during your pregnancy, and your baby is counting on you to provide balanced nutrition.
2. Measure your servings of starchy foods
Include a starch choice at every meal. A reasonable serving size is about 1 cup of cooked rice, grain, noodles or potatoes, or 2 pieces of bread, per meal.
3. One 8-ounce cup of milk at a time
Milk is a healthy food and it is an important source of calcium. Because it is a liquid, milk sugar is absorbed quickly. Having too much milk at one time can lead to high blood sugar. It is best to limit milk to one cup at a time.
4. One small portion of fruit at a time
Fruits are nutritious, but because they have natural sugars, eat only one serving at a time. A serving of fruit is one small piece of fruit, or ½ large fruit, or about 1 cup of mixed fruit. Avoid fruit that has been canned in syrup. Do not drink fruit juice.
5. Eat more fiber
Try whole grain bread, brown rice, wild rice, whole oats, barley, millet or any other whole grains. Include split peas, lentils and any type of bean: pinto, red, black, or garbanzo. These foods are high in fiber and help to keep your blood sugar levels lower than when you eat refined grains such as white bread and white rice.
6. Breakfast Matters
Blood sugar can be difficult to control in the morning because that is when pregnancy hormones are very strong. These hormones can cause your blood sugar levels to rise even before you eat.
Dry cereals, fruits, and milk are not the best choices for breakfast because they are digested very quickly and can cause blood sugar levels to rise quickly.
A breakfast of whole grains plus a protein food is usually best.
7. Avoid fruit juice and sugary drinks
It takes several pieces of fruit to make a glass of juice. Juice is high in natural sugar. Because it is liquid, it raises blood sugar levels quickly. Avoid regular sodas and sugary soft drinks for the same reason. You may use diet drinks and Crystal Light.
8. Strictly limit sweets and desserts
Cakes, cookies, candies, and pastries are high in sugar and are likely to raise blood sugar levels too much. These foods often contain a lot of fat and offer very little nutrition.
9. Stay away from sugars
Do not add any sugar, honey, or syrup to your foods.
10. These artificial sweeteners are safe in pregnancy
- Aspartame; Equal, NutraSweet, NatraTaste
- Acesulfame K; Sunett
- Sucralose; Splenda
- Stevia; Truvia, Purevia
11. Look out for sugar-alcohols in sugar-free foods
Sugar alcohol is often used to make sugar-free desserts and syrups. These products can be labeled "sugar free" but may contain the same amount of carbohydrate as the versions made with regular sugar. Look at food labels to see the grams of total carbohydrate.
Sugar alcohols may have a laxative effect, or cause gas and bloating. The following are examples of sugar-alcohols: mannitol, maltitol, sorbitol, xylitol, isomalt, and hydrogenated starch hydrolysate.