Managing gestational diabetes

Gestational diabetes is diagnosed during pregnancy when your body cannot cope with the extra demand for insulin production resulting in high blood glucose levels. Gestational diabetes is managed by monitoring blood glucose levels, adopting a healthy eating plan and performing regular physical activity. Effective management of gestational diabetes will reduce the risk of complications during pregnancy and the birth of your baby.

Your healthcare team including your doctor, specialist, dietician and Credential Diabetes Educator, can help you with blood glucose monitoring, healthy eating and physical activity.

There are three basic components in effectively managing gestational diabetes:

  • monitoring blood glucose levels
  • adopting a healthy eating pattern
  • physical activity.

Gestational diabetes can often initially be managed with healthy eating and regular physical activity. However, for some women with gestational diabetes, insulin injections will be necessary for the rest of the pregnancy. Approximately 10 – 20% of women will need insulin; however, once the baby is born insulin is no longer needed. This is safe for both you and your baby.

After the baby is born, gestational diabetes usually disappears. A special blood glucose test (Oral Glucose Tolerance Test) (OGTT) is performed six weeks after delivery to ensure that blood glucose levels have returned to normal. However, women who have had gestational diabetes have an increased risk of developing type 2 diabetes later in life and should be tested for diabetes at least every 2 – 3 years.

Can gestational diabetes affect my baby?

If gestational diabetes is not well looked after (blood glucose levels remain high) it may result in problems such as a large baby, miscarriage and stillbirth. A large baby can create the risk of injury at delivery, caesarean delivery, forceps delivery and a need for the baby to be looked after in special care until the glucose level stabilises after delivery. Other complications may include pregnancy loss and premature delivery. If any problems occur, the hospital will care for you and your baby.

Monitoring blood glucose levels while pregnant

It is important that women monitor their blood glucose levels at home through daily blood tests to check that management of diabetes has the expected effect of normalising your blood glucose levels. Your Credentialled Diabetes Educator can show you how and help you understand your blood glucose patterns. This is to ensure appropriate treatment can be administered and changed as necessary.

Your doctor or Credentialled Diabetes Educator will tell you what blood glucose levels to aim for. Blood glucose level targets are between 4 to 6 mmol/L (fasting).

If healthy eating and physical activity cannot control gestational diabetes, insulin injections will be necessary for the rest of the pregnancy. Blood glucose lowering tablets are generally not used in pregnancy.

Learn more about Blood Glucose Monitoring.

Eating well with gestational diabetes

An important part of managing gestational diabetes relates to diet. Following a healthy eating plan will assist in:

  • Managing blood glucose levels within the target range advised by your doctor
  • Providing adequate nutrition for you and your growing baby
  • Achieving appropriate weight changes during your pregnancy.

It is advisable to see an Accredited Practising Dietitian to work out a meal plan that is appropriate for mum and the growing baby.

Guide for healthy eating during pregnancy

Women with gestational diabetes are encouraged to:

  • Eat small amounts often and maintain a healthy weight
  • Include some carbohydrate in every meal and snack (e.g. Multigrain bread, bulgur, pasta, potato, lentils, chickpeas, beans)
  • Choose foods that are varied and enjoyable that provide the nutrients you especially need during pregnancy. This means foods which include: calcium (e.g. Milk and cheese), iron (e.g. Red meat, chicken and fish), folic acid (e.g. Dark green leafy vegetables lightly cooked, low in fat, particularly saturated fat(e.g. use oils such as canola, olive and polyunsaturated oils and margarines and use lean meats such as skinless chicken and low fat dairy foods)
  • High in fibre
  • Avoid foods and drinks containing large amounts of sugar
  • Choose Basmati or Doongara rices – they have a lower glycaemic index and will help you to stay fuller for longer.
  • See a dietitian who can provide expert advice on the proper nutrients for you and your baby, as well as helping you make healthy food choices.

Carbohydrates

Carbohydrate foods are broken down into glucose and used for energy. To help manage your blood glucose levels, it is important to spread your carbohydrate foods over three small meals and 2-3 snacks each day. Foods that contain carbohydrate include:

  • Multigrain breads and breakfast cereals
  • Pasta, rice (preferably Basmati or Doongara) and noodles
  • Potato (in moderation), sweet potato and corn
  • Legumes such as baked beans, red kidney beans and lentils
  • Fruits
  • Milks and yoghurts

Carbohydrate foods that contain little nutritional value include sucrose (table sugar), soft drinks, cordials, fruit juices, lollies, cakes and biscuits.

In some instances, you may be eating the right amount (and type) of carbohydrate foods for your body, but still have high blood glucose levels. If this happens, it is important to talk to your doctor or Credentialled Diabetes Educator.

Fat

Try to limit the amount of fat you eat, particularly saturated fat. Use healthy fats like canola, olive and polyunsaturated oils and margarines, avocados and unsalted nuts. To limit your saturated fat intake, select lean meats, skinless chicken and low-fat dairy foods and avoid takeaway and processed foods.

Protein

Include two small serves of protein each day as protein is important for the growth of the baby and maintenance of healthy mum. Protein foods include lean meat, skinless chicken, fish, eggs and reduced fat cheese. These foods do not directly affect your blood glucose levels. Milk, yoghurts, custards and legumes (beans, lentils, and chickpeas) are also important sources of protein. However, remember that they also contain carbohydrate.

Calcium & iron

Calcium and iron requirements increase during pregnancy. Try to include 2-3 serves of low fat calcium rich foods each day (1 serve = 250 ml milk, 200 g of yoghurt or 2 slices of cheese). The iron from red meat, chicken and fish is readily absorbed. However, if you are a vegetarian or do not eat these foods regularly, an iron supplement or pregnancy multivitamin may be required. Discuss this with your doctor or dietician.

Other dietary considerations

Nutritious foods that will not cause excess weight gain or cause your blood glucose levels to go up can be eaten freely. These foods include fruits such as strawberries, passionfruit, lemons and limes and all vegetables (except potato, corn, sweet potato, taro, beans, lentils and chickpeas). Try to include at least 2 cups of vegetables each day.

Drinks

The best drink for your body is water, plain mineral water and soda water – try it with fresh lemon or lime for something different. ‘Diet’ or sugar-free drinks are suitable for people with diabetes.

However carbonated and caffeinated varieties can increase the risk of osteoporosis and may affect mood so should be consumed in moderation by everyone.

Alternative sweeteners

The use of intense sweeteners by people with diabetes is preferable to use of natural sugars.

Keeping active with gestational diabetes

For women with gestational diabetes, moderate intensity physical activity can help to manage blood glucose levels. ‘Moderate’ means a slight but noticeable increase in breathing and heart rate. If there are no specific obstetric or medical conditions, you should be able to safely exercise during pregnancy.

However, it is best to discuss this with your obstetrician or midwife prior to commencing any exercise regime in pregnancy.

Benefits of keeping active

Physical activity helps to reduce insulin resistance. Regular exercise, like walking, helps to increase fitness and prepares you for the birth of your baby. Physical activity also helps to keep your blood glucose levels under control.

Remember, before starting or continuing any form of physical activity, always check with your obstetrician or midwife.

It’s never too late to start moving, and there are many ways that you can keep active as a part of your everyday routine. Basically, anything that gets you moving is generally good for your diabetes and will also improve your overall feeling of wellbeing. For example, walking is a great way to move.

How to walk more each day

Below are some tips on how you can incorporate more walking into your life. It is important never to exert yourself.

  • Walking to the local shops instead of driving.
  • Start a ‘walking group’ with family or friends - perhaps meet at a regular time and day. This will help make sure you’re committed and help you stay in touch with your loved ones.
  • Take the stairs instead of the elevator.
  • Stand and move while on the phone.
  • Garden.
  • Buy a ‘pedometer’ (or a ‘step counter’), a small device you can clip to yourself that counts your daily steps. This will help you measure just how much walking you’re doing.

After pregnancy

After the baby is born, gestational diabetes usually disappears. A special blood glucose test (Oral Glucose Tolerance Test) (OGTT) is performed six weeks after delivery to ensure that blood glucose levels have returned to normal. However, women who have had gestational diabetes have an increased risk of developing type 2 diabetes later in life and should be tested for diabetes at least every 2 – 3 years.

It is recommended that you check for diabetes:

  • At least every 2 to 3 years
  • Before planning a pregnancy
  • If you’re feeling unwell

Reducing the risk of developing type 2 diabetes

While maternal blood glucose levels usually return to normal after birth, there is an increased risk for the mother developing type 2 diabetes in the future. To reduce your risk or delay the development of type 2 diabetes, keep in mind the following important points:

  • Maintain or achieve a healthy weight. Balancing food intake with activity levels is the best way to maintain or reduce any excess body weight.
  • Eat healthily. Limit saturated fat. Choose lean meat, skinless chicken and low fat dairy foods. Limit processed and fried foods. Eat plenty of vegetables, legumes, fruits, wholegrain breads and cereals.
  • Be physically active. Aim to include at least 30 minutes of moderate intensity physical activity on most days. You should discuss your physical activity plans with your doctor prior to starting any exercise regime.
  • Check blood glucose levels. It is important to have your blood glucose tested every 1-2 years. Discuss this with your doctor.

Can I breastfeed if I have gestational diabetes?

Breastfeeding is recommended for all women, including women with gestational diabetes. Breastfeeding provides the best start for your baby and can help you to return to your pre-pregnancy weight.

National Gestational Diabetes Register

The National Gestational Diabetes Register was established within the National Diabetes Services Scheme (NDSS) to help women who have had gestational diabetes to manage their health into the future. Women who have had gestational diabetes have a higher risk of developing type 2 diabetes later in life.

If you register on the National Gestational Diabetes Register, you and your doctor will be sent regular reminders to have diabetes checks. You will also receive information for you and your family to help you continue a healthy lifestyle.

Registration is free. Women who have been diagnosed with gestational diabetes, reside in Australia and hold, or are eligible to hold, an Australian Medicare Card are entitled to register.

Resources

The NDSS has a dedicated webpage for gestational diabetes. The webpage includes information, resources and support about gestational diabetes and information about the gestational diabetes register.

Visit the Gestational Diabetes NDSS website

Gestational Diabetes - Caring for yourself and your baby

The NDSS has developed a booklet for women with gestational diabetes which provides comprehensive information about gestational diabetes, its management and where to get assistance.

This booklet is also available to download in five other languages – Arabic, Turkish, Vietnamese and traditional and simplified Chinese.

Read the Gestational Diabetes- Caring for yourself and you baby booklet

Visit the NDSS website to access booklet in other languages.

Life After Gestational Diabetes Booklet

This booklet is sent to every woman diagnosed with gestational diabetes and is registered with the NDSS. It is designed to assist women who have had gestational diabetes, and their families to understand how to take steps to reduce their risk of developing type 2 diabetes.

Australasian Diabetes in Pregnancy Society

The Australasian Diabetes in Pregnancy Society is a professional body established to advance clinical and scientific knowledge of diabetes in pregnancy

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