Managing Gestational Diabetes: Diet, Exercise, and Monitoring

Gestational diabetes mellitus (GDM) is a common pregnancy complication that affects up to 14% of pregnancies worldwide1. It occurs when the body cannot produce enough insulin to meet the extra needs of pregnancy, leading to high blood sugar levels. If left uncontrolled, GDM can lead to serious health risks for both mother and baby. However, with proper management through diet, exercise, and monitoring, these risks can be significantly reduced.

Understanding Gestational Diabetes

Gestational diabetes typically develops in the second or third trimester of pregnancy and usually disappears after giving birth. Risk factors include being overweight or obese, having a family history of diabetes, and previously giving birth to a baby weighing more than 4.5 kg2. Symptoms are often mild or absent, so routine screening is important. This involves an oral glucose tolerance test between 24 to 28 weeks of pregnancy3.

Dietary Management

The first line of treatment for GDM is dietary modification. The goal is to control blood sugar levels while providing adequate nutrition for the growing baby. Key dietary principles include45:

• Eating regular meals and snacks, and avoiding skipping meals

• Choosing complex carbohydrates that are high in fibre and have a low glycaemic index (GI), such as wholegrains, legumes, and vegetables

• Limiting sugary foods and drinks, as well as highly processed and refined carbohydrates

• Including lean proteins such as fish, poultry, eggs, and plant-based proteins

• Incorporating healthy fats from nuts, seeds, avocado, and olive oil

• Staying hydrated with water and avoiding sugary drinks

A registered dietitian can provide individualised advice based on pre-pregnancy weight, weight gain goals, blood sugar levels, and food preferences6. They may recommend keeping a food diary and using the plate method (filling half the plate with non-starchy vegetables, a quarter with lean protein, and a quarter with complex carbs)7.

Physical Activity

Regular physical activity is another important aspect of managing GDM. Exercise helps to lower blood sugar levels by increasing insulin sensitivity and glucose uptake in the muscles8. It also provides many other benefits during pregnancy, such as reducing back pain, constipation, and swelling9.

The current recommendations are to aim for at least 150 minutes per week of moderate-intensity aerobic activity, spread out over at least 3 days10. This could include brisk walking, swimming, stationary cycling, or prenatal yoga. Resistance training is also beneficial for maintaining muscle mass and strength. Pregnant women should consult with their healthcare provider before starting an exercise program and avoid activities with a high risk of falling or abdominal trauma11.

Some tips for staying active with GDM include12:

• Finding an enjoyable activity that fits your lifestyle and schedule

• Starting slowly and gradually increasing duration and intensity

• Exercising at a conversational pace and taking breaks as needed

• Staying hydrated and having a snack if needed to prevent low blood sugar

• Listening to your body and stopping if you feel unwell

Blood Sugar Monitoring

Self-monitoring of blood glucose (SMBG) is an essential part of GDM management. This involves using a small device to check blood sugar levels by pricking the finger for a drop of blood. The recommended target ranges are13:

• Fasting: Below 5.3 mmol/L

• 1 hour after meals: Below 7.8 mmol/L

• 2 hours after meals: Below 6.7 mmol/L

Pregnant women with GDM are usually advised to check their levels 4 times per day - once upon waking, and 1 or 2 hours after each meal14. They should record their readings in a logbook or app and review them with their healthcare team regularly. Some women may also be offered continuous glucose monitoring (CGM) for a more detailed picture of their glucose patterns15.

If blood sugar levels remain high despite lifestyle changes, medication may be needed. This is typically insulin injections, as they are safe and effective during pregnancy16. Oral medications like metformin and glyburide may sometimes be used under close supervision17. The dosage will be adjusted based on SMBG readings to maintain target levels.

Preparing for Delivery and Beyond

As the pregnancy progresses, additional monitoring will be recommended to ensure the baby's wellbeing. This includes regular growth scans to check for excessive growth (macrosomia), and monitoring of amniotic fluid levels and fetal movements18. The timing and mode of delivery will be planned based on these factors, with most women aiming to deliver around 38-40 weeks unless there are complications19.

After delivery, GDM usually resolves as hormone levels return to normal. However, an oral glucose tolerance test is recommended at 6-12 weeks postpartum to check for persistent diabetes20. Women with a history of GDM have a 50% risk of developing type 2 diabetes within 5-10 years, so annual screening is advised.

Breastfeeding can help to lower this risk, as well as providing many other benefits for mother and baby. Continuing with a healthy lifestyle through balanced nutrition, regular exercise, and weight management is also crucial. This not only reduces the chances of future diabetes, but sets a positive example for the growing child.

Conclusion

Gestational diabetes can be a challenging condition to navigate during pregnancy. However, with a proactive approach to diet, exercise, and monitoring, it is possible to control blood sugar levels and minimise complications. Women with GDM will need close follow-up and support from their healthcare team, including an obstetrician, endocrinologist, diabetes educator, and dietitian. By working together and staying committed to a healthy lifestyle, they can ensure the best possible outcomes for themselves and their babies.

Sources:

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20

Stay updated with the latest discoveries and recommendations in the health domain! Subscribe to our Instagram, TikTok, and YouTube channels, and join us on Facebook to get the latest updates on health trends and breakthroughs.