Despite starting your pregnancy on a healthy note, unexpected challenges can arise, including heightened blood sugar levels. In gestational diabetes, the mother's body struggles with insulin production, resulting in elevated blood glucose levels and potential complications. Management of gestational diabetes often involves adopting a healthy diet and incorporating regular exercise. In some cases, insulin may be necessary for pregnant women with this condition.

 

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We spoke to Dr. Anuradha Panda, MBBS, MD - Obstetrics & Gynaecology, DGO Obstetrician, Apollo Hospitals and Apollo Cradle in Jubilee Hills, Hyderabad about potential risks associated with gestational diabetes. Dr. Anuradha says, “Gestational diabetes, a form of diabetes occurring in pregnant women with no prior history of the condition, can affect some women in more than one pregnancy. Typically, it manifests around the middle of pregnancy, with doctors commonly screening for it between the 24th and 28th week of gestation. Gestational diabetes can lead to various complications for both the mother and the baby.”

 

She also warns that women who have had gestational diabetes are at an increased risk of developing type 2 diabetes later in life.

 

Complications With Gestational Diabetes

Some of the potential complications include:

Large baby

Babies of mothers with gestational diabetes may grow larger than normal (macrosomia), usually more than 4 kg. Diabetes can result in elevated blood sugar levels in the baby, effectively 'overfeeding' them and causing excessive growth. This can not only lead to discomfort for the expectant mother in the later stages of pregnancy but also poses potential complications during childbirth for both mother and baby. In some cases, a C-Section may be required for delivery, and the baby may experience nerve damage from the pressure exerted on the shoulder during birth.

 

Low blood sugar (Hypoglycemia)

Typically, the target range for fasting blood sugar levels is between 70 and 95 milligrams per deciliter (mg/dL). Post-meal blood sugar levels are usually recommended to be less than 120 mg/dL. If a woman has high blood sugar levels during pregnancy, her newborn is at higher risk of rapidly developing low blood sugar after birth. Thus, it becomes essential to closely monitor the baby's blood sugar for several hours following delivery to ensure their well-being.

 

Jaundice

Elevated bilirubin levels can lead to jaundice in newborns of mothers with gestational diabetes through a process known as hyperbilirubinemia. Bilirubin is a yellow pigment that forms when red blood cells break down. It is normally processed by the liver and excreted from the body. In newborns, the immature liver may not be able to efficiently process bilirubin, leading to an accumulation in the bloodstream. When bilirubin levels become too high, it can cause jaundice, a condition characterised by yellowing of the skin and eyes.

 

Pre-eclampsia

Women with gestational diabetes have a higher risk of developing pre-eclampsia, a condition characterised by high blood pressure and damage to organs such as the liver and kidneys. The exact cause of pre-eclampsia is not fully understood, but there are several reasons why women with gestational diabetes may be at an increased risk such as obesity, inflammation, insulin resistance, and a family history of diabetes or hypertension.

 

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Significance of Insulin Regimen During Pregnancy

The frequency of changing diabetes medications or insulin regimens during pregnancy for individuals with diabetes can vary significantly and is highly dependent on individual circumstances. It is essential for pregnant women with diabetes to work closely with their healthcare providers to determine the most appropriate treatment plan. 

 

“The type of diabetes (type 1, type 2, or gestational diabetes) and its severity can impact the choice of medications and insulin regimens. In the case of gestational diabetes, management may involve dietary changes and exercise, but some women may require insulin to control blood sugar. The treatment plan may need to be adjusted as pregnancy progresses”, says Dr. Anuradha.

 

Further she adds, “If blood sugar levels are consistently too high or too low, adjustments to medications or insulin may be necessary.”

 

Weight gain during pregnancy can affect insulin sensitivity. If significant weight gain occurs, medication or insulin doses may need to be adjusted. If the baby is growing excessively large (macrosomia) due to poor blood sugar control, healthcare providers may adjust the treatment plan to address this issue.

 

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Screening of Gestational Diabetes

Since, there are no apparent symptoms of diabetes. Most women don't know they have it until they get tested. It is advised that pregnant women get the Glucose Challenge Test (GCT) and glucose tolerance test (GTT) to know if they have gestational diabetes. This is typically performed between 24 and 28 weeks of pregnancy.

 

During the examination, you will consume a glucose beverage, and your blood sugar levels will be assessed two hours afterward. In the event of elevated blood sugar levels during this test, a three-hour glucose tolerance test will be administered. If the results of the subsequent test are not within the expected range, a diagnosis of gestational diabetes will be made.

 

Role of Nutrition in Gestational Diabetes

Every pregnancy is unique. There is no one-diet plan-fits-all approach, some women may need to adjust their diabetes medications during pregnancy as hormonal changes affect glucose levels. Pregnant women with gestational diabetes should primarily aim to meet their nutritional needs through a well-balanced diet.

 

We approached Hyderabad-based nutritionist Dr. Lakshmi Kilaru, PhD-Food Science and Nutrition (University of Georgia), Head Holistic Nutritionist, UrLife  and discussed the importance of maintaining a balanced and nutritious diet during pregnancy. Dr. Lakshmi recommends focusing on whole, unprocessed foods, including lean proteins, fibre-rich vegetables, whole grains, and healthy fats. Eating smaller, more frequent meals can help stabilise blood sugar levels.

 

However, in some cases, healthcare providers may recommend specific nutritional supplements or vitamins to help manage gestational diabetes and ensure both the mother's and baby's health. Folic acid, iron, calcium, and other vitamins and minerals support the development of the baby.  Additionally, vitamin D is essential for calcium absorption and bone health and iron supplements, as iron deficiency is common during pregnancy. Omega-3 fatty acids, particularly DHA, are important for foetal brain and eye development.  A vegan or vegetarian individual may require vitamin B12 supplements.

 

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Tips For A Diabetes-Friendly Pregnancy

1. Manage cravings during gestational pregnancy

Dr. Lakshmi advises, “Managing food cravings while dealing with gestational diabetes can be challenging, but it's important to do so to keep blood sugar levels in check for both your health and the baby's.”

 

Here are some strategies to accommodate food cravings while still maintaining a healthy diet:

• Look for healthier alternatives that satisfy your cravings without causing significant blood sugar spikes. For example, if you're craving something sweet, opt for fresh fruit or sugar-free options. If you're craving something salty, choose unsalted nuts or whole-grain crackers.
• Moderation is key. Eating smaller, more frequent meals and snacks can help manage cravings and stabilise blood sugar levels. This prevents extreme hunger, which can lead to poor food choices.
• Foods high in fibre can help stabilise blood sugar levels. Incorporate more whole grains, vegetables, and legumes into your meals to help control cravings and hunger. Including protein in your meals can help control blood sugar and keep you feeling satisfied. Lean sources of protein, such as poultry, fish, tofu, or legumes, can be excellent choices.
• Pay attention to your cravings and try to understand if they are driven by true hunger or other factors like stress or emotions. Mindful eating can help you make more conscious food choices.

 

2. Avoid these foods

To help manage blood sugar levels, it's important to avoid or limit foods that can cause rapid spikes in blood sugar. This is especially critical for individuals with diabetes, including those with gestational diabetes. Here are some foods to avoid or limit:

• Sugary foods such as candies, pastries, cakes, cookies, and sugary beverages like soda and fruit juices should be avoided.
• Processed carbohydrates such as white bread, white rice, and most breakfast cereals, can quickly elevate blood sugar. 
• Limit saturated and trans fats, found in fried foods and many processed snacks.
• Some sauces and condiments, such as ketchup, barbecue sauce, and sweet salad dressings, can contain hidden sugars. 
• Regular soda and sugary drinks are among the worst culprits for causing blood sugar spikes.
• Alcohol can cause fluctuations in blood sugar levels and should be consumed in moderation or avoided, especially if you are on medication that affects blood sugar.

 

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3. Regulate your diet

Managing gestational diabetes through diet is essential for the health of both the mother and the baby. A well-balanced diet can help regulate blood sugar levels and minimise the need for medication. Here are key dietary principles for managing gestational diabetes:

• Choose complex carbohydrates. Opt for whole grains, legumes, and vegetables over refined grains and sugary foods. These complex carbohydrates are absorbed more slowly, leading to steadier blood sugar levels.
• Aim for balanced meals that include a source of lean protein, healthy fats, and plenty of non-starchy vegetables in addition to carbohydrates. Include lean proteins like poultry, fish, tofu, and legumes in your meals. 
• Incorporate high-fibre foods like whole grains, vegetables, fruits, and legumes into your meals. Fibre can slow down the absorption of sugar and help regulate blood sugar levels.
• Include sources of healthy fats, such as avocados, nuts, seeds, and olive oil, in your diet.
• Do regular physical activity into your routine. Exercise can help improve insulin sensitivity and regulate blood sugar.

 

4. A diabetes-friendly pregnancy meal plan

Dr. Lakshmi provided nutritional meal plans during pregnancy with gestational diabetes.

• Breakfast: Scrambled eggs with spinach and tomatoes Whole-grain toast, herbal tea. 
• Morning: Cottage cheese (paneer) (approx. 50gm) with green chutney with an apple
• Lunch: 2 medium-sized ragi rotis, 1 bowl of dal with fenugreek (methi) leaves and 1 large bowl of stir-fried okra (bhindi).
• Afternoon Snack: A glass of watermelon juice with chia seeds and fistful of nuts 
• Dinner: 2 whole moong pancakes with grated carrots or quinoa Upma with carrots, peas and spinach.
• Bedtime: Buttermilk with flaxseed powder.

 

Caution: If you have other disease indications, contact your gynaecologist or nutritionist before starting any diet. 

 

Remember that each person's experience with gestational diabetes is unique, and it's important to work with your healthcare team to develop a dietary plan that meets your specific needs and preferences. In most cases, a well-balanced diet that meets your nutritional needs should provide the necessary vitamins and minerals for a healthy pregnancy. 

 

Consult with your healthcare provider and a registered dietitian to create a personalised nutrition plan that can help you manage gestational diabetes effectively.

 

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