I usually don’t do this, but let me start this article with a disclaimer – I get it. I have two young children and I understand the complex emotional scene of pregnancy – anxiety, stress, excitement, and EVERYONE TELLING YOU WHAT TO DO ALLTHETIME.
As a side note, did you know that the microbiome of a pregnant woman actually shifts toward a different composition of bacterial species? This altered microbiome, via the gut-brain connection, increases anxiety. There is actually an evolutionary reason for this – anxiety causes the pregnant woman to plan and prepare a safe environment for her coming baby. At least now I have an explanation for the hours I spent prepping onesies and agonizing over baby swing decisions.
So, my point is this – I don’t intend any bossy or judgmental messages here. Pregnancy comes with enough of that already. The reason why I want to write this article is that I find the current advice given to women with gestational diabetes to be incredibly poor.
First of all, if you have been diagnosed with gestational diabetes (GD), it is extremely important to meet with your healthcare provider – they may require self-monitoring of blood glucose (SMBG). This is the gold standard for monitoring gestational diabetes – not Hemoglobin A1c (HbA1c), as is used with type II diabetes. In some cases, insulin is needed. Keep in mind that this article is not intended to be used as treatment for gestational diabetes.**
When you meet with your healthcare provider, you may also hear about the risks associated with gestational diabetes. Some of these include (for mom) increased risk of preterm delivery, preeclampsia, cesarean section and future development of type II diabetes. For baby, the risks include macrosomia (large for gestation), low blood sugar at birth, and respiratory distress syndrome. Babies born to mothers with gestational diabetes are more likely to later become overweight or obese and to develop type II diabetes. Fortunately, managing gestational diabetes during pregnancy IS possible and greatly reduces many of these risk factors.
Ok, Let’s Mange it! How?
First of all, there are three major ways that GD can be improved: exercise, normal weight gain, and diet.
- Exercise: as for exercise, discuss with your healthcare professional what is appropriate for you. In most cases, pregnant women can and should exercise. As a general rule, most women can continue exercise that they used to perform as long as they feel comfortable doing so, and as long as it’s not high impact and/or increases risk of falling. Yes, some women run and CrossFit through their pregnancies but you don’t have to. Just walking or swimming is great if that’s what you can do. Again, talk to your healthcare professional and make a plan. In addition to the normal health benefits that exercise provides, it will improve your blood glucose control.
- Normal Weight Gain: don’t roll your eyes at me! I’ve experienced the bi-weekly weigh-ins and comparisons to weight gain charts. It’s not fun, I know. It is true, though, that staying within the recommended amount of weight gain does improve GD management.
However, for most women, these guidelines are extremely frustrating. Women often don’t feel like they have the ability to control how much they gain. The reason for this is that women are told to gain X amount of weight, but not taught a dietary approach that will help them achieve that. As a society, we say out of one side of our mouth that women should gain, say 25 pounds total. Out of the other side of our mouth we say that she should eat whatever she wants, or that she should eat a low-fat, high-carbohydrate diet. It’s a plan doomed to fail.
So yes, it’s best if you gain the recommended amount of weight, but don’t focus on that – focus on eating a nutrient-rich diet and the weight gain will take care of itself.
- Diet: here is where you will find a dramatic difference between an ancestral or nutrient-rich approach and conventional wisdom. I’m sorry, but I might get a little heated here. While preparing for this article I looked up the recommendations for GD from the professional dietetics organizations of the United States, United Kingdom, and Australia. Their suggestions? Low fat. Avoid dietary cholesterol and saturated fat. Whole grain bread at nearly every meal.* Artificial sweeteners (any besides saccharin). Low-fat yogurt and milk. Canola and soybean oil. Margarine. *steam comes out of ears*
Please don’t do that. Follow an ancestral diet. Sticking to ancestral foods may take care of your GD on its own. If not, I’ll describe a more detailed approach below. In general, stick to meat, seafood, poultry, fruit, vegetables (starchy and non-starchy), nuts, seeds, herbs, spices, and healthy fats. If you tolerate dairy, eat full-fat, organic dairy. If you aren’t able to hit your carbohydrate goals with fruit and starchy carbs, add some white rice.
As for meal break-down, make sure to eat 3 meal and 2-3 snacks each day. Get some protein and/or fat with every meal and snack!
* Have you noticed that traditional gestational diabetes meal plans include bread at every meal? I also noticed this with dismay during my dietetic internship. While working in the mother and baby ward, I noticed that pregnant women with GD were constantly being served bread. Wonder why? Bread has around 15 grams of carbs per slice. Makes carb counting pretty easy, right? I’m not sure if this shortcut is intended to make the nutritionists’ life easier or the pregnant woman’s. Either way, it’s a major fail. I believe that you’re smart enough to count carb grams without simply eating one piece of bread at snack or two pieces at a meal.
I Need More Specifics!
According to the American Diabetes Association, all women with GD should receive nutritional counseling from a Registered Dietitian. I really recommend that you do this if at all possible. Dietitians are the only healthcare professionals trained to calculate your individual nutrition needs during pregnancy. They may not make ancestral, whole-foods dietary recommendations but at least you can get from them a specific target for your nutrient goals. As a minimum, find out your requirements for calories and protein.
This is important because simply eating ‘low-glycemic’ foods is not an evidence-based approach to managing GD. Only actual carbohydrate counting has been shown to improve outcomes. You can’t count your carbohydrate intake unless you know what it should be.
No dietitian? One simplistic way of calculating caloric needs is 30-35 kcal/day per kg body weight (note: this equation is only valid if you started your pregnancy with a BMI less than 25; again, see a professional).
- Of this calorie goal, around 20% should come from protein. Pregnant women need at least 71 grams per day.
- As for carbohydrates, the generally-accepted minimum carbohydrate intake for pregnancy is 175 grams/day. A good place to start is 40% of calories from whole-foods sources (not processed, refined flours or sugar).
- Then, the rest comes from healthy, ancestral fats (i.e. olive oil, coconut oil, ghee, lard, eggs, nuts/seeds).
As a general rule, your carbohydrate intake should be lowest in the morning, then can be higher at other meals (insulin sensitivity is poorest in the morning). You should be eating three meals and 2-3 snacks per day. It is important to minimize overnight fasting time, so make sure to get an evening snack!
Let’s Do an Example….
Let’s see how this shakes out in real life – I’ll use myself as an example:
Let’s say I had my GD test (oral glucose tolerance test, or alternate option) at 26 weeks and it was positive. At this point in my pregnancy, I’m usually around 140 pounds or 63.6kg. Let’s say I started my pregnancy at a healthy BMI between 18.5 and 25. So, my calorie needs would be between 30*63.6 and 35*63.6. That comes out to 1908 – 2226 calories. So, I’d shoot to eat 1950-2200 calories.
For protein needs, I want 20% so that comes to 0.2*1950 – 0.2*2200 calories = 390-440 calories. There are 4 kcal/gram protein so that comes to 98-110 grams protein/day. This is over 71 grams so I'm good here.
For carbohydrate, let’s start with 40%. That comes to 0.4*1950 – 0.4*2200 = 780 – 880kcal/day from carbohydrate. Carbs have 4kcal/gram so that comes to 195 -220 grams carbohydrate/day. That checks out with the minimum of 175 grams per day so I’m good to start there. If I don’t manage my blood glucose well with this plan, I could drop down closer to the 175 grams.
I recommend breaking out your carbs into three meals and three snacks, and tracking your carbs each time. Remember to eat less carbs in the morning. So, in my example, it would look something like:
- Breakfast: 15 grams
- Snack: 30 grams
- Lunch: 45 grams
- Snack: 30 grams
- Dinner: 45 grams
- Snack: 30 grams
- TOTAL: 195 grams
The rest comes from protein and fat. Remember to get protein and/or fat with each meal and snack! To monitor your intake, I recommend making a free account with MyFitnessPal. You can set your calorie, protein, and carbohydrate goals. Try each day to stay within (but not much below) your calorie goal, and to meet your protein and carbohydrate requirements. If you meet all of that, you are meeting your fat goal (since you can't drink alcohol, agh! The joys of motherhood). Your healthcare provider should be monitoring your weight gain, so use those checks to update your calorie goal as needed.
Meal Plan Example
The specific way that you meet your requirements using an ancestral diet will likely vary, depending on your tastes, cravings, access to ingredients, etc. If you do tolerate dairy, I actually recommend including it. The best choice is organic, full-fat, and from A2 milk if possible. Have a source for grass-fed? Great. I’m not against raw milk overall, but during pregnancy I don’t recommend it. Your immune system is naturally suppressed during pregnancy, so the risk is higher.
So, here’s how a day of eating this way might look:
- Breakfast: eggs with avocado and some berries
- Snack: organic, full-fat yogurt with live cultures
- Lunch: leftover chicken curry on cauliflower rice (make with bone broth if possible). An apple with almond butter.
- Snack: liver pate on some raw veggies. Some live kimchi or sauerkraut. A peach.
- Dinner: Grass-fed steak with sweet potato fries and steamed broccoli or zucchini. Orange slices.
- Snack: Mango pieces with coconut milk and/or flakes
Again, your insulin sensitivity may improve just by changing to a nutrient-dense diet like this. If not, though, you may need to combine the diet with carbohydrate counting to get within recommended blood glucose ranges.
If you are struggling with gestational diabetes, I truly wish you success with improving your blood glucose, and a healthy, happy pregnancy. If you found this article to be helpful, please feel free to post comments or share it using the social links below.
**Note: Please keep in mind that this article is intended for general information purposes, and is NOT intended to be used as medical treatment of gestational diabetes. If you have been diagnosed with GD, I strongly recommend that you work with a healthcare provider to create an individualized treatment plan.
- Edelstein, S. and Sharlin, J. (2014) Life cycle nutrition. Sudbury, MA: Jones and Bartlett.
- Escott-Stump, S. (2012) Nutrition and diagnosis-related care. 7th edn. Baltimore, MD: Lippincott Williams & Wilkins.
- Nelms, M., Sucher, K.P., Lacey, K. and Roth, S.L. (2011) Nutrition Therapy and Pathophysiology. 2nd edn. Cengage Learning.