Interview has been edited for clarity.
“In all countries, pregnant people are routinely screened for gestational diabetes, and once they get a positive test, we encourage all of them to go on a special diet,” says Dr. Chen.
Here’s what health care providers usually ask people to do once they get a positive diabetes test:
- Meet with a nutritionist to discuss changes they need to make to their existing diet.
- Test their blood glucose levels on a regular basis.
“We typically get them to test four times a day: early in the morning after fasting and then three times after each main meal (breakfast, lunch, and dinner).
“The postprandial tests are usually done two hours after each main meal, but in some countries, the standard of care is to test one hour after each main meal,” says Dr. Chen.
Dr. Chen says that health care providers educate people with gestational diabetes on what their target levels should be.
Insulin is considered the gold standard of treatment, but in some instances, oral hypoglycemic agents such as metformin and/or glyburide can also be considered.
“In the U.S., fasting glucose levels should be below 95 mg/dL, and two-hour postprandial glucose levels should be below 120 mg/dL. If these numbers are continually being exceeded despite being on a low-glycemic diet, then the pregnant person will need to be started on insulin therapy as well.
“Insulin is considered the gold standard of treatment, but in some instances, oral hypoglycemic agents such as metformin and/or glyburide can also be considered,” Dr. Chen advises.
Dr. Chen shares some basic dietary concepts that he personally discusses with pregnant people.
First of all, he finds out what types of drinks they consume on a regular basis. Nearly 40 to 50 percent of all sugar intake comes from beverages on a daily basis.
“If they only drink water, then we quickly move on to the foods that they eat. But if they are
drinking a lot of soda and fruit juices, the first thing I tell them is to reduce their consumption significantly, as this is a very quick and easy way to improve their glucose levels,” says Dr. Chen.
In terms of food, Dr. Chen discusses the broad concepts of glycemic load and glycemic index with his patients.
Dr. Chen counsels people on how to estimate the glycemic load of their meals, and educates them on the importance of maintaining a balanced diet throughout pregnancy, as they need to eat a good amount of carbohydrates for fetal well-being.
“As an example, I tell them to eat roughly 30 grams of carbohydrates per main meal and about 15 grams of carbohydrates for each snack. I tell them to try not to exceed this amount for one particular meal, because if they do that, then it is quite likely that this will cause their glucose levels to rise,” explains Dr. Chen.
As for the glycemic index (GI) of different foods, Dr. Chen encourages people to try to pick foods that have a lower glycemic index, so that their glucose levels do not spike as quickly after they eat.
“Let me give you an example regarding fruits. I will provide people with a table that lists which fruits are high in GI and which ones are low in GI. As an example, fruits like berries, apples, and pears tend to be lower in GI.
“I encourage people to stay away from fruits that tend to be higher in GI such as watermelon, pineapple, and dates. If they do have a craving for these kinds of fruits, I encourage them to eat these as part of a fruit salad, so that they can be balanced out with other fruits that would be lower in GI,” says Dr. Chen.
Dr. Chen also encourages people with diabetes to eat a certain amount of protein with each meal because protein increases satiety, which will in turn prevent overeating. Protein also helps glucose levels remain stable longer.
He also encourages his patients to eat a particular amount of fat with each meal, because fat also affects how quickly carbohydrates are digested.
“So, if you eat a certain amount of fat consistently with each meal, it becomes much easier to predict how quickly carbohydrates will be digested and therefore how quickly glucose levels may spike,” explains Dr. Chen.
In summary, Dr. Chen tells his patients to try to keep to a balanced diet throughout their whole pregnancy. Usually, he says that people do not find it very difficult to maintain such a balanced diet, and if they continue this kind of diet in the postpartum period, it tends to help them in other ways as well.
“It helps them lose weight and get back to their pre-pregnancy weight quicker. And they report to me that they just feel healthier as well. In fact, studies have also shown that if they adopt a healthier diet in between pregnancies, this will reduce the risk of them getting gestational diabetes with a future pregnancy,” says Dr. Chen.
The main point of exercising if you have gestational diabetes is to prevent excessive weight gain and stay in shape, says Dr. Chen.
For people with gestational diabetes, regular low-impact exercise, especially walking, swimming, and also gentle exercising on a bike, helps prevent glucose levels from getting particularly high after they eat.
Dr. Chen notes, “I tell people that being pregnant is like running a marathon. If they start getting out of shape early on during a pregnancy, they could start finding it very difficult towards the end to stay fit and well. And also, it will be a lot harder for them to get back to their pre-pregnancy weight in the postpartum period if they have not been doing any regular exercise throughout the pregnancy.”
For people with gestational diabetes, Dr. Chen says that regular low-impact exercise, especially walking, swimming, and also gentle exercising on a bike, helps prevent glucose levels from getting particularly high after they eat.
“Studies have shown that people who do this exercise on a regular basis are able to keep their glucose levels under much better control during pregnancy by improving their insulin sensitivity,” says Dr. Chen.