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.
We would ask them to meet up with a nutritionist to discuss what changes they need to make to their existing diet. We ask these people to test their blood glucose levels on a regular basis. We typically get them to test four times a day; early in the morning fasting and then test three times after each main meal (breakfast, lunch and dinner). The postprandial tests are usually done 2 hours after each main meal but in some countries, the standard of care is to test 1 hour after each main meal.
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We educate these people to inform them what these targets should be. In the U.S., fasting glucose levels should be below 95mg/dL, and two-hour postprandial glucose levels should be below 120mg/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 to be the gold standard of treatment, but in some instances, oral hypoglycemic agents such as metformin and/or glyburide can also be considered.
Below are some basic dietary concepts which I personally discuss with pregnant people.
First of all, I find 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, so the first thing I do is find out what kind of beverages they drink.
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 to do is to reduce their consumption significantly, as this is a very quick and easy way to improve their glucose levels.
In terms of food, I would discuss with them the broad concepts of glycemic load and glycemic index. I counsel them on how to estimate the glycemic load that they are eating with a particular meal, and I educate them on the importance of maintaining a very balanced diet throughout the pregnancy, as they certainly do need to eat a good amount of carbohydrates for fetal well-being. As an example, I tell them to eat roughly about 30 grams of carbohydrates per main meal and consume 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.
I also counsel them on the glycemic indexes (GI) of different foods. I encourage them to try to pick foods which are lower in 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 them with a table which 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 them to stay away from fruits which 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 these can be balanced out with other fruits which would be lower in GI.
I also encourage them to eat a certain amount of protein with each meal because protein leads to increased satiety, which will in turn prevent overeating. Proteins also help their glucose levels remain stable for longer periods of time.
And I also encourage them to eat a particular amount of fat with each meal, because fat also affects how quickly carbohydrates are digested. So, if they 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.
So, in summary, I tell my patients to try to keep to a very balanced diet throughout the whole pregnancy. Usually I find that people do not find it very difficult to maintain such a balanced diet, and if they continue this kind of diet even 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.
Basically, the main point of exercising is to prevent excessive weight gain as well as just keeping a pregnant person generally in shape. 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, I counsel them to do regular low-impact exercise, especially walking, swimming, and also gentle exercising on a bike, in order to prevent their glucose levels 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.