Have you been diagnosed with Gestational Diabetes and don't know what to do next? In this article, we will explore a little about this disease that affects 8.8% of pregnant women in Portugal and explain what type of follow-up you should look for by healthcare professionals such as dietitians and endocrinologists.
What it is & Risk Factors
Gestational Diabetes (GD) is defined as a subtype of carbohydrate intolerance diagnosed or detected for the first time during pregnancy.3 It usually disappears after childbirth. It differs from Diabetes Mellitus in Pregnancy (DMP) by the time it is identified and by the limit values it presents at diagnosis, being between the values considered normal for pregnancy and the diagnostic values of DMP.3
The gestation period is associated with a natural increase in insulin resistance and cases of hyperinsulinemia, which increases your predisposition to develop GD. However, there are risk factors that can increase the likelihood of a pregnant woman developing GD, namely:
- Body Mass Index (BMI) prior to pregnancy being greater than 30Kg/m2
- Age 40 years or above;
- Have a family history of Diabetes Mellitus (DM) or a personal history of GD;
- Have a history of child(ren) with macrosomia (>4500g);
- Twin Pregnancy. 1
Maternal, Fetal and Neonatal Risks
This condition is associated with maternal risks during pregnancy such as preeclampsia, postpartum hemorrhage, polyhydramnios, infections and trauma.
No less important, there is the risk of fetal and neonatal complications such as macrosomia, neonatal hypoglycemia, jaundice, Acute Respiratory Distress Syndrome (ARDS), hypocalcemia, and trauma during childbirth1 (which is characterized by shoulder dystocia2, fractures, or nerve palsy). However, GD does not pose any risk of deficiencies or abnormalities in your baby's growth.
Diagnosis
In the first pregnancy consultation, you should perform a fasting plasma glucose analysis. If the value is above normal, there will be a diagnosis of GD or DMP. If levels are normal, a reassessment should be scheduled between 24 and 28 weeks of pregnancy consisting of an Oral Glucose Tolerance Test (OGTT) with 75g of glucose. This test assesses your tolerance to the amount of glucose that is ingested.3
During the procedure, several blood samples are taken at specific times, and the results make it possible to confirm or rule out the diagnosis. It is essential that, in the days before the test, you maintain your diet and regular physical activity.
Vigilance
Once the diagnosis of diabetes has been confirmed, it is essential that you maintain glycemic self-surveillance using a glucometer.3 The glucometer is a portable device that measures blood glucose levels in a practical and fast way. Surveillance will allow us to know if nutritional therapy (NT) or pharmacological therapy (if necessary prescribed by the endocrinologist) is having the desired results.3
Nutritional Therapeutics
Ideally, after diagnosis, you should be seen by an Endocrinologist and a Dietitian as soon as possible so that you are carefully informed about your condition.4 Because it is a silent disease, with no apparent symptoms, the treatment requires a conscious and motivated pregnant woman in order to favor better control of it.
Unquestionably, NT is able to maintain adequate glycemic control in about 80-90% of pregnant women5, and only about 30% of pregnant women need pharmacological therapy complementing NT.6
This NT will be prepared by your dietitian according to your nutritional status, your clinical history and your eating and sociocultural habits.
Regularity of Meals: Regarding the regularity of meals, in cases of GD it is important that you maintain regular meals throughout the day as the total daily amount of carbohydrates you eat should be divided by 6/7 meals. In this way, it is possible to control blood glucose levels.3.4
Energy value: In terms of energy, a pregnant woman requires between 1800 and 2500Kcal/day. However, this value varies depending on your BMI prior to pregnancy. This value must be calculated and prescribed by your dietitian.6
Protein: Regarding protein intake, most guidelines advocate a percentage between 10 and 20% of the total energy value, with a minimum value of 71g of protein per day. However, this value must be decided and prescribed by your dietitian.8
Carbohydrates: The portion of carbohydrates for the day should be spread over three main meals (usually breakfast, lunch and dinner), two to three intermediate meals (which includes mid-morning and one to two snacks) and one before bedtime, supper. It is essential that this supper is composed of complex carbohydrates in order to avoid nocturnal hypoglycemia and morning ketosis.3
At breakfast, carbohydrates are not as well tolerated as there is greater insulin resistance and hyperglycemic values may be present. For this reason, the amount prescribed for breakfast will not be very high.3
An assistant in this glycemic control is the preference for foods with a low glycemic index, which naturally avoid excessive peaks in the postprandial periods, namely dairy products, whole grains, legumes, berries, nuts and seeds.3.7
Fibre: There are no studies demonstrating significant benefits of diets rich in soluble fiber in pregnant women with GD. However, it is common knowledge that foods rich in fiber combined with a high water intake are an asset in your daily life and constipation is very common at this time.8.9
Sugary Products: In terms of sugary products, we encourage you to moderate and preferably stop consuming them due to the rapid increase in glycemic values after ingesting them.4
Water Intake: Regarding water intake, the recommendations of the European Food Safety Authority (EFSA) for pregnant women in general are maintained. Increasing the intake of water and foods rich in it such as soups, vegetables and fruit, becomes essential to compensate for your increase in blood volume, which exists mainly between and after the 6th and 8th weeks of gestation, reaching its peak at 32-34 weeks. For this reason, it is recommended to drink 3L of water per day, especially including soups, infusions and the water that makes up all foods.4
Physical Activity
Finally, regarding physical activity, aerobic physical exercise is encouraged in a daily practice of walking for at least 30 minutes in postprandial periods. This physical activity has been shown to be effective in helping your glycemic control during the day.3
Key messages and how Oh!My Snacks can help you
To conclude, GD is a condition that requires extra attention during pregnancy, both to protect your and your baby’s health. A proper diagnosis, the implementation of personalized nutritional therapy and regular physical exercise are essential for an effective blood glucose control.
Within our portfolio, you can find several options to help you maintain good glycemic control, namely:
• Chocolate Protein Balls, with an oat base and no added sugar
• Raw Brownie Bars with an Oat Base and No Added Sugar
• Salted Fusions and Nuts
• Protein bars with no added sugar
• Milk chocolates with higher protein content, with no added sugar
Bibliography
1. Queensland Clinical Guidelines. Gestational diabetes mellitus (GDM). Guideline No.MN21.33-V5-R26. Queensland Health. 2021
2. Lai, F., Johnson, J., Dover, D. and Kaul, P., 2015. Outcomes of singleton and twin pregnancies complicated by pre-existing diabetes and gestational diabetes: A population based study in Alberta, Canada, 2005-11. Journal of Diabetes, 8(1), pp.45-55.
3. Revista Portuguesa de Diabetes, 2016. Consenso "Diabetes Gestacional": Atualização 2016. 12, pp.24-38.
4. Alberta Health Services, Nutrition Services., 2018. Nutrition Guideline: Diabetes in Pregnancy.
5. M. Alfadhli, E., 2015. Gestational diabetes mellitus. Saudi Med J, 36, pp.399-406.
6. SANDU, C., BICA, C., SALMEN, T., STOICA, R. and GHERGHICEANU, F., 2020. Gestational diabetes ‐ modern management and therapeutic approach (Review). EXPERIMENTAL AND THERAPEUTIC MEDICINE.
7. Filardi, T., Panimolle, F., Crescioli, C., Lenzi, A. and Morano, S., 2019. Gestational Diabetes Mellitus: The Impact of Carbohydrate Quality in Diet. Nutrients, 11(7), p.1549.
8. Kapur, K., Kapur, A. and Hod, M., 2020. Nutrition Management of Gestational Diabetes Mellitus. Annals of Nutrition and Metabolism, 77, pp.17–29.
9. Tsirou E, Grammatikopoulou MG, Theodoridis X, Gkiouras K, Pet- alidou A, Taousani E, et al. Guidelines for medical nutrition therapy in gestational diabetes mellitus: systematic review and critical appraisal. J Acad Nutr Diet. 2019;119(8):1320–39.
Author:
Matilde De Carvalho (CP.5756N)