THE CORNERSTONE OF GESTATIONAL DIABETES TREATMENT: NUTRITIONAL THERAPY

November 20, 2021 · Dr. Tuba Günebak

Diabetes diagnosed during pregnancy is called "gestational diabetes." The difference between gestational diabetes and known diabetes (sugar) disease is that it can heal by the end of pregnancy. Some hormones (prolactin, progesterone, cortisol) that facilitate the fetus's attachment to the uterus during pregnancy can suppress insulin secretion. Consequently, reduced insulin secretion leads the moth

THE CORNERSTONE OF GESTATIONAL DIABETES TREATMENT; NUTRITIONAL THERAPY

Diabetes diagnosed during pregnancy is called "gestational diabetes." The difference between gestational diabetes and known diabetes (sugar) disease is that it can heal by the end of pregnancy. Some hormones (prolactin, progesterone, cortisol) that facilitate the fetus's attachment to the uterus during pregnancy can suppress insulin secretion. Consequently, reduced insulin secretion leads the mother to a diabetes-like condition. This situation usually emerges around the 24th week of pregnancy and is observed in about 7 out of every 100 pregnancies. Gestational diabetes is diagnosed with a glucose tolerance test, and as long as its presence is detected and controlled, the mother experiences no significant issues. However, if left untreated, it can lead to various complications. The most crucial part of the treatment is nutritional therapy. The aim of nutritional therapy is to keep the mother's blood sugar balanced by providing healthy nutrition and to protect against potential complications.

Who is at Risk?

Women with a history of gestational diabetes in a previous pregnancy, those diagnosed with insulin resistance or glucose intolerance before pregnancy, those with a family history of Type 2 diabetes, those with a history of risky diabetes due to reduced amniotic fluid in a previous pregnancy, women who have given birth to large babies (birth weight over 4 kg), women who have gained over 20 kg in a previous or current pregnancy, those with fasting blood sugar levels above 100 mg/dl or post-meal blood sugar levels above 140 mg/dl, and women with a high pre-pregnancy weight are at risk for gestational diabetes.

Does a Woman with Gestational Diabetes Have a Risk of Being Diagnosed with Type II Diabetes After Birth?

Studies indicate that mothers who do not regulate their eating habits have a 20-30% risk of developing Type II diabetes within the first 7 to 10 years after birth, and 50-60% risk in other years of their lives. A mother with gestational diabetes who does not pay attention to her diet may also lay the groundwork for her newborn to carry risks of diabetes, obesity, and glucose intolerance in later life.

To Prevent Gestational Diabetes, You Must Pay Attention to Your Weight Gain During Pregnancy

The amount of weight you should gain during pregnancy varies according to your pre-pregnancy body weight. If you are pregnant, let's do a calculation; first, let's calculate your Body Mass Index (BMI). BMI is obtained by dividing body weight (kg) by the square of height (m). First, measure your height; let's say it's 160 cm. 160 cm = 1.6 m. Let's square your height in meters; 1.6 x 1.6 = 2.56 m². Now let's divide our body weight by this value. Let's say we weigh 60 kg; 60 / 2.56 = 23.44. This value (23.44) is your Body Mass Index. Now let's look at the table below and see how much total weight we should gain throughout the pregnancy.

Table. Recommended weight gain during pregnancy (ADA Report)

Every woman should follow a personalized nutrition program throughout her pregnancy. This is because when calculating the needs for a woman to have a healthy pregnancy, her height, pre-pregnancy weight, age at conception, gestational week, physical activity level, smoking status, dietary habits, previous pregnancy history, and medical history are taken into account.

I Have Been Diagnosed with Gestational Diabetes, How Should I Eat Now?

The main principle in nutritional therapy is to offer the mother a varied diet and to meet her carbohydrate needs from complex carbohydrates. When we consume foods containing carbohydrates, our body converts them to glucose. Glucose is the primary fuel for all cells. Therefore, eliminating carbohydrates from the diet is never an option. The advantage of consuming complex carbohydrates is that they raise blood sugar slowly and in a controlled manner. Examples of foods containing complex carbohydrates include legumes and whole grains.

Which Foods Contain Carbohydrates?

What are Your Nutritional Recommendations for a Woman Diagnosed with Gestational Diabetes?

First of all, I must state that keeping the mother's blood sugar level within the normal range protects her from the complications of gestational diabetes, especially from giving birth to a baby weighing over 4 kg. Additionally, it protects the baby from developing hypoglycemia, hypocalcemia, hyperbilirubinemia, and polycythemia.

• You should start nutritional therapy immediately. The person providing your nutritional recommendations must be a nutrition and dietetics specialist (dietitian). Ensure that the specialist you consult has graduated from a Nutrition and Dietetics Department of a university. Your dietitian will plan and calculate how much carbohydrate you should consume daily and how to achieve this from which foods in what order. This will be the key to your healthy pregnancy.
• Breakfast, lunch, and dinner are all important. Do not skip any of them. Make sure to include a food item from each food group on your plate at every main meal. For example, let's consider breakfast; you can consume 1 glass of semi-skimmed milk or 1 small bowl of semi-skimmed or probiotic yogurt from the dairy group, pasteurized white cheese and/or eggs from the protein group, whole grain bread and/or plain oatmeal from the grain group, and a well-washed vegetable or a whole fruit from the vegetable-fruit group.
• Pay attention to eating every 2 to 2.5 hours.
• Try to drink 1 glass of semi-skimmed milk during the morning snack. Besides being a good source of calcium, it also helps regulate your blood sugar.
• Control your fruit portions. Fruit is not as innocent as you might think. Moreover, do not forget that the carbohydrates in its structure can rapidly increase your blood sugar. Therefore, I recommend not forgetting to consume milk or a dairy product with your fruit snack. Do not buy or consume canned fruit.
• Due to hormonal changes during night sleep, you may find your blood sugar level outside the normal range when you wake up in the morning. Do not panic. What you need to do is never skip your breakfast and night snack.
• Believe me, no matter how much you crave them, cakes and cookies containing simple sugars are not suitable for you...
• Include whole grain products (like whole grain bread, bulgur, buckwheat, brown pasta), vegetables, legumes (like green lentils, chickpeas), and oilseeds (like walnuts, raw almonds) in your daily diet. These foods are not only good sources of fiber but also vitamins, minerals, trace elements, antioxidants, and some protective phytochemicals (plant bioactive compounds).
• Do not use artificial sweeteners.
• Consult your doctor and monitor your blood sugar regularly every day, keeping a logbook.
• Develop the habit of reading label information. Do not be fooled by a "sugar-free" label on a food item; examine the label.

Should I Exercise?

Although regular exercise supports the treatment process of gestational diabetes, the decision to exercise or not should be shaped according to your doctor's recommendation. If your obstetrician-gynecologist believes there is no harm in exercising, my recommendation would be to walk at a moderate pace for 20 to 45 minutes daily.

Healthy eating is a hidden key that unlocks every door, controls the course of the disease, alleviates symptoms and signs, and improves health status. Have a beautiful day, and may your awareness of nutrition be high. Best regards...

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