What is gestational diabetes?

Gestational Diabetes Mellitus (GDM) or gestational diabetes (GD) is a type of diabetes that occurs during pregnancy. It is diagnosed following a 2-hour Oral Glucose Tolerance Test (OGTT) at around 24 to 28 weeks of pregnancy.  

Some women whose health, pregnancy or family history put them at a higher risk will also have this test early in their pregnancy.  

The OGTT is a blood test ordered by your GP, obstetrician, or antenatal clinic. This is considered a ‘universal test’, which means all pregnant women should have this test. 

What happens if my blood glucose levels stay too high in pregnancy?

If high blood glucose levels (BGLs) are not treated you and your baby may experience a number of problems.  Women with sub-optimal BGLs are at much higher risk of developing type 2 diabetes mellitus after pregnancy. This risk increases when women are not supported to follow a healthy lifestyle during and after pregnancy. This risk is exacerbated by postpartum weight retention in the longer term.

A woman with GDM can have a baby that has an unhealthy growth pattern before it is born.  Glucose crosses the placenta into your baby’s bloodstream. If your BGLs are high, your baby will receive high amounts of glucose.  A baby’s insulin still works well meaning, even in utero, it is able to store this extra glucose and will grow faster and fatter.

This means the growing baby can be at risk of:

  • being a very large baby
  • being born early
  • being distressed during birth, and/or
  • having low blood glucose levels at birth.

Babies born to mums who have had sub-optimal BGLs are also more likely to be overweight or obese into their adult lives, and have diabetes themselves.

What do I do if I have a high BGL reading?

If you have a high BGL it is important to work out why so you can minimise the chance of it happening again. Ask yourself the following questions to help work out why your level might be high.

Did you eat a larger meal than usual (e.g. eating out)?

Check your serve sizes against the portions list and sample meal plan provided by your dietitian.

Did you eat too much carbohydrate?

Take care with large serves of bread, pasta, noodles and rice – these can increase your BGLs.

Try to choose slow release (low GI) carbohydrate e.g. grain bread in place of white, high fibre cereal rather than low fibre and fresh fruit rather than juice. Make sure you choose ‘slow’ rather than ‘no’ carbs.

Did you wait long enough after eating before your BGL test?

Always wait for a full hour after starting to eat a meal before testing and delay snacks until after you test.

Were your hands clean?

Always wash your hands prior to testing, dirty hands can affect your BGL reading.

Have you been taking your diabetes medication as prescribed?

If you have been prescribed insulin or other medication to manage your gestational diabetes missing this medication will cause a high BGL reading.

Were you active after your meal?

Sitting down immediately after your meal can cause a higher BGL reading than if you do some activity such as a short walk or some housework.  Exercise can help to lower your BGL after a meal.

Do you need more help?

Our specialist maternal health-GDM dietitians are able to tailor a program to support you to adapt guideline recommendations to your lifestyle and preferences. If you need support, please make an appointment to help you achieve your goals. 

 

 

 

IMAGE CREDIT: Unsplash Rima Kruciene

IMAGE DESCRIPTION: Six people doing yoga on a porch in the one leg up from downward dog pose

What is gestational diabetes?

Gestational Diabetes Mellitus or GDM is a type of diabetes that occurs during pregnancy. It is diagnosed using a 2-hour Oral Glucose Tolerance Test (OGTT) at around 26 to 28 weeks of pregnancy*.

The OGTT is a blood test ordered by your GP, obstetrician, or antenatal clinic. This is a ‘universal test’, which means all pregnant women should have this test.

How do I prepare for my OGTT?

Discuss any medication, both prescription and non-prescription, with your doctor or midwife. You may need to stop medications before the test. The OGTT is a fasting test, so have nothing to eat from 9pm the night before the test. Water is permitted in small amounts. You will need to avoid strenuous exercise and smoking for 8 hours before the test. During the test you will need to sit for the two hours. Even walking around the shops can interfere with the test results.

Does my diet affect the outcome of the test?

Some written information provided to women can be a little misleading or hard to understand.

Some examples of (confusing) advice we have seen include…

Continue to eat your normal balanced diet making sure you include at least 150 grams per day of carbohydrate for at least 3 days prior to the test. You diet should include cereals, grains, rice,  pasta, fruits, crackers and starchy vegetables such as potatoes, beans and corn

and

 “..consume at least 10 serves of carbohydrate each day”

We get lots of questions from concerned women that “this seems to recommend a lot of carbohydrate!”. Many ask,

Is this ON TOP of what I usually eat?

and

What happens if I don’t eat this?

To make sense of this it helps to know how much carbohydrate is in food and how much most Australians eat.

First of all, the ‘minimum of 150g per day’ is easily consumed by most people. Serves of carbohydrate can be quantified in 15g serves and usually equates to a ‘serve’ of food. For example, a slice of bread, half a cup of pasta, a glass of milk, a tub of yoghurt, a medium potato, or an apple, orange or banana each contain about 15g of carbohydrate.

So, by having cereal and milk or toast for breakfast, a sandwich, bread roll or wrap at lunch, and meat with vegies (including a potato, sweet potato, or corn) or a stir fry with some noodles or rice at dinner, plus snacks through the day of fruit and yoghurt, or even plain biscuits, you will easily consume the minimum 150g of carbohydrate per day required.

Some studies have shown that not eating ENOUGH carbohydrate before your test might give a ‘false positive’ result – it might look like you have GDM when you do not (eek!).

To ensure you get the correct result following your OGTT we advise women to continue to eat a healthy balanced diet that includes foods from all the food groups in the days leading up to their test. Use the above examples as a guide to what you might eat throughout the day.

What happens after an OGTT?

If your results are normal you can continue with your usual antenatal care. If your blood glucose levels are raised you have GDM.  It is best practice for you to see an range of specialists including an endocrinologist, diabetes educator and a maternal health specialist dietitian to assist you in the management of GDM.

What changes do I need to make?

A healthy lifestyle incorporating diet and exercise is the starting point to best manage GDM.  Regular meals incorporating slow acting carbohydrates, reducing saturated fats and added sugars/ultra-processed foods and including regular walks and other physical activity will help manage GDM.

A dietitian is the best person to help you build your knowledge, skills and confidence to make these and many more changes to optimise your health with GDM.

Current research shows us that women with GDM who attend regular appointments with a dietitian during their pregnancy have a greater chance of managing their GDM and weight gain. This in turn helps baby to have good outcomes and reduces your risk of developing diabetes in the future.

So, how often should I see the dietitian?

All studies point to the benefits of ongoing contact and support from an expert maternal health dietitian when managing your GDM. Studies testing the effectiveness of GDM nutrition guidelines have shown improved pregnancy outcomes (less need for insulin and better control of blood glucose levels) when women saw a specialist maternal health/GDM dietitian a minimum of three times during their pregnancy + a postnatal review.

Our Director and Principal Dietitian, Dr Shelley Wilkinson, has applied these findings in health services she has worked in and collaborated with and now brings them to Lifestyle Maternity.

Our specialist maternal health-GDM dietitians are able to tailor a program to support you to adapt guideline recommendations to your lifestyle and preferences. If you need support, please make an appointment to help you achieve your goals. At these appointments a dietitian can assist you to adjust your individual meal plan timing and the content of your diet to optimise your BGLs.

Practical suggestions to help you balance your dietary goals for GDM, manage your weight gain to your individual needs, and develop the healthiest baby possible will be negotiated and matched to your needs.

What does the Lifestyle Maternity GDM service offer?

We would love you to learn to manage your blood glucose levels while still meeting your pregnancy nutrition needs through participating in our innovative gestational diabetes mellitus (GDM) model of care.

 Once you book your GDM package with Lifestyle Maternity you will be sent:

  1. a one-page sheet that summarises your NEED-TO-KNOW dietary modifications. This will help you get your head around and changes you may need to make,
  2. an introductory video to support your first week after diagnosis. It’s a GDM explainer plus more in depth dietary information,
  3. a diary to start keeping a WEEK LONG food and blood glucose record. This will allow your Lifestyle Maternity dietitian to review your progress BEFORE your SECOND appointment with us.

Your individual consult will involve a thorough assessment of your dietary and lifestyle patterns with a personalised action plan being developed in collaboration with the dietitian. This will involve tailoring best practice nutrition guidelines to your personal circumstances and preferences to optimise your health once bub arrives.

The cost of the GDM package (your individual assessment and plan PLUS being sent the starter information sheet, PLUS video link and food and blood glucose diary paperwork, PLUS the review and assessment of this diary by an expert maternity dietitian) is $185. Current Lifestyle Maternity clients will received reduced rates for this appointment ($140).

Each subsequent “review” appointment costs $105. This includes out-of-appointment review of your BGLs and diary prior to each appointment. At your third appointment (your second ‘review’) you will receive a PeNut + Lifestyle Maternity GDM Cookbook (RRP $49). This will help give you extra meal time inspo and includes 30 dietitian-designed, low GI recipes (10 breakfasts, 10 lunch/dinners, and 10 snacks).

 

Don’t have GDM but still need general nutrition help?

We offer individual consultations and self-paced online courses as we know you all have different learning styles and budgets. Attending an individual session OR online course with a Lifestyle Maternity dietitian will allow you to assess your diet against recommended guidelines and identify changes that can be tailored to your lifestyle and dietary preferences.

In our self-paced online course you will be encouraged and guided to assess your own health habits against pregnancy recommendations, participate in activities around setting health goals for optimal nutrition and learn how to adapt your routines with confidence to achieve these goals to make them stick. More information here.

An individual consult involves a more thorough assessment of your dietary and lifestyle patterns with a personalised action plan being developed in collaboration with the dietitian. If you would like further information book an appointment  now.

* People from the groups below are those who would be considered at higher risk of GDM and should be tested for GDM in EARLY PREGNANCY.

  • Previous hyperglycaemia in pregnancy
  • Previously elevated blood glucose level
  • Maternal age ≥40 years
  • Ethnicity: Asian, Indian subcontinent, Aboriginal and Torres Strait Islander, Pacific Islander, Maori, Middle Eastern, non-white African
  • Family history of diabetes mellitus (first degree relative with diabetes or a sister with gestational diabetes mellitus)
  • Pre-pregnancy body mass index >30 kg/m2
  • Previous macrosomia (baby with birth weight >4500 g or >90th centile)
  • Polycystic ovary syndrome
  • Medications: corticosteroids, antipsychotics

IMAGE CREDIT: Richard Jaimes/Unsplash

IMAGE DESCRIPTION: Pregnancy woman with young boy kissing her pregnant belly and looking at the camera

What is gestational diabetes? 

Gestational Diabetes Mellitus (GDM) or gestational diabetes (GD) is a type of diabetes that occurs during pregnancy. It is diagnosed following a 2-hour Oral Glucose Tolerance Test (OGTT) at around 24 to 28 weeks of pregnancy.  

Some women whose health, pregnancy or family history put them at a higher risk will also have this test early in their pregnancy.  

The OGTT is a blood test ordered by your GP, obstetrician, or antenatal clinic. This is considered a ‘universal test’, which means all pregnant women should have this test. 

Why do some women get GDM? 

GDM occurs as a result of changes in hormone levels as pregnancy progresses. These changes  can interfere with how some women’s insulin works. Insulin usually helps process glucose from the blood into the muscles (for energy) and liver (for storage and energy).  

What happens if my blood glucose levels stay too high in late pregnancy? 

If high blood glucose levels (BGLs) are not treated, a number of problems can be seen in a pregnant woman or her baby.   

Women with poorly-controlled BGLs are at much higher risk of developing type 2 diabetes mellitus after pregnancy. This risk increases when women are not supported to follow a healthy lifestyle or to healthily lose their pregnancy weight.  

A woman with GDM can have a baby that has an unhealthy growth pattern before it is born.  A baby’s insulin still works well so, even in utero (in the womb), it is able to store extra glucose and will grow faster and fatter. This means the growing baby can be at risk of: 

  • being a very large baby,  
  • having early delivery, 
  • being distressed during birth, and/or
  • having low blood glucose levels at birth.  

Babies born to mums whose BGLs have been higher than ideal, without good support for BGL management, are also more likely to be overweight or obese into their adult lives and have diabetes themselves.   

So, do I have to cut all sugar out of my diet to control my blood glucose levels? 

No. Although some foods we eat (carbohydrates) put glucose into our blood stream, cutting these foods out completely means we cut out all the nutritious goodness we need for a healthy pregnancy and a growing and developing baby. We also need carbohydrates to run our body – without them it is like a car running out of fuel. 

GDM is primarily managed by following a healthy well-balanced eating plan, taking into consideration carbohydrate intake and physical activity. If women’s BGLs are unable to be managed with diet and activity alone, medication such as insulin (injections) or metformin (tablets) are sometimes needed.   

Ongoing, regular contact with Diabetes Educators, Dietitians, and medical specialists during pregnancy is important for good BGLs and best outcomes for mother and baby.  

How many visits should I have with a dietitian? 

All studies point to the benefits of ongoing contact and support from an expert maternal health dietitian when managing your GDM. Studies testing the effectiveness of GDM nutrition guidelines have shown improved pregnancy outcomes (less need for insulin and better control of blood glucose levels) when women saw a specialist maternal health/GDM dietitian a minimum of three times during their pregnancy and a postnatal review 

Our Director and Principal Dietitian, Dr Shelley Wilkinson, has applied these findings in health services she has worked in and collaborated with and now brings them to Lifestyle Maternity. Our specialist maternal health-GDM dietitians are able to tailor a program to support you to adapt guideline recommendations to your lifestyle and preferences. If you need support, please make an appointment to help you achieve your goals. 

 

IMAGE CREDIT: Unsplash, Paul Lin 

IMAGE DESCRIPTION: Pregnant woman standing outside, side on, looking down at an orange gerbera