What is Gestational diabetes ?. How you can manage it with proper Diet?

Can Gestational diabetes cause preterm labor? / Gestational diabetes and premature birth- Dietary management

-- Dhanalakshmi Umachandran M.Sc., M.Phil. Foods and Nutrition

Consultant Nutritionist and Dietician

Diabetes means higher than normal levels of blood sugar. The food we eat is digested and converted into glucose molecules which are used by the cells for energy. Insulin plays a very important role because it helps the body cells get these glucose molecules, which are converted into energy.

During pregnancy, hormonal changes make the cells less sensitive to insulin, leading to insulin resistance, so the glucose molecules don’t enter the cells as required and thus remain in the blood elevated. This condition during pregnancy is called Gestational Diabetes.

If you have been diagnosed with Gestational Diabetes, it is natural to feel concerned. However, having a good understanding of the condition and its dietary and lifestyle management will help prevent various complications which may develop due to Gestational diabetes.

Elevated blood sugar levels can increase the risk of premature birth. Studies show that the risk of premature delivery due to gestational diabetes is greater if the mom develops diabetes before the 24^th week of pregnancy.

How does Gestational Diabetes affect pregnancy and the unborn baby:

• Smaller than average baby size/ IUGR: If gestational diabetes occurs during the early stages of pregnancy, there may develop Placental insufficiency and so the baby won’t get enough nutrients and oxygen through the placenta. As a result, the growth of the baby is reduced and lead to a smaller baby and Intra Uterine Growth Restriction.
• Larger than normal baby size (Macrosomia): High blood sugar levels in the mom, lead to too much glucose in the baby’s blood and the baby’s pancreas needs to produce more insulin to deal with the extra glucose. Due to this excess insulin production, the baby’s cells get bigger and leads to macrosomia which is larger than normal baby size. A caesarean may be required to deliver a bigger baby. Moreover, the complications also increase during delivery due to baby size.
• Feeding difficulty: Due to prematurity, the babies develop breathing difficulties, low-blood sugar, jaundice and which makes feeding more difficult.

Management of Gestational Diabetes:

Managing Gestational Diabetes can help prevent the complications mentioned above.

Dietary Management:

This is not a diet that is restricted, but a change in eating habits, food patterns that will help you eat healthily.

4 important things a diabetic should keep a check are,

• Healthy and timely eating habits
• Required physical activity
• Medication
• Proper sleep

Let us look into the recommended sources from the food groups

Cereals:

During digestion, sugars (simple carbohydrates) and starches (complex carbohydrates) break down into blood glucose. Stop any refined carbs like white rice, white bread, maida etc.  Instead consume whole grains like whole wheat, ragi, bajra, jowar, broken wheat, quinoa and oats regularly to improve glucose control. Whole grams like channa, rajmah and moong provide complex carbohydrates. Eating more of these instead of simple ones like rice and maida will help control blood glucose. 

Fiber:  

Fiber regulates the way in which the body digests food which in turn helps control blood sugar levels. Foods high in fiber include bran, vegetables, fruits (especially those with skin), nuts, legumes (beans, peas and lentils), and whole-wheat flour. 

Pulses:  

Protein slows the absorption of carbohydrates. Include dals, pulses, legumes, soy and its products, low fat dairy products, egg whites and lean cuts of chicken and fish. Skinless chicken and fish are healthier alternatives to red meats. In addition, fish has less saturated fat and cholesterol than meat and poultry and is rich in omega 3 fatty acids which promote heart health by lowering blood fats called triglycerides. 

Healthy fats:   

1. They can help lower cholesterol levels as they contain monounsaturated (MUFA) and polyunsaturated fats ( PUFA) . Include avocados, nuts like -almonds, walnuts, olives, oils- canola, olive and peanut oils. However, even though they are healthy they should be taken in moderation, as all fats are high in calories. 
2. For the whole month’s cooking, an individual needs only ½ l of oil. (For e.g.- a family with 3 adults ( above 14 years of age) needs 1.5 litres of oil for the month. This translates to 1 tbsp. or 2 ½ tsp. of oil per day for each individual)
3. Choose a combination of oils (cold pressed oils are best) which will provide essential fatty acids. The oils which can be used for combinations are sunflower, safflower, canola, corn, groundnut, olive and soybean oils. You can also use ‘vegetable oil’ which is a blend of these oils.  If using combination of oils, you can change them every month. Use cooking spray instead of
4. pouring oils from a bottle while cooking.

Sugars: 

1. Fruits though high in fiber and nutrients, also contain natural sugars which need to be accounted for while you are trying to control blood sugar.  Fruits low in sugars includes- papaya, watermelon, orange, grapefruit, musambi, amla, guava, pomegranate, jamun, muskmelon, apples, pears, kiwi, berries (cranberries, raspberries, and strawberries). Have 1-2 portions of these fruit every day.
2. High calorie fruits include banana, chikkoo, jackfruit, custard apple, avocado, lychees, fresh figs, cherries, grapes and mango. Limit these to 1 portion, 1/ week
3. Cut down on your coffees and teas. Restrict to a small cup once or twice a day and without sugar. You can use stevia instead which is better than artificial sweeteners.
4. If you have sweet cravings, eat 2 – 3 raisins or a small piece of fruit. 

Foods to avoid:

1. Saturated fats. High-fat dairy products and animal proteins such as beef, mutton, and pork
2. Trans fats. These types of fats are found in processed snacks, baked goods, and bakery products
3.  Sources of cholesterol include high-fat dairy products and high-fat animal proteins, egg yolks, liver, and other organ meats. 
4.  Have less than 2,300 mg of sodium a day, this equals 1 tsp. of salt for the whole day’s meals and snacks. In addition, avoid processed foods which contain added salt.

Manage your blood sugar levels during pregnancy, and prevent preterm labor and complications during pregnancy and delivery.

Stay healthy!