Dietary advice for Gestational Diabetes

Introduction

A healthy diet is an important part of a healthy lifestyle at any time but especially for women who are pregnant or planning a pregnancy. Sometimes pregnant women develop a type of diabetes where their blood glucose level starts to rise which can cause their baby to grow larger than the gestational size which can cause complications if not managed. Your midwife & obstetrician will normally discuss this further with you.

What is Gestational Diabetes (GDM)?

Gestational Diabetes (GDM) is the name given to diabetes that can occur during pregnancy (Gestation). Diabetes is an inability of the body to control the amount of sugar (glucose) in the blood.

Some known risk factors for developing gestational diabetes.

A body mass index of above 30 kg/m²
Maternal age of 30 years or over
A history of polycystic ovary syndrome (PCOS)
A previous baby weighing 9.9lbs (4.5kg) or more.
A family history of type 2 Diabetes
Some ethnic groups (African, African-Caribbean and Asian) are more susceptible.
Weight gain between pregnancies

Blood Glucose Targets for GDM

Before breakfast: Below 5.3 mmol/L
One hour after each main meal: Below 7.8 mm ol/L

How can I control my blood glucose with GDM?

Diet & lifestyle changes is the first line management for GDM
Follow a healthy balanced diet, in particular balancing the macronutrients like carbohydrates, protein & fats can make a difference to your blood glucose post meals.
Making simple changes to the food choices & portion sizes can help with controlling blood glucose.
Sometimes eating patterns & food choices may need to be adjusted to improve blood glucose.
Physical activity especially after eating can help lower blood glucose levels.

Which food and drink cause my blood glucose levels to rise?

What you eat and drink has a key role in managing your blood glucose levels during pregnancy. The right balance of a variety of food is also important to make sure you and your developing baby get the nutrition you both need.

There are three main nutrients in the food/drink that we consume: Carbohydrate, Protein and Fat.

Carbohydrates have the biggest impact on our blood glucose levels. They are the body’s preferred source of energy and can provide fibre as well as other vitamins so try not cut them out completely. There are two main types: Sugars and starches.

Sugars

All fruit—fresh and dried
Fruit juices
Natural syrups—maple, honey, agave, jaggery, molasses
Milk
Yogurt
Ice cream
Custard
Table sugar—white, golden and brown
Confectionary
Fizzy drinks
Cakes
Biscuits
Chocolate
Sweets
Desserts

Starches

Bread
Pasta
Noodles
Rice
Flour
Chapatti
Couscous
Polenta
Quinoa
Oats
Oat cakes
Rice cakes
Cereals
Potato
Sweet potato
Parsnips
Swede
Beans
Lentils
Peas
Sweetcorn
Yam
Idli
Dosa
Green bananas
Plantain
Cassava
Fufu
Manioc

The effect on blood glucose levels depends on the amount and type of carbohydrates eaten.

Glycaemic Index (GI)

All food that contains carbohydrate have a glycaemic Index value (GI). This describes the speed that the body breaks down carbohydrate into glucose and absorbs it into the blood. Low GI foods are the best choices as they are absorbed and raise the blood glucose more slowly so can help to keep your blood glucose levels within the healthy range & regulate your appetite much better. High G.I. foods are absorbed quicker and raise the blood glucose quickly. Therefore, can be problematic if you have GDM.

Table below shows you some examples of Low GI and High GI foods.

Low GI

Plain rolled Oats.
No added sugar Muesli
Oat flakes no added sugar.
Wholegrain breads: Granary, multigrain, other seeded varieties
Rye bread, pitta bread, sourdough bread and chapattis
Basmati & brown rice
Wholegrain pasta & noodles
New potatoes
Sweet potatoes
Beans, lentils, such chickpeas, kidney beans, and butter beans
Plantain, yam, green banana
Couscous, Bulgur wheat and Quinoa

High GI

All refined cereals, such as cornflakes, rice crispies, crunchy nut cornflakes, coco pops
White bread
Muffins
Biscuits
Cakes
Sugar
Honey
White rice – easy cook variety
Fries
Normal fizzy drinks
Fruit juices

Portion size for carbohydrates (carbs)

When eating carbs, remember these four key principles:

Watch your portion sizes (the amount on your plate)
Choose higher fibre low GI options, as they generally tend to release the glucose slowly and keep you fully for longer, they also help with constipation.
Avoid food and drinks containing added sugar.
Pair your carbs with protein and healthy fat, this will help lower the GI of the carbohydrate food further.

Aim to have no more than one fist sized portion of cooked starchy carbohydrate in each meal, for e.g. 2-3 egg sized potatoes OR 3-4 tablespoons or a small cup of cooked pasta/noodles/rice OR 2 slices of bread OR 1-2 small high fibre chapattis. This portion size will roughly be around 30 – 50g carbs in a main meal.

Generally counting the amount of carbs in your meals is not necessary, however if you find it helps, as a guide, per meal:

Breakfast: 30- 40g total carbs (if you become more insulin resistant in the morning, you may need to either split your breakfast or lower the total carbs)

Lunch: 40 – 50g total carbs

Dinner: 40 – 50g total carbs

Snacks: 10 – 15g

Note: This is just a guide, everyone has different degree of insulin resistance with their GDM. By regular blood glucose monitoring you’ll be able to adjust your diet accordingly.

Resources that can help with carb counting

Food labels, look at Nutritional info at the back of packets and look at total carbs per portion you are eating.
Internet search, look for carbohydrate information in the portion of food you are eating.
Carbs & Cals book or App can help by giving you a visual guide to raise awareness during your pregnancy & post-delivery.

Fruit & Vegetables

These provide variety to your diet.
Good source of vitamin C, micronutrients and minerals
Fibre – bowel health (helps prevent constipation)
Avoid excessive amount of fruit, although generally a healthier choice snack, too many can raise blood glucose.
Try instead, a fist size portion for e.g., 1 handful of berries or 1 slice of a larger fruit, you can combine this with some protein food such as cheese or handful of nuts (see protein section below) which will provide you with protein & some good fat as well as stopping a rise in glucose.
One portion of fruit can be a healthy snack in between meals, when you feel hungry, for e.g. Generally aim for 2 portions of fruit per day
- 1small – medium apple/orange/pear
- x2 small fruit; plum or satsuma
- small handful of berries
Veg/salad be more generous, as they have very little impact on your blood glucose levels, aim for half your plate, as it helps with keeping you fuller for longer, they provide variety and bulk to a meal.
Frozen & Fresh vegetables are equally beneficial.

Protein

Protein foods include meats, eggs, chicken, fish, seafood, cheese, yoghurt, milk, non-meat origin: Tofu, Soya, Quorn, beans, lentils, nuts.

These are important for growth, tissue repair, and maintenance & hormone production.
They help lower GI of your meals and help keep glucose levels in range.
Improve satiety.
Aim to include 1 portion at every mealtime, choose leaner cuts, for e.g., 1 skinless chicken breast/ piece of fish, a small cup of cooked lentils, a handful of nuts.
Ensure all your meats/chicken/fish are well cooked to avoid contamination.
Aim for x2 portions of oily fish/week, a portion is: a piece of fresh salmon or 1 tin of mackerel or sardine.

Fats

Some dietary fats are important, as we need them for energy, to make hormones and for our cell membranes. However, too much can contribute towards the total amount of calories we consume. You don’t need to avoid them; you need to exercise moderation and choose the good fats over the processed varieties.

There are 3 main types of dietary fats:

Saturated

Mostly from fatty & processed meats like sausages & salamis, pies, pastries anything cooked in lard
Clotted Cream

Monounsaturated

Also known as Omega 3 fats
High level in avocado, olive, rapeseed, ground nut oil, seeds & nuts
Also, high quantity in a Mediterranean diet

Polyunsaturated

Also known as Omega 6 fats
Seeds & nuts, oils
Oily fish like salmon, sardines, mackerel, trout (in pregnancy the current recommendation is x2 portions of oily fish per week)

Key messages

Fat is important in our diet but watch the amount as they are also high in calories which can lead to excess weight gain during pregnancy.

Watch the amount you add to food.
Limit intake of saturated fat partial substitution with good fats such as monounsaturated and polyunsaturated
Fats can help lower GI of meals, for example putting peanut butter or avocado on toast for breakfast.

Meal pattern

Try to eat regular meals (breakfast, lunch and evening meal). Spreading your intake over the day can help to manage your blood glucose levels. If you skip meals, you might be more likely to overeat at the next meal or end up on snacking on things that can have a big impact on your blood glucose.

Avoid eating carbohydrate late in the evening. Having your dinner too late at night can affect your fasting blood glucose the next day. If you can, try to have your dinner before 8pm. If you need to snack after dinner, opt for low carb options e.g., nuts, cheese, small portion of Greek yogurt.

Meal 1	Meal 2
Breakfast Options: Wholemeal/Granary toast 1-2 (see low GI options in previous section) with nut butter/egg, cheese, ham, reduced sugar baked beans, marmite Plain rolled oats with unsweetened milk or Greek yoghurt or Skyr Unflavoured Greek yoghurt or Skyr with a handful of berries, nuts & seeds	Breakfast Options: 1 small chapatti with dhal or curry 1-2 slices of seeded toast with scrambled eggs OR avocado & smoked salmon OR grilled bacon OR A small seeded wrap with chicken, fish or roasted vegetable Plain natural yoghurt with a handful of fresh berries, nuts, seeds
Mid-morning snack ideas: X1 ryvita with peanut butter A portion of fruit A pot of plain or no added sugar yoghurt A handful of plain nuts	Mid-morning snack ideas: A cup of tea with no sugar A small fruit A plain or no added sugar yoghurt A handful of nuts
Lunch: A bowl of vegetable/meat soup with a seeded or granary bread roll A sandwich 1-2 slices bread (from low GI choices) containing salad & a protein choice like Small baked potato with skin with protein & salad fish/cheese/ Cheese/mushrooms/tomato/peppers omelette with salad & a roll Chicken/tuna/mixed beans & salad with a handful of either a boiled new potato or cold pasta	Lunch: A small cup of cooked either brown or basmati rice with plenty of vegetable & meat curries or dhall avoid potato curries 1-2 small chapattis with meat/dhall & vegetable curries & salad A small bowl of chicken, vegetables & noodle broth 2-3 small meat/ chicken samosas with plenty of green salads & plain yoghurt & cucumber
Mid-afternoon: A small fruit or plain nuts A sugar free drink Sugar free yoghurt/jelly A baby bel & nuts	Mid-afternoon: A small fruit or plain nuts A sugar free drink Sugar free yoghurt/jelly Veggie sticks & hummus.
Dinner: Roast/baked meat or fish with veg & 3-4 small potatoes (avoid Yorkshire pudding or trade-off for potatoes) Lasagne & salad Chilli con carne & a small cup of cooked rice/pasta with salad Curry & rice or meat stew with plenty of veg	Dinner: Stir fry with more vegetables & meat/chicken & less rice or noodles 1-2 small wholemeal chapattis & curry (lentils, veg or meat) & salad Meat stew and 3-4 egg sized potatoes and plenty of vegetables Small baked potato with meat/fish and vegetables/salad
Bedtime: A sugar free drink or plain glass of milk, stick with protein food if hungry	Bedtime: A sugar free drink or plain glass of milk, stick with protein food only

Examples of snacks containing around 10 – 15g carbs/ portion

Food	Amount	Food	Amount	Food	Amount
Corn on the cob	1 – 2 small pieces	Hummus + Rye/Pumpernickel bread	1 slice	Diet or plain natural yoghurt	Small pot
Plain wholegrain crackers	1 - 2	Plain popcorn (no sugar)	30 g /small handful	Small Samosa	1
Piece of fruit, e.g. apple/banana	1 small- medium	Fresh berries	1 handful	Plain milk	1 glass

Examples of snacks with very low carbohydrate content

Food	Amount	Food	Amount	Food	Amount
Nuts/Seeds	small handful	Char-grilled vegetables	One large handful	Raw vegetables with low fat savoury dip	Large handful
Meat, chicken, fish (use caution with coating)	e.g., A slice ham / cooked chicken	Cream cheese (e.g., Cottage cheese)	30 – 40 g	Avocado	1 small
Boiled egg	1	Firm cheese e.g. cheddar	1 match box size or slice	Cheese strings or baby bel	1 serving
Sugar free jelly	1 pot	Olives	Small handful	Unsweetened almond milk/soya milk	200 mls

Food safety in pregnancy

There are certain foods that are best to avoid while you are pregnant as they can put your baby’s health at risk. These include some types of cheese and raw or uncooked meat. For more details, please see websites below.

Exercise in pregnancy

Exercising during pregnancy has been shown to have many benefits, including reducing stress and anxiety, improving sleep patterns. Please check with you doctor if you are experiencing any discomfort or bleeding.
Exercise can also help your insulin work more effectively, which keeps your blood glucose level under control, especially walking or being more active post eating.
For more information on this please check:

‘Exercise in Pregnancy’ Royal College of Obstetricians and Gynaecologist, 2006. NICE ‘Diabetes in Pregnancy’ July 2008.

In summary

Eat three regular meals every day.
If hungry in between meals aim for a small snack containing carbohydrate between 10 – 15g (preferably low GI) or have a carb free snack,
Avoid large meals – spread your carbohydrate portion as evenly as possible over the day.
Try not to miss meals as you are likely to eat more later.
If appetite is poor aim for little and often for e.g. a yoghurt with fruit &nuts
Balance your main meals with other nutrients coming from lean meat, fish, chicken or meat alternatives and plenty of salads/vegetables.
Ensure your meat, fish, chicken or other sea foods are well cooked.
Ensure good fluid intake, aim for 2 litres of sugar free fluid per day, water and tea without sugar also counts towards your daily fluid intake. This will help avoid or relieve constipation.
Choose lower carbohydrate toast toppings such as peanut butter, cheese, marmite, and avocado instead of jam, marmalade, and honey.
Avoid highly processed breakfast cereals such as cornflakes or crunchy nuts as these can cause blood glucose to rise rapidly.
Protein foods do not cause your blood glucose to rise, so opt for a larger serving of lean meat, fish, eggs, nuts at meals if you are hungry.
Exercise is important in pregnancy so aim for 30 mins of exercise daily. For instance, 15 – 20 minutes’ walk or longer after meals will help to control your blood glucose.

Post delivery care

Most women return to normal blood glucose levels as soon as their baby is born. Usually, 6 weeks after delivery you will be asked to take an appropriate blood glucose test to confirm that you no longer have diabetes.

You should continue making healthier food choices and exercise regularly to help you achieve and maintain a healthy weight. This is important as you are at more risk of developing diabetes later in life if you have had it during pregnancy.