What is Gestational Diabetes Mellitus (GDM)?
According to American Diabetic Association, gestational diabetes mellitus (GDM) is the development of high blood sugar during pregnancy. It usually occur around 24th week of pregnancy which is second trimester.
The cause of gestational diabetes is unclear. The hormone from the placenta will block the action of mother’s insulin in the body, which is known as insulin resistance which will make it hard for the mother’s body to use the insulin. Without enough insulin, glucose cannot be converted into glycogen for storage; therefore it will cause high blood sugar.
After the baby is born, the gestational diabetes usually will disappear. A blood glucose test (Oral Glucose Tolerance Test, OGTT) should be performed six weeks after the delivery to make sure that the blood sugar level has return to normal. However, women who had gestational diabetes will have higher risk of developing Type II Diabetes in later life. Therefore, a routine check up is crucial.
Who is at risk of Gestational Diabetes Mellitus?
There is higher risk of developing GDM if:
- Body Mass Index (BMI) is above 30kg/m2
- The weight of previous baby is more than 4.0kg
- Diagnosis with gestational diabetes in a previous pregnancy
- Family history of diabetes
How gestational diabetes affect my baby?
Gestational diabetes can affect the baby if the blood sugar is consistently high or not well controlled.
It may cause a few problems including:
- Macrosomia (large baby) where baby weight is more than 4.0 kg
- Big baby will cause difficulties during delivery where increased the likelihood of caesarean section.
- Pre-mature baby where baby give birth before 37th week of pregnancy
- Pre-mature baby might have a delay in the cognitive function where their learning abilities might be affected.
- Pre-eclampsia this is a high blood pressure during pregnancy which will lead to other complications.
- Increased risk of developing Type II diabetes in later life.
Screening of gestational diabetes
A screening test which is called oral glucose tolerance test (OGTT) will be performed between 24th and 28th week of pregnancy.
This is a test where blood test will be taken in the morning two hours after you drink a cup of glucose water. Therefore, you will need to fast for the whole night.
Management of Gestational Diabetes
There are two ways to manage gestational diabetes which is
- Insulin injection
- Lifestyle changes including dietary changes and physical activity
By following a healthy eating plan will assist in managing blood glucose level within target range. Besides that, it is important to provide adequate nutrition to the baby.
Guide for healthy eating during pregnancy
- Eat small and frequent meals
- Do not skip meal and practice regular meal timing
- Understand complex and simple carbohydrate
- Choose a variety of food
- Have a balanced meal including carbohydrate, protein, fats and fiber
Carbohydrate containing food are broken down into glucose and used for energy. Carbohydrate food plays an important role in managing blood sugar level. Food that contain carbohydrate including,
- Cereals and grains (rice, noodles, bread, flour based food, pasta, biscuit)
- Starchy Vegetables (Potatoes, yam, pumpkin, lotus, corn)
- Legumes and pulses
- Milk and dairy products
Sweets (honey, sugar, cakes, chocolate, ice-cream, carbonated drinks)
- Have a look at the healthy plate. A quarter of the plate should be grains. For the three main meals, one can take one Chinese rice bowl of rice or noodles. In other word, one can take 3 ladles of rice or noodles.
- If you are taking potatoes, you should decrease the intake of your rice. As both of the food containing carbohydrate.
- For the snacks, one can take either one cup of low fat milk or three to six pieces of cream cracker or two slices of bread where can make it into sandwiches.
- Always choose wholegrain or whole meal products such as brown rice, whole meal bread, and whole wheat biscuits. This is because wholegrain products are higher in fiber which will help in controlling blood sugar level.
- You can choose low GI foods as well. A systemic review reported that diet with low GI and reduces portion was associated with less frequent insulin use and lower birth weight.
It is important to have three main meals and two snacks everyday and it should be distributed throughout the day.
- Fruits are advisable to take and it is limited to two servings per day. Fruits should be taken separately.
One serving of fruits is equivalent to:
|Apple/oranges/kiwi/pear||One tennis ball size|
|Pineapple/papaya/ honeydew/watermelon||One slice|
|Mangoes||½ small unit|
|Banana||1 small (60g)|
- Half of the plate should be green leafy vegetables as it is high in fiber, vitamins and minerals.
- Fiber containing food is able to slow down the rise of blood glucose level and pregnant mother will feel full for a longer period of time.
- Sweets (simple carbohydrate) should be avoided at the time being as it will increase the blood sugar drastically.
- Simple carbohydrate are usually the food where you can taste the sweetness when you eat it including ice-cream, sugary drinks, cordial, honey, chocolate, sweets, cakes, local desserts, carbonated drinks.
- Protein is one of the important sources as well. Pregnant mother should take more fish such as salmon and mackerel. This is because fish are high in omega 3 which has a beneficial effect for the brain and eyes development.
- Other protein sources food available are chicken, pork, beef, bean curd and eggs.
- Calcium requirements increase during pregnancy.
- Include 2-3 servings of calcium rich food in the diet daily for example low fat milk, yogurt, cheese and so on.
- It is advisable to take low fat milk instead of milk supplement specially formulated for pregnant women.
- This is because the carbohydrate in low fat milk is lower than milk supplement.
- If you have bought the milk supplement, do not worry. You can always drink them after delivery.
- The best drink for pregnant women is water, as it contain zero sugar and zero calories.
- Avoid caffeinated and carbonated drinks.
Please consult a dietitian for an individualized diet plan in order to have a better blood sugar control.
- Luciana V, Jorge L, Mirela J. Dietary Intervention in Patients With Gestational Diabetes Mellitus: A Systematic Review and Meta-analysis of Randomized Clinical Trials on Maternal and Newborn Outcomes. Diabetes Care2014 Dec; 37(12): 3345-3355. http://dx.doi.org/10.2337/dc14-1530