7 Tips for Dealing with Gestational Diabetes, According to Top OBGYNs
By Alexandra Frost
Gestational diabetes can be a scary thing, but it’s important to know that you, or your loved one, are not alone and that you can still have a completely healthy pregnancy. Hear tips, tricks, and what to expect when dealing with gestational diabetes from top OBGYN’s.
Between weeks 24 and 28 of your pregnancy, your healthcare team will do a standard screening of your glucose levels to test for gestational diabetes. In this moment, just when you are about to enter the third and final trimester of pregnancy, coming up on the home stretch, you may be hit with some shocking news – you, along with 14% of pregnant women, have gestational diabetes (GD), and your life is about to change.
We spoke to OBGYNs who have seen thousands of people thrive while living with GD to get some insight into what this experience may be like. They’ve revealed the tips and tricks, along with concrete medical advice they use with the people they treat, to ensure the calmest and healthiest path to a successful pregnancy and birth. Here’s what they recommend.
#1 Don’t get scared and do nothing
After going to your OBGYN, drinking that nasty orange glucose test drink and waiting a few days for your test results, hearing that your glucose test results indicated GD can be scary and disappointing. Some people need to move on to an additional test to confirm a diagnosis, and then their healthcare professional will determine if they need medication, lifestyle changes, glucose monitoring, or insulin injections, or some combination thereof.
Dr. Cindy Duke, MD, PhD, FACOG, a fertility specialist and virologist in Las Vegas, said this is the part where some people freeze and do nothing about it, but shouldn’t.
“They go into denial and decide it’s not them. It’s important once you are diagnosed to do everything you can to get as healthy as possible for overall long term health and for the risk that it poses to the baby,” she said.
Having GD means that the mother’s high levels of circulating glucose can cross the placenta, causing the baby’s pancreas to make high levels of insulin, she explained. This can lead to a larger baby (called macrosomia), resulting in a cesarean section instead of a vaginal birth, or a stuck baby (dystocia) resulting in what is know as a “big episiotomy,” (or an incision made to widen the opening for the baby).
Other risks to the baby include excessive birth weight, early premature birth (which can have a host of associated problems), respiratory difficulties, low blood sugar, obesity and type 2 diabetes later in life, or even stillbirth.
These are all significant reasons, Duke says, to take action and not “hide” from the diagnosis. Instead, work with your HCP to properly manage your GD.
“The biggest key to success when diagnosed is taking charge,” she said. One way to do this is to check your glucose levels often with either a blood glucose meter or a continuous glucose monitor (CGM). Focus on keeping your glucose levels in a target range of 63 to 140 mg/dL at least 85% of the time – including spending less than 4% of the time below 63 mg/dL and less than 10% of the time above 140 mg/dL.
#2 Don’t play the blame game
Even though there are some lifestyle factors that play into being diagnosed with GD – staying active and eating healthy can help all women have a safe pregnancy – you didn’t get it solely because you have excess weight, or because you ate too much ice cream, or because you aren’t a good parent to your unborn child.
There are a host of factors that play a role in the development of GD, many of which you may not have control over, such as the hormones released as the placenta grows, said Dr. Heather Masters, MD, MS, and the Director, Diabetes and Pregnancy Program at the University of Cincinnati College of Medicine. Other factors such as age, genetics, a family history of GD, or health problems (heart disease, high blood pressure, or polycystic ovary syndrome) that coincide with your pregnancy all play a role.
While pregnant women and their partners often worry that problems with their pregnancy are a result of their lifestyle choices, this one is not. The faster you can move past (or completely avoid) self-blame, the more mental energy you can devote to positive lifestyle and nutrition changes.
Dr. Lauren Demosthenes, OBGYN and senior medical director with Babyscripts, echoed this recommendation. She hopes people move away from blame towards a curiosity mindset instead.
“Watch your blood sugars and be curious – if you have a high blood sugar, reframe that and be curious as to why,” she said. “What can you change? Just that simple change of becoming ‘curious’ instead of ‘blaming’ will give you power.”
#3 Make it a family affair
So many things about a pregnancy can make it seem like it’s just the mother’s problem, from navigating morning sickness all the way through going back to work postpartum. But GD can be a family affair that involves the creativity of everyone, from partners and other children, to grandparents, neighbors and close friends.
Demosthenes said, “Discuss ways to incorporate food changes and exercise into family goals.”
For people with GD, this usually looks like working with a dietician to implement the following eating habits, though it can vary from person to person, according to Duke:
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Eating low carbohydrate foods in moderation (not NO carbohydrates)
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Eating frequent snacks, such as one between each main meal, and one before bedtime if bedtime is later, like 5-6 hours after dinner, including a protein with each snack
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Integrating as many healthy foods as possible into your diet
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Planning your meals ahead of time so you can make better choices
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Don’t starve yourself
Your family can provide moral support by eating more of these foods with you, helping with food preparation, and reminding you to eat if you are too busy and skipping meals.
#4 Strive for 10,000 steps for a healthier pregnancy
This isn’t time to do that CrossFit trial class you’ve never been to. This is time to get moving, our experts recommend, but to integrate exercise that is comfortable and doable for you in your specific pregnancy. Duke said she recommends her patients get a simple step tracker (pedometer) and aim for around 10,000 steps per day, or at least increase by 33%.
“Do you have a pet? Walk your pet,” she said. “If your neighborhood is safe, and if you have kids, turn it into a family event to go walking in the evening.” Even just parking further from a building can help the steps build up.
“The biggest part of the body taking up sugar is your muscles, so you need to work them… working your muscles helps regulate your sugar, and exercise decreases the need for C-section,” Duke said. “Regular exercise also decreases the risk of a prolapse, if someone delivers a big baby, that work strengthens the muscles in the pelvis.”
Duke also recommends trying aqua fitness, stretching or yoga, and resistance bands – depending on where you live and what might be available to you.
#5 Find a culturally competent dietician you trust
You may find yourself heading to a dietician for more specific help with the foods you are choosing, and how they work with your glucose, after your diagnosis. But not all dieticians are the same, and Duke said she hopes pregnant women are finding one that is culturally competent or sensitive, as many food choices are related to your specific culture and background.
“For example, you can’t take a [pregnant person] from South East Asia or India and tell her no flour or rice, or you just eliminated three-fourths of her usual diet,” Duke said. “You can’t show her a ‘meat and potato’ menu.” She urges those at risk of, or with, GD to speak up about allergies, food preferences, and current diet, and report back to your OBGYN if they recommended someone you didn’t “gel with” to find someone different, rather than settling.
In addition, “Sometimes women feel like bringing their blood glucose logs is like bringing homework to be graded but think of it more as a map to tell us how to move forward,” she said. “We prefer honest blood glucose logs, even if the numbers are not [well managed].”
A dietician can also help you find “substitute” foods, Masters said, if you are missing a specific food and need an alternative “that will hit the spot.”
#6 Build support networks
GD can feel like it’s become a major part of your life, and without the proper support it can be overwhelming. Experts recommend reaching out for support in a variety of ways. Duke recommends looking for support groups near you by using the American Diabetes Association's directory resource, though you can also join groups on social media and other platforms as well.
On Facebook, the “Gestational Diabetes Support and Meal Ideas” group has almost 25,000 members and a few hundred posts per day, for example. Anonymous online support in these types of groups can give you a place to vent, commiserate, get ideas, and more.
Demosthenes wants people with GD to deliberately add spiritual and mental health support. She recommends writing down three good things at the end of each day, a habit she says is proven to make you a happier person overall. Some examples she gives include: “The clouds are beautiful,” “a stranger smiled at me,” “I ate plain oatmeal and it satisfied my hunger,” and similar small victories.
#7 Pay attention to postpartum health due to increased risks
Sometimes people with GD wonder if this will lead to developing type 2 diabetes postpartum and beyond, and the truth is that it is a possibility.
“People who develop [GD] need to be aware of it because it poses risks in the pregnancy, but is also the biggest determinant or risk of type 2 diabetes later in life,” Demosthenes said. She recommends postpartum parents keep up with their new good habits to promote overall health for the whole family going forward.
The CDC recommends that you get tested for diabetes 6 to 12 weeks after your baby is born, and then every 1 to 3 years after that. Statistics show that about half of all women who had gestational diabetes develop type 2 diabetes later in life.
Some concrete ways to prevent type 2 diabetes include those who have excess weight losing weight (safely, after pregnancy, if your HCP recommends it) and keeping it off, and everyone moving more and eating healthy foods most of the time, according to the National Institute of Diabetes and Digestive and Kidney Diseases. In addition, results from the Diabetes Prevention Program (DPP) showed that intensive lifestyle intervention and the use of metformin after pregnancy could help lower a woman’s risk of developing type 2 diabetes later on in life.
While you may be at an increased risk, you are also at an increased advantage armed with this new knowledge and lifestyle hacks to make sure you are as healthy as possible for your new baby, and for yourself. For more information on GD, read: “Understanding Gestational Diabetes.”
