Gestational Diabetes: How Should Pregnant Mothers Treat, Eat, and Exercise?

In traditional concept，pregnant mothers are considered as “one person eating for two,” which leads to an increase in various meals and nutritional supplements provided to pregnant mothers, artificially causing more blood sugar load and even increasing the incidence of gestational diabetes mellitus (GDM). Gestational diabetes can be “endless trouble” for both mothers and babies, and today we will discuss this topic.

Gestational diabetes mellitus (GDM) refers to the condition where the insulin produced by the body during pregnancy cannot meet the additional demand for insulin, leading to abnormally increased blood sugar levels during pregnancy. GDM usually begins in the middle to late stages of pregnancy (24-26 weeks).

Very common, in the Asian population, about 18 out of every 100 pregnant women suffer from gestational diabetes.

The doctor will make a judgment based on the pregnant mother’s family history, past history, BMI, and other comprehensive factors, which are divided into the following two situations:

A. No high-risk factors for GDM: Between 24-28 weeks of pregnancy, undergo the oral glucose tolerance test (OGTT).

B. With high-risk factors for GDM: Between 16-18 weeks of pregnancy, undergo OGTT.

If the result is negative, retest OGTT between 24-28 weeks of pregnancy; if the result is positive, a diagnosis of GDM can be made;

If persistent glycosuria is present, GDM screening will be advanced.

Diagnosis of Gestational Diabetes Mellitus (GDM)

A.    Risks to the baby

Short-term: Macrosomia, birth injury, fetal growth restriction, fetal death, neonatal complications, neonatal respiratory distress syndrome, hypoglycemia, hypocalcemia, etc.

Long-term: Increased risk of obesity, type 2 diabetes, hypertension, coronary heart disease, etc.

B.    Risks to the pregnant mother

Short-term: Diabetic ketoacidosis, cesarean section.

Long-term: Abnormal sugar metabolism-related diseases (obesity, type 2 diabetes, etc.).

A. Purchase a blood glucose meter at a regular pharmacy, such as Roche or Bayer brands.

B. Contact a specialist nurse, who will teach you how to use the blood glucose meter correctly, when to monitor blood sugar; provide dietary health management education and teach you how to fill in a food diary, when to submit a food diary, etc.

C. If possible, contact a dietitian for dietary and weight guidance.

D. Follow the “Zhuozheng Clinic” public account, enter “gestational diabetes” to view related popular science.

Dietary management + blood sugar monitoring + weight control + exercise.

You may need to make some minor adjustments to your eating habits to help you maintain stable blood sugar levels.

• Reasonably arrange 3 main meals and consider adding 2-4 intermediate small meals.

• Reasonably distribute the daily amount of carbohydrates among the 3 main meals to minimize significant fluctuations in blood sugar levels.

• Adding a nighttime snack can help maintain healthy blood sugar levels during sleep and ensure good sleep. For example: a piece of fruit, a few low-sugar soda crackers, etc.

Appendix: Suggestions and recommendations for the use of various foods

(√ for recommended, ● for acceptable, × for prohibited)

A. For the first time monitoring blood sugar, the frequency is: 5 times/day, including: fasting, 2 hours after breakfast, 2 hours after lunch, 2 hours after dinner, before bedtime.

B. Monitor at this frequency for 1 week, if the blood sugar control is ideal within 1 week, and the number of abnormal results is less than 2 times, please persist, then record for another week, send the 2-week record form to the specialist nurse via WeChat or email, and the obstetrician will determine the monitoring effect and adjust the monitoring frequency.

C. If there are 2 or more abnormal blood sugar results within 1 week, it is recommended to send this week’s food diary to the specialist nurse first, and she and the obstetrician will provide dietary guidance and instruct you to make corresponding dietary adjustments.

D. Pregnant mothers monitor for another week according to the new diet plan. If the blood sugar level is well controlled in the new week, persist; if the blood sugar level is still not well controlled in the new week, please seek medical attention in time, and the obstetrician will make a comprehensive judgment and decide whether it is necessary to use insulin control.

Measure weight weekly and adjust the dietary structure according to the weight gain. Maintaining appropriate weight gain during pregnancy is crucial for the health of the fetus.

A. Within 12 weeks of pregnancy, control weight gain within 2kg.

B. Starting from the 13th week of pregnancy, those with a pre-pregnancy BMI of 18.5-24.9 should gain about 0.45kg per week.

C. Those with a pre-pregnancy BMI of 25-29.9 should gain about 0.3kg per week.

D. Those with a pre-pregnancy BMI of 30 or more should gain about 0.25kg per week.

*【BMI=weight/height^2 (Kg/m^2)】

Moderate-intensity exercise is an important part of maintaining a healthy pregnancy. For pregnant mothers diagnosed with GDM, it not only makes insulin work better in the body but also effectively controls blood sugar levels.
Please remember: physical activity may take 2-4 weeks to affect your blood sugar levels, so be persistent.

A. It is advisable to engage in moderate-intensity aerobic exercise, avoiding high-intensity exercise.

B. Pregnant women who did not exercise before pregnancy, it is recommended to start with 3 times/week for the first 3 weeks, 15 minutes of low-intensity exercise each time. Then gradually increase to 4 times/week, each time ≥30 minutes.

C. Pregnant women who have a habit of exercising before pregnancy, it is recommended to engage in 4 times/week, each time ≥30 minutes of moderate-intensity exercise.

D. Pre-exercise assessment: the overall condition of the pregnant mother and the fetus.

E. Identify danger signals: lower abdominal pain, vaginal bleeding, palpitations, shortness of breath, headache, chest pain, fatigue, dizziness, blurred vision, reduced fetal movement, calf pain and swelling, etc.

F. Dress comfortably.

G. Warm up and relax before exercise (warm-up: about 5-10 minutes of stretching exercises; relaxation: about 5-10 minutes).

H. Avoid exercising on an empty stomach. Carry biscuits or candy with you to avoid hypoglycemia after exercise.

I. Exercise effect assessment: good weight control is the best assessment.

A. When using insulin, three meals and intermediate snacks should be regular and consistent. Because they affect the balance of glucose-insulin in the body.

B. Recognize the symptoms of hypoglycemia, although hypoglycemia is not common in pregnant mothers with GDM, if you use insulin, the risk of hypoglycemia will increase. Such as: strong hunger, fatigue, trembling, sweating, nervousness, confusion, dizziness, loss of consciousness, blurred vision.

Consider regular glycated hemoglobin (HBA1c) testing as a marker of overall blood sugar control.

Most pregnant mothers’ blood sugar levels will return to normal after childbirth, usually between 6-13 weeks postpartum to recheck blood sugar:

1. Fasting blood sugar (less than 6.0 mmol/l) or glycated hemoglobin test (checked 13 weeks postpartum, less than 5.7%);

2. If abnormal, consult a doctor, and complete diabetes diagnostic tests, such as the oral glucose tolerance test (OGTT).

References:

1.Diabetes In Pregnancy: Management Of Diabetes And Its Complications From Preconception To The Postnatal Period. RCOG. 2015

2.Gestational Diabetes Mellitus. ACOG. 2013