Gestational diabetes mellitus is becoming an increasingly more common problem in Australian pregnant women affecting between 5-8% pregnancies3. That equals about 1 in every 15-20 women.
This week will focus on how Gestational diabetes develops, what it means for your pregnancy and ways you may be able to help prevent the disease through your diet.
Gestational diabetes is described as the body being in a state of hyperglycemia, which simply means that your blood contains too much glucose. This disease is first diagnosed in pregnancy and disappears not long after delivery with glucose levels returning to normal1,4,7.
During pregnancy the placenta produces hormones that help the baby grow, however they can interfere and block the action of your normal hormones such as insulin10. In order to overcome this insulin resistance your body must produce 2-3 times the normal amount of insulin10. Insulin is responsible for transporting glucose from the blood into cells where it is used for energy; if there isn’t enough insulin then there will be too much glucose left in the blood and your blood glucose levels will rise and cause diabetes7.
Having diabetes also means that your growing baby is exposed to very high levels of glucose as glucose travels freely from your blood, across the placenta to the fetus. The baby will produce excessive amounts of insulin in efforts to reduce its own blood sugar level7. Insulin is also a growth hormone; thus as more insulin is produced, this will cause excessive growth and fat in the baby 2,7.
Gestational diabetes can affect the pregnancy by3,2,7,4,5:
- Premature delivery – Baby may be delivered at an earlier date than expected.
- Large for gestational age baby – This is where baby’s size is over the normal range. If it is greater than 4.5kg then baby is described as having ‘macrosomia.’
- Injury to the baby during labour – Large babies are at risk of shoulder dystocia whereby the infant’s shoulder gets stuck during delivery, bone fractures or nerve palsies due to nerves being compressed as baby is pushed out.
- Obstructed labour – This occurs when the labour progression slows to a halt due to baby not moving down through pelvis adequately. If this occurs it is likely that assisted delivery is needed with either forceps or vacuum, or an emergency caesarean section.
- Higher risk of developing pre-eclampsia, the blood pressure disease of pregnancy.
- Newborn issues – Baby is at high risk of developing hypoglycaemia or low blood sugar levels after delivery, as well as respiratory distress syndrome, and may be required to be admitted to intensive care unit and stay in hospital for longer period of time.
- Risk of childhood disease –The infant is at increased risk of developing obesity, Type 2 Diabetes mellitus, and metabolic syndrome.
- Risk of maternal disease – You will have an increased risk of developing Type 2 Diabetes Mellitus (30-70%), gestational diabetes in future pregnancies, obesity and metabolic syndrome.
Every pregnant woman as part of her Antenatal Care has a Glucose Challenge Test between 26 and 28 weeks gestation8. This involves consuming 50g of glucose in a non-fasting state. If results are positive you will be required to have another test called Glucose Tolerance Test. This is a fasting test, which involves consuming 75g glucose drink, and if results are positive or high confirms the diagnosis of Gestational diabetes.
Risk factors that increase your chance of developing Gestational diabetes include7,5,9,10:
- Age – If greater than 24 then have 7-10 times greater chance of developing disease.
- Previous Gestational diabetes
- Overweight, obesity
- History of large babies / macrosomia
- Polycystic ovarian syndrome
- Family history of Gestational diabetes, Type 2 diabetes mellitus
- Ethnicity – Indigenous, South Asian, Vietnamese
There is no specific diet for preventing the development of Gestational diabetes6. However both high fibre diets and low glycaemic-index diets have shown to improve insulin sensitivity and glucose tolerance6. This means avoiding high sugar foods and opting for more complex carbohydrate choices, and substituting sugar with foods that naturally contain sugar, as shown in the recipe below. This is discussed further in the blog Diet Recommendations in Gestational Diabetes.
Physical activity also reduces the risk of developing diabetes by 50% through improving the body’s sensitivity to insulin and helping facilitate weight loss which overall improves glucose control. It is recommended that you exercise regularly for at least 30 minutes every day, without overdoing it and staying well hydrated.
By taking on the tips discussed this week this should reduce your chances of developing Gestational diabetes. The following recipe is a good healthy morning tea snack with minimal sugar to help you avoid sweet treats! I will admit these cakes aren’t the most attractive little morsels; however taste and nutritional content does compensate!
Sugar Free Mini-Carrot Cakes – Makes 12
- 2 cups wholemeal flour
- 1 tbsp baking powder
- 1 ¼ cup cold water
- ¾ cup sultanas
- 2 cinnamon sticks
- 1 cup grated carrot
- 1 cup pureed apple (100% apple, baby food)
- to serve – Philadelphia cream cheese, reduced fat
- Preheat oven to 160. Grease 12-muffin tin with minimal butter or alternately use spray.
- Place sultanas, cinnamon stick and water in a small saucepan. Bring to boil and continue to simmer for 5min.
- Combine flour and baking powder together in bowl.
- Place grated carrots in large mixing bowl. Pour in the sultana mixture and applesauce, and gently mix in the dry ingredients.
- Spoon mixture into muffin tin and bake in oven for 30-40min or until cooked when tested with a skewer.
- Cool the cakes on wire rack.
- To serve spread a small teaspoon of cream cheese over the mini cakes.