Category Archives: pregnancy conditions

Diet recommendations in Gestational Diabetes

Gestational diabetes mellitus is a form of diabetes or carbohydrate intolerance that occurs during pregnancy, affecting between 5.2-8.8% Australian pregnant women1,2,3,4,5.

When you are first diagnosed with Gestational diabetes dietary therapy is usually considered to be your first line of treatment1,3. This means that eating the right diet is essential for optimal outcomes and this blog looks at how that can be achieved.

Firstly your dietary goals are6,12:

  • Maintain your blood glucose levels in accordance with guidelines.
  • Eat a well-balanced diabetic diet with carefully selected carbohydrate foods that have low glycaemic index.
  • Prevent excessive weight gain.
  • Seek dietitian advice.

Carbohydrates are essential for a healthy diet and once consumed, are broken down by the body into glucose and used for energy. However they must be carefully selected as the type, amount and frequency has major influence on your blood glucose levels12. The Glycaemic Index (GI) is a way of ranking foods that contain carbohydrates and how your body and blood sugar levels will respond6,12. The lower the glycaemic index, the smaller the rise in blood sugar levels resulting in a more sustained release of energy and keeping you fuller for longer6,12.

Your diet will be individualized according to your weight as well as gestation, however is based on the following principles:1,6,8,9,12

1. Eat well balanced diet

2. Daily carbohydrate intake,

  • Makes up 35-40% of your total daily calorie intake.
  • Carbohydrates should be spread over the day into 3 main meals and 3 small snacks. This will help keep blood sugar levels steady and avoid fluctuations.
  • Main meals = 2-3 small carbohydrate serves, snack = 1-2 small serves.
  • Choose low GI and low fat options.

2. Low GI foods

  • Aim to consume recommended amounts of carbohydrates with a low glycaemic index and high fibre content at each meal.
  • Do not overcook carbohydrate foods as this may increase the GI.
  • Avoid sugary soft-drinks that contain large amounts of sugar, and instead opt for freshly squeezed juice or sparkling water instead

3. Limit fat intake

  • Fats affect the body’s ability to digest carbohydrates and can also raise the ‘bad cholesterol’ levels.
  • Lower your intake of saturated fat by avoiding untrimmed meats, chops and sausages, butter, and full-fat dairy products.
  • ‘Reduce the spread on bread’ – Use a light margarine on sandwiches instead of butter.
  • Use less fat in cooking using fresh ingredients such as herbs and spices to flavour foods, and use sunflower or canola oil instead that contain the good fats.
  • Choose low-fat dairy products. Look at the label and choose milk, cheese and yoghurt with less than 10% fat content.
  • Trim off any of the animal fat before cooking and choose lean meat varieties.
  • Avoid creamy sauces or dressings. Use instead reduced-fat dressings or no-oil mayonnaise.

Physical activity also helps control blood sugar levels. You should be aiming for at least 30 minutes of moderate intensity exercise every day, in activities such as brisk walking, swimming or pregnancy pilates11,12. This will also help you prevent excessive weight gain and keep your fitness levels at a good level.

In order to assess your diabetic control you will be required to do your own blood sugar monitoring at home3,12. Levels must be taken first thing in the morning for a fasting level, and 2 hours after each main meal for a post-prandial level3,10. National targets specified for Gestational diabetes are a fasting blood sugar level of less than 5.5 and 2 hour post-prandial level of less than 7.01,10,11. If your blood glucose levels exceed recommendations on at least 2 occasions within 1-2 week interval then insulin therapy will be necessary1,3.

Your doctor should also refer you to a dietitian who can provide you with an individual eating plan. This will also ensure that you aren’t restricting yourself of too many calories that can cause your body to go into ‘starvation mode’ which has significant health effects, as well as reducing the supply of glucose to the baby which can have detrimental effects on its growth and neurological development1,6. Studies have also shown that women on very strict diets are more likely to be non-compliant with them and have much greater and frequent cravings for sweet foods due to feelings of deprivation6,7.

Having Gestational diabetes does mean changes to your diet. One of the great motivating factors however is that if you follow the guideline and have great glucose levels, insulin therapy and the daily injections it involves can be avoided!

These pikelets prove that morning tea can still be an exciting part of the day for a diabetic mother. I will admit they have a slightly different ‘wholesome’ taste, however given high protein content, low GI, and no sugar or saturated fats, they make a truly perfect and allowed treat!

Wholemeal Quinoa and Raspberry Pikelets – makes 14

  • 1 cup uncooked quinoa
  • 3 cups boiling water
  • juice of 1 orange
  • 1 ½ cups wholemeal flour
  • 2 tsp baking powder
  • ½ tsp salt
  • 2 large eggs
  • 2 large egg whites
  • 2 tbsp butter
  • 2 cups low fat milk
  • 400g box frozen raspberries, unsweetened
  • natural yoghurt, to serve
  • Place the boiling water, fresh orange juice and quinoa in a medium saucepan. Bring the mixture to boil and then simmer for further 15min or until quinoa is cooked. It should be soft with still a mild bite.
  • Place the flour, cooled quinoa, baking powder and salt in a large mixing bowl. Stir well to combine.
  • Whisk the eggs, egg whites, melted butter and milk in another smaller bowl.
  • Stir into the dry ingredients.
  • Heat a skillet pan over medium-high heat. Spray the pan with canola spray and place a heaped large spoonful of mixture into the centre of the pan and top with frozen raspberries. Cook until the tops start to bubble and flip the pikelet over and cook remaining side.
  • Repeat for the remainder of mixture.
  • Serve the pikelets with natural yoghurt.


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An overview of Gestational Diabetes

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.

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