How to prevent gestational diabetes in second pregnancy

According to the CDC,  two to 10 percent of pregnancies in the United States every year are affected by gestational diabetes. However, many pregnant women have not heard of gestational diabetes — or know little about it — until they find out they have it. Unfortunately, that can leave little time to navigate what it is, how to manage and treat it, and knowing your options in doing so.

That’s what happened to me. About halfway through my second pregnancy, when I was only a few months shy of my 40-th birthday, I took the mandatory glucose test where you drink a super sugary drink every hour for three hours and get blood drawn afterward to check your glucose levels. And I  failed. Sure, I knew I was carb-loading throughout the day with bread, pasta and pizza (thanks, non-stop nausea!) but otherwise I didn’t think I was eating that badly. Even pre-baby, although I admit I was not on a rigid diet to get back to my pre-baby #1 weight, nor super fit like my pre-mom days, I definitely considered myself healthy and fairly fit for a (nearly) 40-year old mom of (almost) two.

So, what is gestational diabetes exactly and how is it different from standard diabetes? “Gestational diabetes is a type of diabetes caused and seen for the first time in pregnancy and it causes higher than normal blood sugar levels in cells and the body cannot make or use insulin correctly, which can negatively affect the mom and developing baby,” explains Dr. Sherry Ross, author of she-olo gy, co-founder URJA Intimates. “Type 2 diabetes occurs when the body cannot break down sugar (aka glucose) or use insulin normally and occurs when you are not pregnant.”  

The reason that you can have gestational diabetes when you’re pregnant even though you did not have type-2 diabetes prior is because experts say there is a hormonal connection during pregnancy that is affecting glucose and insulin levels. “GDM usually occurs around 24 weeks of pregnancy,” explains Ross. “That’s why testing for GDM is done between 24 and 28 weeks using a high sugar drink given to a pregnant woman and one hour later a blood test is drawn checking the blood sugar (glucose) level.”

What came next for me: an Rx for a blood sugar monitor where I pricked my finger several times a day — first upon waking for a fasting number, then two hours post meals and journaled my readings. My numbers were elevated at both according to the guidelines I was given. And it turns out, pregnant women are kept to a lower blood sugar level range than non-pregnant people because of what’s going on in their body and how levels affect the baby in utero. Therefore, fasting blood sugar numbers should be below 90, and two hours after eating they should be under 140. 

When I gave my week’s worth of statistics to the doc, she recommended I start injecting insulin to manage my blood sugar. But I insisted that I have a little more time to do it with my diet. I knew I could make even better food choices and be mindful of when I was eating, all of which I was not doing prior. 

For example, for breakfast, I had an omelet instead of a bagel, packed cheese sticks in my bag to control my nausea and my blood sugar between meals, curbed my daily chicken salad craving by having it over a salad, not a sandwich, had zoodles instead of pasta and so on. After another week and a half, the numbers were better but they were not great, especially at fasting which is the first reading when I woke up. Again, I was told I needed to take the insulin. Although the doc insisted that data shows insulin did not penetrate the placenta barrier, I was adamant about controlling my blood sugar naturally. And I was met with major resistance. She said I had to see a nutritionist and gave me scary details of how I could harm my baby.

Concerned about what to do, I did see a nutritionist, although reluctantly, since as a beauty and wellness writer, I was sure I knew what to eat and didn’t think I needed the guidance. While some of the info provided seemed way too basic (the likes of not eating processed food like chips or cookies and avoiding fast food), I did learn helpful tricks specifically targeted for me. For example, the half of a banana, I thought was fine in the late a.m. as a snack? Nope. My blood sugar spiked. My early a.m. high readings? She explained that a nighttime snack could help. I started eating a p.m. snack literally in bed that was high in protein, like Greek yogurt or a cheese stick, to help my body level off overnight for lower morning stats.

To help myself make even healthier but also more results-driven food choices, I ordered Real Food for Pregnancy and Real Food for Gestational Diabetes from Amazon. According to Lily Nichols, registered dietitian and certified diabetes educator, and author of this book, paying attention to your diet to help manage gestational diabetes is key. “The goal is to minimize large amounts of carbohydrates at any single meal or snack to prevent a significant blood sugar spike,” she explains. “The standard diet for gestational diabetes includes a consistent intake of carbohydrates (no less than 175g per day) spread out over the course of the day into three meals and three snacks.”

However, like with my case, initially anyway, “unfortunately, this advice is often not sufficient to manage gestational diabetes, especially when women are not offered any wiggle room to decrease their carbohydrate intake to a level that their body can handle,” Nichols says. “This is why I developed my ‘real food approach’ for managing gestational diabetes, which focuses more on matching carbohydrate needs to the individual client such as going lower than 175g per day, if needed, choosing lower glycemic carbohydrates alongside sufficient protein, fat, and fiber, all of which help mitigate blood sugar spikes, and ensuring enough intake of micronutrients that improve blood sugar metabolism and insulin sensitivity,” Nichols notes that in her clinical practice, this approach was able to reduce the chances that a woman will require medication or insulin by 50 percent. 

And while carbohydrates and sugar may seem like the only thing to avoid, Nichols explains that “carbohydrates don’t necessarily need to be avoided, but they need to be eaten in moderation and paired appropriately with enough fat, protein, and fiber to prevent blood sugar spikes.” And I found that for me, that was the missing link: Making the right pairings and timing my eating. “In my many years of practice, I’ve found it necessary to work individually with each woman to better understand her blood sugar patterns when we’re troubleshooting high fasting blood sugar,” she says. 

Ross explains that “some women with GDM respond well to diet and exercise while others need oral medication and sometimes insulin to control their sugar (glucose) levels.” Like me, it took time and a strict diet to curb my numbers and control them without medication or insulin. That meant nixing all simple carbohydrates such as pasta, pizza, and bread as well as even foods naturally high in sugar such as fruit. It also meant timing my meals better to control my glucose and not allow it to have drastic spikes or drops. 

Ross also does note that the older you are while pregnant, statistics show you may be more at risk for developing gestational diabetes, which was likely my issue. And while there is a correlation between gestational diabetes and adult-onset diabetes, there is more to it. Are you someone who eats and lives healthy? If so, your case could have been strictly tied to pregnancy-related hormones. However, if you have underlying conditions, a family history of diabetes, or do not make healthy diet and lifestyle choices later on, yes, it could be a red flag that you are at risk for developing type-2 diabetes post-pregnancy or later in your life. And if that is the case, “identifying early risk factors for adult-onset diabetes such as GDM can be an early call to action to start changing your eating patterns, exercise regimen, and other harmful lifestyle habits,” Ross explains.

The good news: “Once the baby has been delivered, gestational diabetes typically goes away,” says Ross. “And depending on the severity of the GDM, whether you need diet and exercise to control the blood sugar or insulin will determine the follow-up.” She recommends requesting a glucose test postpartum to understand how at risk the mom is to persistent glucose abnormalities, and to eat a healthy diet, exercise regularly, and keep your BMI under 30. 

Yes, it took about two weeks longer than my docs wanted it to in order to get my glucose readings on point, but I was happy I kept at it. And while that won’t work for everyone, and medication or insulin may be necessary, I want to share my story to help give motivation to not give up should managing gestational diabetes with diet and exercise be the road you choose. The bright side: not only did I not gain as much weight as I did in the last few weeks of my pregnancy as I did for my first, as a result of my diet, I felt more energized by the end as well. I can now look at my gestational diagnosis as a blessing now knowing it helped me eat healthier and make healthier choices for my body and my baby. 

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