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Gestational Diabetes (Part 2): Medical Nutrition Therapy

Medical nutrition therapy is the first line of treatment for gestational diabetes (GDM). However, there has been a lack of well controlled studies to support a diet that best meets glycemic targets during a pregnancy complicated by GDM.  This means there is no consensus on the optimal distribution of macronutrients for women with gestational diabetes. If medical nutrition therapy alone fails to meet glycemic targets, then medication (either insulin or oral medication) is indicated.

Various diet restrictions have been studied, some of which include:

  • High carb (45% of total energy as carbs) vs. low carb (42% of total energy as carbs)
  • High glycemic index vs. low glycemic index
  • Low sodium (Dash diet) vs. no sodium restriction
  • High monounsaturated fat vs. low monounsaturated fat

Of the research studies evaluated thus far, results have demonstrated:

  • Improvements in blood glucose readings can be seen in as little as 4 days following a diet change
  • Higher carb amounts may be tolerated if the carbs consumed are unrefined, rank low on the glycemic index scale and are high in fiber
  • High amounts of saturated fat may worsen insulin resistance
  • Diets containing 40% of total energy as carb (40% carb, 20% protein, 40% fat) may improve blood glucose levels 1 hour after a meal

The above information may leave you wondering, “What should I eat?”

  • First things first: as soon as you are diagnosed with GDM ask your physician for a referral to meet with a registered dietitian (ideally someone who has a background in diabetes education, or even a certified diabetes educator). Below is what you might want to learn:

What foods have carbohydrates (carbs)?

  • Grains: cereal, bread, rice, pasta, crackers
  • Dairy: milk, yogurt, ice cream, dairy alternatives (soy milk, soy yogurt)
  • Fruit: fresh fruit, dried fruit, juice
  • Starchy vegetables: potatoes, peas, corn, legumes
  • Sweetened beverages: regular pop, sweet tea, lemonade, etc.

What foods are carb free (or have small amounts of carb)?

  • Meats: beef, pork, poultry
  • Seafood
  • Eggs
  • Cheese
  • Nuts, seeds
  • Fats: butter, cream, oils
  • Vegetables (Most vegetables have 5 grams of carb per serving or less. Starchy vegetables, see above, have greater amounts of carb)

How do I read a nutrition label?

  • Start with the serving size. This will tell you how much of each nutrient is in a single serving. Serving size can be found at the top of the nutrition label.
  • Next, look about half way down the nutrition label for, Total Carbohydrates, this will tell you how much carbohydrate is in a single serving.
  • See the following article for more information on reading nutrition labels:Reading Food Labels

How much carb should I be eating at each meal?

  • This is an important question you should discuss with your physician and registered dietitian/diabetes educator.
  • The American Congress of Obstetricians and Gynecologists (ACOG) recommends the following for women with GDM:
    • Total carb intake remains between 35-40% of total energy intake
    • For someone who needs 1,800 calories per day, this amounts to:
      • 158 to 180 grams of carb per day
      • According to AGOG: the rationale for a lower carb intake is that greater amounts of carb will increase maternal weight gain and increase maternal glucose levels, both of which contribute to macrosomia (baby with a birth weight over 8 pounds 13 ounces).
    • Many women find they need to eat lower carb (less than 30 grams of carb) amounts in the morning hours as there is a tendency to be more insulin resistant at that time of day.

Is fiber Important?

  • Yes! Fiber is a non-digestible type of carbohydrate that has many health benefits.
  • Foods high in fiber (such as whole grains, fresh fruits, fresh vegetables, and legumes) often are lower in the glycemic index, resulting in less of a blood glucose spike following a meal.
  • The recommended daily fiber intake is 25-30 grams (from food sources not supplements)
  • Quick tips to increase your fiber intake:

Do I need to check my blood glucose?

  • This is another important question you should discuss with your physician. Your physician may want you to check your blood sugar at the following times:
    • Fasting (before breakfast)
    • 1-2 hours after a meal
  • Target blood glucose (According to ACOG) levels for GDM:
    • Fasting: 95 mg/dL
    • 1 hour after meal: 130 mg/dL
    • 2 hours after meal: 120 mg/dL
  • A diabetes educator (CDE) can teach you how to use a blood glucose monitor (glucometer)

A few last words:

  • Make sure you are getting adequate protein (meats, fish, dairy, eggs, legumes). Protein needs increase during the second and third trimester of pregnancy when your baby is growing its fastest.
    • During this time, you will need an additional 25 grams of protein per day.
    • Protein can also help keep you feeling satisfied longer in between meals.
  • Non-nutritive sweeteners (found in foods such as diet pop): saccharin, aspartame, acesulfame K, sucralose, and neotame, have all shown to be safe for use in pregnancy (This is according to The Food and Drug Administration).
  • If you are diagnosed with gestational diabetes, you will have an increased risk of developing type 2 diabetes. It is important to keep up with the healthy lifestyle changes you made while pregnant.
    • Your physician will likely screen you for diabetes 6 to 12 weeks after delivery.
  • As always, before making any major diet changes, make sure to discuss such changes with your physician.

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

  1. Mensing, C. 2011. The Art and Science of Diabetes Self-Management Education Desk Reference, Second Edition. Chicago, Illinois: American Association of Diabetes Educators.
  2. Hernandez T, Anderson M, Chartier-Logan C, Friedman J, Barbour L. (2013). Strategies in the Nutritional Management of Gestational Diabetes. Clinical Obstetrics and Gynecology, 56 (4): 803-815.
  3. Mulla, W. (2016). Carbohydrate Content in the GDM Diet: Two Views. View 2: Low-Carbohydrate Diets Should Remain the Initial Therapy for Gestational Diabetes. Diabetes Spectrum, 29 (2): 89-91.