Gestational diabetes (GDM) is a type of diabetes that develops during pregnancy. It can happen at any stage of pregnancy, but is more common in the second or third trimester. It can be managed effectively through diet, exercise, and sometimes medication.
Risk factors for GDM include:
GDM can be effectively managed with diet and exercise. A well-balanced diet is crucial for controlling blood sugar levels and ensuring the health of both mother and baby. Presented below are comprehensive strategies for managing GDM.
When you are diagnosed with GDM, we recommend that you monitor your blood sugar levels regularly. Understanding how your body responds to different foods and activities can be achieved by keeping a log and sharing it with your healthcare provider. Your blood sugar levels can often be lowered by making appropriate changes to lifestyle.
In some cases, diet and exercise may not be sufficiently effective to control blood sugar levels. Thus, some women may be started on medications such as metformin or insulin to manage GDM.
A dietitian can provide personalised nutrition advice tailored to your diet and lifestyle. Here are some general tips to help you achieve a balanced diet during pregnancy while helping to control blood sugar levels:
1. Eat balanced meals
‘My Healthy Plate’ designed by the Health Promotion Board can be used as a guide to achieve a balanced diet.
2. Have moderate amounts of carbohydrates
Carbohydrates are important for energy and baby development. You should not avoid carbohydrates completely. Instead, control your portion of carbohydrates. To achieve good blood sugar control, it is recommended to:
3. Choose foods that are lower in glycaemic index
When choosing carbohydrates, it is recommended to choose low glycaemic index (GI) foods. The GI measures how quickly a carbohydrate-containing food raises blood sugar levels. Choosing low GI foods like multigrain bread, basmati rice over high GI foods like white bread, white rice or yellow noodles can help maintain more stable blood sugar levels.
4. Enjoy plenty of non-starchy vegetables
Aim for half the plate to be filled with non-starchy vegetables such as green leafy vegetables (choy sum or spinach), gourd vegetables (brinjal or bitter gourd), broccoli and carrots. These non-starchy vegetables contain fibre which can help stabilise blood sugar levels and keep you feeling full longer.
5. Protein foods
Protein foods such as meats, chicken, fish, tofu, eggs, cheese, nuts, and seeds are essential for supporting the growth and development of healthy babies. You should aim to fill a quarter of your plate with protein foods which is equivalent to around a palm size of lean meat, poultry or fish at each meal.
Depending on the stage of pregnancy, amount of weight gain progress and the baby growth scan, your protein requirements might differ. Consult your dietitian if you are concerned about your individual protein needs.
6. Fats and oils
Healthy fats are important for your health and your baby’s growth and development. - Use tiny amounts of healthy oils (e.g., olive, canola, sunflower) in cooking, and include foods like nuts, avocado, and deep-sea fish such as salmon and mackerel as part of your diet. Fats taken excessively can lead to unnecessary weight gain and may cause blood sugar levels to stay high for a longer period.
7. Limit processed foods
Processed foods often contain high levels of sugars, unhealthy fats, and sodium. Excess sugars and unhealthy fats can negatively impact blood sugar control, while high sodium intake can affect blood pressure. Focus on whole, unprocessed foods as much as possible.
8. Stay hydrated
Plain water is the best way to stay hydrated. Otherwise, choose unsweetened beverages in moderation.
9. Food safety
Remember, food safety is important during pregnancy. To prevent food poisoning and keep you and your baby healthy:
Have your weight checked regularly throughout your pregnancy. Healthy weight gain during pregnancy is important for you and your baby. It is usual to gain some weight during your pregnancy, as your baby grows. How much weight you should gain depends on your weight before you were pregnant.
Not gaining enough weight can mean that your baby may not be getting all the nutrition they need.
Gaining too much weight during pregnancy can increase the risk of high blood pressure, having a large baby, birth complications or needing a caesarean section. Extra weight gain can also make it more difficult to manage your blood sugar levels.
The table below shows recommended weight gain during a single pregnancy:
| Pre-pregnancy BMI | Weight range | Pregnancy weight gain (kg) | Monthly weight gain 2nd and 3rd trimester (kg) |
|---|---|---|---|
| < 18.5 | Underweight | 12.5 - 18 | 2 |
| 18.5 - 22.9 | Healthy weight | 11.5 - 16 | 1.5 |
| 23 - 27.5 | Overweight | 7 - 11.5 | 1 |
| > 27.5 | Obese | 5 - 9 | 1 |
Regular physical activity can help with managing your blood sugar levels effectively. It is recommended to engage in at least 150 minutes of moderate-intensity physical activity every week. Activities such as brisk walking in the park, swimming at community pools, and practicing prenatal yoga in local studios are excellent options that can help manage blood sugar levels. In general, ease into your physical activity routine progressively and as everyone’s medical condition is different, it is crucial to seek advice from your doctor before starting any exercise regime.
Women with GDM are at increased risk of developing diabetes, fatty liver disease, and cardiovascular disease during their lifetime.
After pregnancy, pregnancy hormone levels rapidly decrease, which resolves insulin-resistance in many women with GDM. However, some women may progress to develop diabetes or pre-diabetes after pregnancy. Therefore, it is important for all women with GDM to have regular follow-up tests for diabetes after pregnancy and before becoming pregnant again.
All women with GDM are recommended to have an oral glucose tolerance test (OGTT) to determine their diabetes status at around 6 to 12 weeks after giving birth.
If the result is normal, women with GDM should still have a yearly blood test for diabetes at least for the next five years.
If diagnosed with diabetes, treatment should be started as soon as possible. It is important to continue a balanced diet, maintain a healthy weight, and exercise regularly during this period. Further advice can be obtained from your doctor and dietitian.
Risk factors for women with GDM developing into diabetes include:
After you have delivered your baby, you will need to repeat a simple blood test called the OGTT to check that your sugar level is normal or if you have diabetes.
This matters because if your test shows you have diabetes, treatment can be started right away. Even if the results are normal, the check-up helps to determine if you might be at higher risk of diabetes later and advice can be given on how to remain healthy.
If you had GDM during your pregnancy and deliver in NUH, a 6-to-12 weeks postpartum appointment for OGTT will be arranged for you by the Obstetrics and Gynaecology team. You will also be invited to come back to the NUH Diabetes Clinic within 6 months from your delivery date to review your OGTT results and to discuss about your diabetes risk. Our aim is to help you stay healthy after your pregnancy and to support you in lowering your risk of developing diabetes.
If you cannot make it for your appointment in NUH, please visit your primary care doctor (e.g. polyclinic) within a year after delivery for continued follow up and screening for future development of diabetes.
Body mass index (BMI) is a straightforward way to check if your weight is healthy for your height. You calculate it by dividing your weight in kilograms by your height in meters squared:
BMI = weight (kg) ÷ [height (m) × height (m)].
BMI Categories and Risks:
Your Goal: If your BMI is above the healthy range, aim to lose about 7% of your body weight over six months. For example, if you weigh 70 kg, losing around 5 kg in six months is a safe, effective target.
Exercise helps your body respond better to insulin, controls blood sugar and keeps your weight in check. Try to do moderate exercise for at least 150 minutes each week (that is about 30 minutes on most days). “Moderate” means your heart beats faster and you can talk comfortably but cannot sing. Some ideas for moderate activity include brisk walking, gentle cycling, water aerobics, dancing, or gardening.
Half your plate with vegetables and fruits, one-quarter with whole grains (like brown rice or whole-wheat bread), and one-quarter with lean protein (like fish, chicken, beans). A balanced diet gives you the nutrients to support breastfeeding.
Aim to breastfeed for the first 6 months. You can breastfeed for up to 2 years or beyond after delivery. Breastfeeding burns extra calories and is a natural way to help you lose weight that was gained during pregnancy. Breastfeeding also strengthens your bond with your baby and lowers your risk of future diabetes. For the baby, breastfeeding provides perfect nutrition, helps build immunity, and promotes healthy growth.
Managing gestational diabetes with proper nutrition is vital for the health of both mother and baby. By following these dietary guidelines, monitoring blood sugar levels, and maintaining a healthy lifestyle, you can effectively manage gestational diabetes and promote a healthy pregnancy. Always consult with your healthcare provider before making any significant changes to your diet or exercise routine.
