Gestational Diabetes – as the name suggests –  is diabetes that occurs during pregnancy. Diabetes in general relates to our body’s ability (or lack thereof) to control the sugar we take in from food to use as energy. During pregnancy, if all goes as it should, as the baby grows our body actually changes it’s reaction to the key hormone that controls how much energy our cells take from food. This helps the body move from early stage (energy hoarding) to later stage (energy using). Clever stuff. For various reasons however, this adaption sometimes doesn’t happen. That’s when we can get Gestational Diabetes. Unfortunately it impacts as many as 20% of pregnancies worldwide and is on the rise. In some areas it impacts as many as 40% depending on where you are. (2)

The trouble is it can have a whole host of consequences short and long term for you and your baby if your body cannot manage this shift. So, it makes sense to use the latest science and research to reduce our risks of getting it. To help our bodies adapt. 

First thing’s first: a few things to understand when it comes to tackling risks around gestational diabetes: 

Obviously during pregnancy there are enormous changes that go on throughout the body. Did you know however that how our body reacts to the sugar we eat changes as well? Specifically it’s sensitivity to the key hormone Insulin. (1) It is insulin that enables sugar that we eat to enter cells to be used for energy. Without it, the sugar cannot get in and stays in the blood. Think of Insulin as like a key in a lock, enabling sugar from food into our cells for use as energy. 

What ‘should’ happen in early pregnancy: 

During early pregnancy our sensitivity to insulin INCREASES. The reason it does this is to take up as much energy as possible for stores. In preparation for the energy needs later in pregnancy. Makes sense… 

This shifts as pregnancy progresses – but at this point we can be more vulnerable to Gestational Diabetes: 

Did you know that as your pregnancy hormones from the placenta surge you actually get into a degree of insulin resistance? That means that your cells are less likely to react as they should to insulin’s ‘unlocking’ effect and can raise your blood sugar. Simply: to give more fuel to your growing baby. 

‘As a result, blood glucose is slightly elevated and this glucose is readily transported across the placenta to fuel the growth of the fetus.’ (1) 

Helping your body manage this shift…. 

As you become more ‘insulin resistant’ to allow your baby to get the energy it needs your body should compensate. It does this by increasing the size and number of the all important Beta cells (that produce/store insulin) in the pancreas. 

When this doesn’t happen, you’re potentially at risk of developing Gestational Diabetes: 

Whilst there is absolutely a degree of genetics at play for some people predisposing them for this to happen, it is by no means the only explanation. In fact, research has shown that lifestyle (diet/activity) intervention before and during pregnancy could potentially reduce as many as 45% of incidence of Gestational Diabetes cases. (4) Given that getting it during pregnancy can lead to problems with your pregnancy (increased risk of preeclampsia/birth complications etc) plus problems for your baby in the near term (under/overweight) and longer term risks of metabolic issues it is worth reducing our risks wherever possible. 

So, who is more at risk from developing Gestational Diabetes? 

Genetics aside the following groups need to pay extra attention and could be vulnerable: 

• maternal age + 35yrs 
• High BMI
• Excessive weight gain during pregnancy
• Western diet
• Smoking
• Ethnicity (there are particularly high rates in South East Asia) 
• Family history
• PCOS 

The good news is that for some people the evidence does suggest there are things that have real benefit in the quest of reducing our risks of developing gestational diabetes. 

Here are 10 science backed ways you can help reduce your risks of developing gestational diabetes: 

First up the bad guys to avoid…. 

Endocrine disrupters: 

An Endocrine Disruptor in simple language is something that can disrupt our hormonal balance. Unfortunately they are rife in modern life. One in particular that has been linked to Gestational Diabetes is BPA which is found in many plastics. How does it have an impact? Research has identified that BPA can interfere with processes in the placenta (exosome signalling in case you were wondering!) (1, 4). Either way they are not good for us or growing babies. The suggestion is too much can add to our risk for Gestational Diabetes – not to mention others. Click here for more. 

BPA is found in many plastics so for yourself and the planet it really is best to avoid. Click here for easy ways to identify it. 

B Vitamins and Gestational Diabetes: 

Having enough of the good stuff is crucial for a healthy pregnancy. Particularly things like the B vitamins and Folate. Super important for growing brains and nervous systems. Click here for more. 

However, not having ‘enough’ has also been linked to higher probability of developing Gestational Diabetes (1). The recommended intake at least of Folate is 400 micrograms pre and during pregnancy. Obviously a healthy balanced diet is helpful too. Think whole grains, legumes, eggs and dairy, nuts and seeds and dark leafy green vegetables. 

Nitrites/AGEs and processed meats: why they can play particular havoc with Gestational Diabetes: 

So most of us by now know that processed meats are not good. The evidence suggests that the ‘relationship between processed meat and Gestational Diabetes remains strong.’ (1) Why? It has been suggested that by-products related to the processing of meat could be responsible. Nitrites (a common preservative in processed meat) or AGEs (advanced glycation end products) have both been implicated in beta-cell toxicity. (1, 5) Remember, it is these Beta cells that play such a big role in production and storage of insulin. So, steer clear! 

Saturated/animal fats and proteins: 

Like most things in life. It is all about quality and not quantity. Particularly when it comes to animal protein and fat. Saturated fats directly interfere with insulin signalling. They can also bring on our enemy inflammation (click here for why that is not what we want!). (1, 3, 4). 

Linked to this: Gestational Diabetes and Iron?! 

Whilst pregnant women are often at risk of deficiency on the flip side – too much has been implicated in greater risk of developing Gestational Diabetes (5). Heme iron is the form most commonly found in animal produce like red meat/chicken etc. Keeping your intake consistent and moderate never a bad thing. It is also yet another reason why we have to avoid wildly taking supplements without regular blood tests during pregnancy. Make sure your health care provider is on top of your iron levels. Click here for much more on what you need to know about managing your iron during pregnancy. 

Next: the good guys when it comes to risk reduction: Fibre: 

Not only can fibre potentially reduce the chances of our kids developing autoimmune conditions like Coeliac disease (click here), but it can seemingly reduce our risks around developing Gestational Diabetes too. Even more reason to get involved. 

How? This could be the result of reduction in appetite from feeling full for longer. It could also be a result from slowing glucose absorption and reducing the demand on the beta cells in the pancreas whose job it is to produce insulin. Either way it is good all round. (1) 

Examples of foods high in fiber:

Peas, Cauliflower, Avocado, Strawberries, Banana, Raspberries, nuts, chia seeds, legumes, lentils, whole grain pasta, Quinoa and oats. 

Omega 3 fatty acids: 

We know that chronic inflammation is not what we want. It has been linked to development of Gestational Diabetes. One reason is that once again the all important Beta cells are particularly vulnerable to Oxidative Stress which is a bi-product of too much inflammation for too long. (1, 3, 4).

Omega 3 fatty acids (commonly found in fish) have been found to have strong anti inflammatory properties. Click here for much more. 

Inositol a secret weapon particularly for those with PCOS who may be more vulnerable to Gestational Diabetes: 

One aspect that many women with Polycystic Ovaries suffer from is a degree of Insulin Resistance. This is pre pregnancy. In fact it has been said to impact as many as 70% of those with PCOS. Research has shown compelling evidence that Myoinositol can help the body manage insulin resistance. Click here for much more detail. 

Once again, for any supplement speak to your doctor. However, research (6) suggests evidence that taking this supplement ‘from the first trimester through to delivery in women at risk may reduce not only Gestational Diabetes rate but also its principal complications.’

So, worth a discussion with your doctor, particularly if you’re in the high risk group.

Carbs: quality not quantity and not about avoiding either:

There has been some thinking that when it comes to diabetes in general avoiding any ‘sugar’ or carbs is the way to go. However, when it comes to pregnancy the research suggests that focusing instead on higher quality carbohydrates – those with low Glycemic Index – ie. that break down slowly and are unprocessed is the best way to go. (2).

Think whole grain pasta, brown rice, Quinoa and starchy vegetables like sweet potato. On the flip side highly processed carbohydrates like fizzy drinks, sweets are of course the enemy.

Activity Levels… particularly pre-pregnancy: can reduce chances of Gestational Diabetes by 50%?! 

We know that being physically active through pregnancy is beneficial in an uncomplicated pregnancy. Click here for more. In fact, ‘recreational physical activity in early pregnancy was related to a >20% reduction in risk of Gestational Diabetes. (4)

Even more significantly, pre-pregnancy activity on average related to a reduction of risk of > 50%! (4)

We are also not talking about running a marathon: ‘among women who did not engage in vigorous activities a brisk walking pace and stair climbing were associated with lower risk.’ (4)

In fact, the simple act of walking after meals can have a real benefit. One study suggested that ‘acute bouts of moderate-intensity walking after eating improved fasting and (after eating) glycemia… for up to 3hrs after the meal.’ (2).

Obviously the key to any form of exercise during pregnancy is if it is safe for your particular pregnancy. However, as above walking can be really beneficial.

Bottom line? 

Gestational Diabetes is on the rise globally. For some of us genetics makes us more vulnerable. There are a good percentage of us however who can really benefit from lifestyle intervention. We hope these ten evidence-backed nuggets we hope can help reduce the risks of it developing for you and your baby.

References: 

1) Plows J, Stanley JL, Baker PN: Reynolds CM: The Pathophysiology of Gestational Diabetes Mellitus: International Journal of Molecular Sciences: October 2018. 

2) Szmuilowicz ED, Josefson JL, Metzger BE: Gestational Diabetes Mellitus: Endocrinology and Metabolism Clinics of North America: 2019 Sept; 48(3): 479-493 

3) Farabi SS, Hernandez TL: Low-Carbohydrate Diets for Gestational Diabetes: Nutrients: 2019 Aug: 11(8) 

4) Zhang C, Rawal S, Seng Chong Y: Risk factors for gestational diabetes: is prevention possible? Diabetologia: 2016 Jul: 59(7): 1385-1390 

5) Zhang C, Rawal S: Dietary iron intake, iron status and gestational diabetes: American Journal of Clinical Nutrition: 2017 Dec: 106

6) D’Anna R, Santamaria A, Alibrandi A: Myo-Inositol for the Prevention of Gestational Diabetes Mellitus: A Brief Review: Journal of Nutritional Science and Vitaminology. 

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