This post was written by Juna Advisor & Registered Dietician and Nutritionist – Lauren Manaker, RDN and Rachelle Mallick

When the dreaded glucose tolerance test is around the corner, many pregnant women start thinking about the “what ifs”.

What if I get a diagnosis of gestational diabetes?”

“Will I hurt my baby?”

“Will I have to revamp my whole diet? Will I be able to have a slice of baby shower cake?

Fortunately, getting a diagnosis of gestational diabetes isn’t all that bad and is totally manageable. A lot of the anxiety surrounding the condition stems from the unknown. Well, fear not, my friends! We rounded up the most important information for you to understand all you should know about gestational diabetes. We got you, mama!

What exactly is Gestational Diabetes?

We hear the term gestational diabetes a lot, but do you really know what it means beyond needing to limit your sugar intake? Fair warning, this next part comes with quite a bit of science. If you really don’t need to know the details, skip over to the next part.

To understand how gestational diabetes comes about, you first have to have a basic understand the placenta.

Your placenta does more than support your baby; it also produces hormones to help the baby develop. The hormones are released into your body and some hormones may cause what is called insulin resistance.

Think about a time that you have eaten a carbohydrate-rich meal, like spaghetti. During digestion, the carbohydrates from the meal were broken down into a simple sugar called glucose.

Your body depends on the hormone insulin to help absorb and use glucose. Insulin is released when your body senses glucose in the bloodstream after carbohydrates are eaten.

The glucose needs to enter the cells of organs (like the brain) in order for it to be used as energy. The glucose depends on insulin to help it get into the cells. Otherwise, glucose would remain in the bloodstream.

Insulin Resistance

In insulin resistance, your cells do not respond to insulin. As a result, the glucose may not enter the cells, and may stay in the bloodstream. This is called having a HIGH blood sugar level. The body will attempt to overcome this challenge by secreting MORE insulin. The cells literally become resistant to insulin.

The Problem With Insulin Resistance During Pregnancy

So, your body is experiencing insulin resistance. As a result, the extra glucose that is not entering your cells like it did before pregnancy can pass the placenta and essentially go to your baby. Your baby is therefore being exposed to way too much sugar if mom is not managing her gestational diabetes. Risks associated with gestational diabetes include:

• baby can become very large,
• baby can become at risk for developing diabetes herself,
• baby can have a higher chance of becoming obese,
• Mom can have a higher risk of not being unable to deliver vaginally and delivering via c-section (which is associated with its own risks).

If you have gestational diabetes, you want to make sure that you are eating enough carbohydrates to sustain yourself and your pregnancy, but not eat TOO many that results in a high blood sugar. It is a balance that many women achieve successfully.

Is the gestational diabetes test evaluating how healthy I have been eating since I became pregnant?

In a word: no. Gestational diabetes is a result of those pesky hormones that naturally are secreted from your placenta. It is not a test to determine how many milkshakes you enjoyed during your first trimester.

With that being said, carrying excess weight puts you at a higher risk of having gestational diabetes, so swapping out a milkshake for a Greek yogurt parfait once in a while is a good practice.

Are there any factors that put you at risk for developing gestational diabetes?

Yes, some factors put you more at risk for developing gestational diabetes. Most are unfortunately out of your control. So, even if you have been eating a well-balanced diet and taking care of yourself, you may still be at risk.

Some risk factors include:

• advanced age (≥35 years old according to some experts, >25 according to others)
• overweight or obesity
• excessive gestational weight gain
• excessive central body fat deposition
• family history of diabetes
• history of recurrent miscarriage
• gestational diabetes during prior pregnancies
• polycystic ovary syndrome
• sedentary lifestyle (1)

In the literature, the lowest cutoff is ≥25 years old as a risk factor, as recommended by the American Diabetes Association. (2)

How does the gestational diabetes glucose tolerance test work?

Many providers will start with a glucose challenge test. This test determines how your body tolerates and utilizes a large amount of carbohydrate/sugar/glucose that is taken in at once.

Before the test, a woman will drink a very sweet drink called glucola (or an alternative). One hour later, she will get her blood drawn to determine how much of the sugar from the glucola was used by her body, and how much remains in the bloodstream. If the blood has too much sugar remaining in the blood after an hour of drinking the glucola, further testing may be recommended.

The one-hour glucose challenge test is not a foolproof test and is not 100% accurate. It is used more as a screening to determine whether a woman needs to do the three-hour test. As long as your provider approves and your insurance will cover it, you may be able to just take the three-hour test and skip the initial test.

Glucose tolerance test

Unlike before the one-hour test, the three-hour glucose tolerance test should be taken after fasting. You may be permitted to take some medication, but otherwise should not eat or drink anything before the test.

The test is then performed as follows:
1. You will first have your blood measured to get a value of fasting blood sugar.
2. Afterward, you will drink Glucola (or equivalent).
3. Your provider measures your glucose levels once per hour for the next three hours (bring a good book to read!).

From there, your provider will evaluate your blood sugar results obtained from your blood draws and determine whether you have gestational diabetes.

What is glucola? Can I drink something other than glucola?

Glucola is a a liquid that provides a specific amount of carbohydrates. Is it the healthiest drink in the world? No way. Does it taste great? Not really. Will it harm your baby if you drink one or two bottles of it? In our opinion, no.

While the ingredients are not what we normally recommend pregnant women drink, we do not feel that one or two servings of the syrupy drink will cause any negative consequences to your baby. Living with gestational diabetes and not being aware of it and therefore not managing it is much more risky to yourself and to your baby.

Some alternatives that have been suggested to be an acceptable alternative to the glucola are 28 jellybeans that provide 50 gm glucose (2) or ten strawberry-flavored Twizzlers (3).

Please speak with your health care provider if you are exploring any alternatives to the glucola and do not go rogue without getting the green-light first.

What should I eat before the test?

If you are going in for the three-hour test, you should be fasting unless your provider tells you otherwise.

For the one-hour test, the goal should not be to “pass” the test. The goal is to allow your provider to get accurate results. Failing has such a negative connotation to it. If your results indicate that you have a diagnosis of gestational diabetes, don’t consider it a failure, consider it a blessing that you know what you have to do to keep your baby healthy while you are pregnant.

With that being said, it is possible for you to eat in a way that may give you a false-positive. Some tips:

1. Avoid high-sugar foods shortly before the test and cut back on simple, or refined, carbs. This includes fruit juice, candy, soda, and sweet tea for all of our Southern friends. If you choose to eat a piece of fruit, pair it with a healthy fat and protein like a Tablespoon of nut butter or piece of string cheese.

2. Focus on a balance of complex carbs (like whole grains), protein, and healthy fat. A piece of whole grain toast topped with mashed avocado and an egg is a perfect option!

3. Don’t starve yourself. Your body may over-compensate for the lack of energy that you did not take in and cause your blood sugars to go sky-high.

If you are taking the three-hour test, you must be fasting before the test. Some say that eating a carbohydrate-free snack may be ok, but this is something you need to confirm with your provider before you decide to nosh on a handful of walnuts or some scrambled eggs.

Is there any risk to baby if I “cheat” and try to pass?

We understand why people may want to do everything they can to pass the test. Just like when you were in school, cheating catches up with you in the long-run (do we sound like your parents right now?). If your body is truly experiencing gestational diabetes, why wouldn’t you want to know about it and make some changes to help manage it. If you have gestational diabetes and are not aware of it and therefore not managing it, ultimately you are putting your baby at risk.

Don’t cheat the system. Follow the guidelines your doctor provided you and learn what your true results are.

We addressed the risks to baby previously if you do not manage your gestational diabetes if you truly have the condition.

If you get a diagnosis of gestational diabetes, now what?

Many look at pregnancy as a time for them to “eat for two”. Honestly, the recommended dietary pattern to manage gestational diabetes is a way of eating that would likely benefit almost all pregnant women. It is a balanced way of eating that is rich in fiber, healthy fats, and protein while being low in concentrated sweets.

You should schedule a time to meet with a registered dietitian or a certified diabetes educator to help guide you with your food choices. You will likely be checking your blood sugars to learn your body and determine which foods you should be focusing on.

Some additional supplements to consider if you get a diagnosis of gestational diabetes:

• L-carnitine supplementation may be something to consider to help manage your gestational diabetes or reduce the risk of developing gestational diabetes (4).

• Some data also suggests that certain probiotic supplementation may help manage gestational diabetes as well (5).

• A promising supplement is myo-inositol which was given from first trimester until delivery to women at risk for GDM reporting a significant decrease in gestational diabetes occurrence by more than 60% comparing to the placebo group. Recently, a secondary analysis from 3 randomized controlled trials demonstrated that myo inositol may also significantly reduce some of gestational diabetes complications such as pre-term birth with a favorable impact on mother and fetus well-being (6)

Bottom Line

Gestational diabetes is a condition that affects many women and is easily managed with the right tools.

If you follow the guidance of your health care providers, there is no reason why you should have any concerns about your baby’s health during pregnancy. It is all about balance and taking care of your body.

And in most cases, that means that mama can certainly still enjoy a piece of cake at her baby shower.

This post was written by Juna Advisor & Registered Dietician and Nutritionist – Lauren Manaker, RDN. 

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