Gestational Diabetes – how do I reduce my risk of getting it again?

This blog was co-written by Lana Hirth, Postnatal Dietitian, and Alessandra Rigoli, student dietitian.

Did you have gestational diabetes in your first pregnancy? Are you worried it will come back again for your second? 

Women who are diagnosed with gestational diabetes in their first pregnancy are 30-69% more likely (Noctor et al. 2015) to develop it again in their next pregnancy. Whilst this may sound a bit scary – fear not! There are many ways to manage diabetes during and after pregnancy to reduce your risk of developing it again.

What is Gestational Diabetes? 

Diabetes is where there is excess sugar, glucose, in your bloodstream. Normally, our body releases sufficient amounts of the hormone insulin from the pancreas, This allows glucose to leave the blood and enter into the body’s cells, where it can then be used for energy. 

However, during pregnancy, the action of insulin can be affected by some hormones that come from the placenta, causing insulin resistance. This effectively makes insulin less effective. If insulin cannot allow glucose into the cells properly, the sugar remains in the blood and can contribute to gestational diabetes. 

Why is managing gestational diabetes important?

If you’ve had gestational diabetes before, you’ll know there’s a team that helps you manage it and there are extra considerations during your pregnancy. Why? There are a few reasons. 

  1. Type 2 Diabetes Risk –  Managing gestational diabetes helps reduce the risk of developing diabetes in future – for both you and bub! Women with gestational diabetes are more likely to develop Type 2 Diabetes within 10 years. 
  2. Size of  your baby We know that controlled sugar levels for the mum during pregnancy help to reduce the risk of having a baby that is large for gestational age. When the baby is large for gestational age, this increases the risk of interventions during labour and NICU admissions.
  3. Hypoglycaemia in bub – Glucose also crosses the placenta, so if blood sugar levels are high, this can cause hypoglycemia (low blood sugar) in the baby after birth. This is because the baby gets used to having the extra blood sugar from mum and will release more insulin to use up all the glucose. After birth, the baby doesn’t get the same amount of sugar but is still releasing lots of insulin, causing blood sugar levels to drop too low. 

The good news is, blood sugar levels will return to normal after birth for most women with gestational diabetes. In some cases, insulin resistance will continue after pregnancy and can develop into Type 2 Diabetes.

So, what can I do to reduce my risk of developing it again?

You may be feeling like the odds are stacked against you – but there are many effective ways of reducing your risk of gestational diabetes from reoccurring in your next pregnancy. The best way to keep blood sugar levels within the healthy range is through a healthy diet and regular exercise. Let’s take a closer look at what that might mean for you. 

Maintain a Healthy Diet during and after pregnancy

Eating a wide variety of healthy foods during and after pregnancy can help to maintain a healthy weight and keep blood sugar levels steady, reducing the risk of developing diabetes.

Carbohydrates

Spread your carbohydrate foods across the day to make sure you have enough energy and avoid spiking your blood glucose at one meal. We still need these during pregnancy and postpartum as they are the main fuel source for our bodies. 

Include low GI carbohydrate foods such as:

  • Fruits like apples, pears, oranges and peaches – have 2 serves per day!
  • Whole grain foods like breads, rice and pasta varieties as well as oats 
  • Milk, cheese and yoghurt, but opt for low fat varieties
  • Include both starchy (potatoes, peas, lentils) and non starchy vegetables (broccoli, carrots, eggplant, mushrooms) with every meal

Have a look at your portion sizes

Being mindful of your portion sizes of carbohydrate foods can also help keep blood sugar levels steady. Enjoy a balanced diet, with meals incorporating low GI carbs, lean protein sources, and healthy fats. You can take a look at our blog post on getting back to basics, which breaks down what a serving size is.

Consider limiting high-fat foods

One way to assist with maintaining a healthy weight between pregnancies and reduce the risk of developing gestational diabetes, foods high in fat should be eaten in moderation

  • Avoid foods with high saturated fat content such as fried foods like hot chips 
  • Enjoy healthy, unsaturated fats like Extra Virgin Olive Oil and Nuts 

Inositols

Inositols are a compound that is thought to have positive impacts on blood sugar levels and is typically used in people with PCOS. It can help improve insulin resistance. While it can be found in some foods, a supplement form is usually the best way to get adequate amounts to have the impact we’re wanting on your insulin levels. There is some research to suggest that before pregnancy it can help with insulin resistance, but please see your health care professional for tailored advice for use of this before and during pregnancy.

Managing a healthy weight for you

This can be a sensitive topic, and we’ve put it at the end of this post to show that there are SO many other things that can be done to reduce your risk of gestational diabetes. If you are in a larger body, and particularly have excess fat stores, this can increase your risk of gestational diabetes. We know that changes of even 5% of body weight can reduce your risk. 

Caffeine

You might think that less coffee is better in all cases during pregnancy, but some new research has come to challenge this idea. A new 2021 study compared women who had low to moderate caffeine to those who had no caffeine. They found women who had moderate to low coffee intake (in line with the current guidelines of less than 200mg of caffeine per day) had a reduced risk of developing gestational diabetes than those women who had no caffeine.

Keep in mind, this was done on a relatively small number of women and didn’t include caffeine intake from foods such as dark chocolates. I like to think of an approach like this as the sprinkles on top of a cake, it may have an impact but it won’t play as big of a role as the strategies we discussed above. You shouldn’t rely on this as the only way to reduce your risk of developing gestational diabetes.

Exercise Regularly

Regular physical activity can help keep blood glucose levels steady, as your muscles and organs will use up the sugar for energy. Finding movement you enjoy is a great way to stay active, and doing some form of activity is better than none at all. You should aim for at least 30 minutes of moderate activity, this can include walking, swimming, or resistance training. Consistency is key, so try for 5 days a week of planned exercise, or even incorporating some movement into your everyday routine will have maximum benefit! 

The Verdict

The good news is that these changes can help to reduce your risk, however, if you are one of the 30-69% of people who develop it again in your second pregnancy – all the strategies can help to have a healthy pregnancy while managing your gestational diabetes. Overall, considering your carbohydrates (remember, we don’t need to cut them out), low GI carbohydrates, fats, and exercising regularly can reduce your risk of developing Gestational Diabetes in your next pregnancy.

Do you want to have the best chance of reducing your risk of gestational diabetes? Book a consultation with Lana today for personally tailored nutrition advice.

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