When I was six months pregnant with my daughter, I was shocked to discover that I had gestational diabetes. My only risk factor was being older than the age of 25 – not a difficult risk factor to achieve! The fact that I’m a Registered Dietitian gave me a slight advantage in my ability to manage my disease, but still, I was far from being an expert on gestational diabetes. I had a lot of learning to do!

Gestational diabetes is a temporary form of diabetes that occurs during pregnancy and usually ends after the baby is born. For more details about gestational diabetes, including risk factors for developing it, go to this link: http://www.diabetes.org/diabetes-basics/gestational/ .

Left untreated, gestational diabetes causes high blood sugar. In pregnant women, frequent high blood sugars can lead to a very large baby, which can lead in turn to a difficult delivery or a C-section. The baby’s shoulders may get stuck during delivery, leading to nerve damage for the baby. Other possible complications of high blood sugar during pregnancy for the mother include dangerously high blood pressure. Possible complications for the baby include low blood sugar after birth, jaundice, respiratory distress, and others.

Once a woman has gestational diabetes, nutrition plays a very important role in keeping her blood sugars within a healthy range. The way to manage blood sugar is to manage the amount of carbohydrate you eat. This does not mean cutting carbohydrate out of your diet or going on a low carbohydrate diet! Doing so would harm the baby, and isn’t good for you, either (even when you’re not pregnant). Your body, and that of your baby, requires a certain amount of carbohydrate in order to work best. So they key is to eat the right amount of carbohydrate at each meal and snack, so that your blood sugar rises a little bit, but not too much.

But first, you have to know which foods have carbohydrate. Actually, it’s easier to remember which foods don’t have carbohydrate! These include meat and eggs, non-starchy vegetables, and fats (like margarine and oils). Everything else has carbohydrate.

Ideally, women with gestational diabetes should work with a Registered Dietitian to receive an individualized meal plan. But in general, they should aim for three meals and three snacks per day. They should not wait more than three hours in between meals or snacks. And for many (but not all) women, meals should offer three servings, or 45 grams, of carbohydrate, while snacks should offer two servings, or 30 grams, of carbohydrate. To get an idea of what a serving of carbohydrate looks like, go to http://www.diabetes.org/food-and-fitness/food/planning-meals/carb-counting/.

Breakfast, however, is a little trickier. Hormones can cause high blood sugars in the morning, so most women with gestational diabetes should limit their carbohydrate intake at breakfast. In my case, I ate two servings, or 30 grams, at breakfast, but some practitioners tell their patients to limit it to only one serving. For perspective, one serving of carbohydrate is one slice of toast!

To further complicate matters, at breakfast time only, it’s a good idea to avoid cold breakfast cereals, dairy, refined bread, and fruit. These foods cause blood sugar to spike very quickly at that time of day. So what does that leave you for breakfast? Not much, as I discovered! Technically you can have oatmeal, but since you can’t put fruit, honey, or sugar in it, that didn’t sound too appetizing to me. What did that leave me for my carbohydrate? Just whole grain toast. So each morning, I had two slices of whole grain peanut butter toast (I found a brand of bread that had 11 grams of carb per slice).

It’s important to combine carbohydrate with a source of protein at each meal or snack. For one thing, imagine if all you could have for breakfast was a slice or two of toast! But also, protein helps stabilize your blood sugar and keeps you from getting hungry too quickly after meals and snacks. For example, for breakfast, I would combine my two slices of peanut butter toast with some scrambled cholesterol-free egg substitute and two veggie sausage patties. Later in the day, when I was allowed to have dairy, I would often enjoy a container of Greek yogurt for a snack. Greek yogurt is higher in protein than ordinary yogurt – for example, the kind that I ate had 11 grams of protein per serving (as well as 18 grams of carbohydrate). Crackers and low fat cheese also makes a great snack. With meals, I would aim for a 3 ounce serving of meat, to provide 21 grams of protein.

What about sweets and desserts? People with diabetes can enjoy these things, but they have to pay attention to portion sizes. For example, one two-inch square of cake constitutes one carbohydrate serving. So does 1/2 cup of ice cream. But if you’re used to eating desserts the way most Americans eat them, you could easily eat twice the amount of carbohydrate you’re supposed to have at an entire meal!

Finally, many women with gestational diabetes have a sweet tooth but don’t want to waste precious carbohydrate servings on foods sweetened with sugar. (I’m not saying that was me, but many women. Ahem.) So what about artificial sweeteners like sucralose, aspartame, acesulfame potassium, sugar alcohols, and saccharin? Are they safe for pregnant women to eat?

The safety of artificial sweeteners is a very controversial and misunderstood topic, and could take up an entire blog post in itself. Currently, the Food and Drug Administration considers sucralose, aspartame, acesulfame potassium, and saccharin safe for general consumption, even by pregnant women. There have been some studies which have raised concern about some of these artificial sweeteners. For example, one study in 1977 suggested that saccharin may cause bladder cancer. The problem is, in this study, they gave lab rats (not humans) the equivalent of hundreds of cans of diet soda every single day! Since that time, studies in which humans were given normal amounts of saccharin have not shown any increased risk of cancer.

Two points worth mentioning: pregnant women with a disease called phenylketonuria (PKU) should not use aspartame. And eating too many sugar alcohols (like sorbitol, mannitol, and xylitol) can cause gas and diarrhea. Just what a pregnant woman needs – more gas!

So far, no well-designed studies have suggested any harm from sucralose (for example, Splenda), so I often suggest that patients with a sweet tooth can try foods sweetened with sucralose.

Remember, if you have gestational diabetes, nothing in this blog post should take the place of individualized nutrition counseling from a Registered Dietitian. Managing your blood sugar with diet and exercise is critical for the health of both you and your baby. And be sure to check your blood sugar as often as your doctor tells you to!

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