Healthy Eating and Gestational Diabetes

Follow these steps to help control your sugars:

There is no need to ‘eat for two’ even if you are expecting twins or triplets. To manage feeling more hungry, eat regularly during the day. Try to have three small meals and a small snack between each meal.

• Eat plenty of vegetables and up to three portions of fruit each day.
• Cut down on added sugars and sweet foods, and avoid sugary drinks (this includes fruit juice and smoothies).
• Try to choose higher fibre foods throughout the day.
• Eat less fried and fatty foods, or high fat snacks.
• Limit alcohol intake. Not drinking alcohol at all is the safest approach for your baby.

Along with eating well you should try to take regular exercise each day.

• Keep up with your normal daily physical activity or exercise for as long as you feel comfortable. Don’t exhaust yourself. You may need to slow down as your pregnancy progresses.
• Moderate-intensity exercise (where you are still able to hold a conversation) is not dangerous for your baby. However, do avoid contact sports (squash, kickboxing etc.) and undertake activities that have a risk of falling (e.g. cycling) with caution.
• If you weren’t active before you got pregnant, don’t suddenly take up strenuous exercise. Start with low intensity sessions for no more than 15 minutes and increase this gradually.
• Being physically active helps lower your blood glucose levels. It can also make your muscles use insulin more effectively. Try to take a walk (up to 30 minutes) after meals to improve blood glucose control.

If you have any concerns about your pregnancy/baby and exercise then do not hesitate to contact your midwife or doctor.

The diagram below shows the ideal amounts from different foods in your meal.

Your body breaks down carbohydrates into glucose (sugar). It is important to not cut these foods out completely as they are the main source of energy for your body and your growing baby. Try to have a small portion (quarter of a plate) at each meal.

All types of carbohydrates can be eaten, but some will raise your blood glucose levels less than others, even when an appropriate portion size is eaten. Try to eat more of the higher fibre, more slowly absorbed carbohydrates, as per the list below:

Breakfast cereals: many of our patients find breakfast cereals cause blood glucose levels to rise too much. Try lower carbohydrate alternatives such as natural yogurt and fruit, or eggs with one slice of seeded bread.

Grains: two tablespoons cooked bulgur wheat, quinoa, semolina, couscous, pearl barley.

Rice: two tablespoons steamed/boiled Basmati rice (white or brown).

Pasta: three tablespoons of cooked pasta, all kinds.

Potatoes: two - three egg-sized new potatoes, small (fist-sized) sweet potato (with skin).

Bread: two medium slices of seeded, granary or rye bread, or one pitta bread.

Aim to have at least two to three portions of vegetables or salad and two or three portions of fruit and each day.

A portion of fruit is:

• One large fruit e.g. apple, small banana, pear, orange.
• Two small fruits e.g. plums, apricots, prunes.
• Two tablespoons stewed (without added sugar)/ tinned fruit in juice (drained).
• Eight to ten large grapes or cherries.

A portion of vegetables is:

• Two to three tablespoons of cooked, raw, frozen or canned vegetables or beans e.g. broccoli, cabbage, carrots, cauliflower, courgette, French green beans, mushrooms, peas, peppers, spinach etc.
• Small bowl of salad e.g. lettuce with cucumber, tomatoes, onions and pepper.

Choose two to three small portions (size of the palm of your hand / deck of playing cards) each day from the following list:

• Lean meats or poultry (chicken or turkey) without skin – try not to add extra fat or oil when cooking. Make sure it is cooked all the way through.
• Fresh or frozen fillet of fish (see note below) - preferably not in batter or breadcrumbs.
• Eggs - cooked without fats and oils.
• Cheeses - low fat pasteurised soft cheeses or small amounts of hard cheese.
• Baked beans, lentils, kidney beans, chick peas and similar beans, tofu.

Note: Oily fish such as fresh tuna, sardines, pilchards, mackerel, trout, kippers, herrings, or salmon may be beneficial for you and the baby, however do not eat them more than twice a week. Avoid shark, swordfish and marlin. Limit the amount of tuna you eat to four medium tins a week.

It is also recommended you avoid liver. For further information visit www.nhs.uk

Aim to keep your intake of sugary foods and drinks as low as possible. Sugar is a concentrated form of carbohydrate and can raise your blood glucose levels quickly.

Most people eat too much fat. Eating less fat, especially saturated fat, will reduce your risk of heart disease and diabetes later in life. Fats are particularly ‘energy-dense’ and therefore are high in calories. Reducing your overall fat intake will help control your weight during pregnancy which will also help with your glucose levels.

Ways to have a lower fat intake

• Ready meals, fast foods and takeaways may be high in fats. Look for ones with less than 5% fat (less than 5g fat per 100g of the product).
• Eat fewer pies, pasties, pastries, crisps, nuts, corn or potato snacks (crisps), cakes, desserts and biscuits.
• Limit roast potatoes or chips to once a week or less.
• Limit cheese to four ounces (100g) a week. Try a low fat variety and try grating cheese to make it go further.
• Use skimmed, 1% or semi-skimmed milk rather than full cream milk.
• Use tomato or vegetable-based sauces for pasta rather than cream or cheese based sauces.
• Choose plain fish rather than fish in batter or breadcrumbs.
• Use a spray bottle or measure out oil with a teaspoon.
• Limit high fat ‘extras’ such as salad dressing, mayonnaise, nut butters to a teaspoon serving.

Reducing fat intake when cooking and preparing food

• Use all fats, spreads and oils sparingly. Try using a spray bottle, or measuring out with a teaspoon to limit how much you use.
• Grill, casserole, microwave or bake foods rather than frying it.
• Use low fat yoghurt rather than cream, sour cream or crème fraiche in cooking or on desserts.
• Remove skin and visible fat from meats before eating.

Although all fats are high in calories and therefore can lead to weight gain if eaten in too large a quantity, not all fats have the same effects on the body.

Saturated fats tend to raise the ‘bad’ cholesterol levels in the body. These fats are usually hard or solid at room temperature.

Hydrogenated vegetable oils, also known as ‘trans-fats’ also increase the ‘bad’ cholesterol levels in the body. Trans-fats are no longer used by UK food manufacturers, but foods made outside of the UK could still contain trans-fats.

Unsaturated fats particularly monounsaturated fats and fish oils, offer more benefits to your health.

• Most people consume far more salt than their body needs. If you have high blood pressure, you may be able to reduce it by taking less salt.
• Use less salt in cooking, try using herbs, spices, vinegar and pepper instead.
• Avoid adding salt to meals at the table.
• Cut back on salty foods such as cheese, processed meats and ready-made dishes.

Aim to have at least eight cups of fluid each day e.g. water, tea, coffee, no-added-sugar squash and diet drinks.

It is best to avoid fruit juice and smoothies even if it is labelled no-added- sugar as they can still contain a large amount of natural sugars.

Please note that you do not need to cut out caffeine completely but it does need to be limited. For further information visit www.nhs.uk

If you are eating smaller meals than normal, you may feel the need to have a snack between each meal. Try not to have a snack until you have checked your blood glucose levels one hour after a meal.

Examples of suitable snacks include one of the following options:

• A portion of unsalted nuts (20g serving/ a few in the palm of the hand).
• One hard-boiled egg.
• Vegetable sticks with a teaspoon of houmous, cottage cheese or low fat cream cheese.
• One portion of fruit.
• One to two plain rice cakes, oatcakes or crispbreads topped with a slice of ham, cottage cheese, avocado or teaspoon of peanut butter.
• A portion (approx. 125g) of low fat plain, natural or Greek yoghurts.
• Glass of skimmed or semi-skimmed milk.
• Small packet of lower fat crisps (occasionally) e.g. Popchips™, Walkers Oven Baked™, Walkers French Fries™
• One to two plain biscuits e.g. rich tea, malted milk, shortcake.

It is not always easy to stick to a sensible eating plan. Eating is often triggered by certain situations, emotions or feelings, not just physical hunger. Changing the way you think about eating can take time but it will help you keep your blood glucose levels under control.

Keep a food, mood and blood glucose diary

This can be a useful start. It may help you understand your eating patterns and how they affect your blood glucose levels. Be honest and write down everything you eat and drink for a few days.

Make a note of:

• When you ate or drank.
• How much you had.
• Where you were.
• How you felt and what were you thinking at the time and afterwards.
• What happened to your blood glucose levels.

A few questions to think about:

• Did you find it more difficult to make helpful choices and control your portion sizes at a particular type of day?
• Did your eating behaviours change if you went too long between eating and got overly hungry?
• Was there a difference in your eating at times when you had planned and prepared what you were going to eat beforehand?

Did some foods increase your glucose levels above 7.8mmol?

• Could you consider having a smaller portion or an alternative option next time?
• Some mothers find ‘pairing’ carbohydrates with a protein or a small portion of a healthy fat can help to prevent post-meal spikes. For example:
  • A portion of fruit with a teaspoon of no-added-sugar nut butter/ thin slice of cheese.
  • Slice of seeded toast with a poached egg/tbsp of mashed avocado/ tsp of no-added-sugar nut butter.

Please note: For some expecting mothers it is not possible to manage their blood glucose levels through dietary changes alone and it may be necessary to start medication to help. Please do not feel that you have failed if this is the case.

Breakfast

• One portion of fruit with low fat natural yoghurt.
• One slice of granary, seeded or rye bread or toast with a little low fat spread / boiled or scrambled eggs / baked beans / tinned tomatoes / spinach and mushrooms.

Quick meals

• Sandwiches (made with granary, seeded or rye bread) with salad and tinned fish, lean meat or eggs, with some chopped vegetables on the side.
• Lentil or vegetable soup and a small bread roll with some low fat cream cheese.
• Small (fist-sized) baked sweet potato with filling such as baked beans, cottage cheese or tuna, served with a side salad.
• One to two slices of granary, seeded or rye toast, topped with baked beans, egg, tinned fish, cheese, tomatoes or mushrooms.
• Tinned fish in tomato sauce on bread or toast with low fat spread

Main Meals

• Lean roast meat with boiled or dry-roasted potatoes and a selection of vegetables.
• Small bowl of pasta with a tomato-based sauce and bowl of salad.
• Fish or cottage pie served with peas or a green vegetable.
• Vegetable or lean meat curry with rice and salad.
• Spaghetti Bolognese made with very lean mince and served with a salad
• Stews and casseroles made with lean meat and vegetables.

Aim for a healthy weight and lifestyle to prevent diabetes

After you have had the baby, losing the weight you have gained during pregnancy and continuing to eat a healthy diet is important for your long term health. This will help to reduce your chances or delay you developing diabetes.

If you are breastfeeding do not try to ‘diet’ until you stop.

It is usually better to make small changes to your eating habits which can be sustainable, rather than go on a ‘crash diet’ which you cannot keep to for long. A healthy rate of weight loss is about 0.5kg (one pound) a week.

The best way to lose weight is:

• To keep a better balance of foods at meals.
• Look at your portion sizes.
• Limit snacks.
• Limit fatty and sugary foods.
• Avoid sugary drinks and excessive alcohol intake.

It is also helpful to increase the amount of physical activity you take. If you can, be more active. Build up to 30 minutes walking or other activity each day.

If you decide to have another baby, you may be more likely to have abnormal blood glucose levels again. You will be asked to have a glucose tolerance test at booking, and again at around 16 weeks.

1. NHS Choices. Your pregnancy and baby guide. https://www.nhs.uk/conditions/pregnancy-and-baby/
2. Diabetes UK. Diet and lifestyle with gestational diabetes. https://www.diabetes.org.uk/diabetes-the-basics/gestational-diabetes/diet-and-lifestyle
3. National Institute for Health and Care Excellence (NICE). Diabetes in pregnancy: management from preconception to the postnatal period. NICE Guideline https://www.nice.org.uk/guidance/ng3