Gestational diabetes is high blood sugar (glucose) that starts or is first diagnosed during pregnancy. Pregnant women with gestational diabetes tend to have larger babies at birth. This can increase the chance of problems at the time of delivery.

This article discusses the diet recommendations for women with gestational diabetes who do NOT take insulin.

Eating a balanced diet is an important part of any pregnancy. The food you eat helps your baby grow and develop while in the womb. Diet is even more important if you have diabetes. Most of the time, eating properly can keep your blood sugar (glucose) levels from becoming too high or too low. Eating properly can also help you avoid needing medications for your diabetes.

You can help manage gestational diabetes with diet and exercise. Every pregnancy is different. Your doctor and dietitian will create a diet just for you, based on:

• The type of calories you need
• Your weight (pregnant women who are obese may need a diet with fewer calories that other pregnant women)
• How far along you are in your pregnancy
• How fast and how large your baby is growing
• Your activity level

Remember that "eating for two" does not mean eating twice as many calories. You usually need just 300 extra calories a day (such as a glass of milk, a banana, and 10 crackers).

Recommendations:
The best way to improve your diet is by eating a variety of healthy foods. You should learn how to read food labels, and consult them when making food decisions. Talk to your doctor or dietitian if you are a vegetarian or on some other special diet.

In general, your diet should be moderate in fat and protein and provide controlled levels of carbohydrates through foods including fruits, vegetables, and complex carbohydrates (such as bread, cereal, pasta, and rice). You will also be asked to cut back on foods that have a lot of sugar, such as soft drinks, fruit juices, and pastries.

You will be asked to eat three small- to moderate- sized meals and one or more snacks each day. Do not skip meals and snacks. Keep the amount and types of food (carbohydrates, fats, and proteins) the same from day to day.

Carbohydrates

• Carbohydrates should make up less than half of the calories you eat.
• Most carbohydrates are found in starchy or sugary foods, such as bread, rice, pasta, cereal, potatoes, peas, corn, fruit, fruit juice, milk, yogurt, cookies, candy, soda, and other sweets.
• High-fiber, whole-grain carbohydrates are digested more slowly and are healthier choices.
• While vegetables (such as carrots, broccoli, and spinach) contain carbohydrates, they add much more to your health than to your blood sugar. Enjoy lots of them.
• Carbohydrates in food are measured in grams. You can learn to count the carbohydrates in the foods that you like and that you eat.
  

Grains, beans and starchy vegetables

• Eat 6 or more servings a day: one serving equals 1 slice bread, 1 ounce ready-to-eat cereal, 1/2 cup cooked rice or pasta, or 1 English muffin.
• Foods like bread, grains, beans, rice, pasta, and starchy vegetables serve as the foundation of your diet. They are loaded with vitamins, minerals, fiber, and healthy carbohydrates.
• It is important to chose carbohydrate sources with plenty of fiber. Eat whole-grain foods such as whole-grain bread or crackers, tortillas, bran cereal, brown rice, or beans. Use whole-wheat or other whole-grain flours in cooking and baking.
• Eat more low-fat breads, such as tortillas, English muffins, and pita bread.

Vegetables

• Eat 3 - 5 servings a day: one serving equals 1 cup leafy, green vegetables; 1 cup cooked or chopped raw leafy vegetables; 3/4 cup vegetable juice; or 1/2 cup of chopped vegetables, cooked or raw.
• Choose fresh or frozen vegetables without added sauces, fats, or salt. You should opt for more dark green and deep yellow vegetables, such as spinach, broccoli, romaine, carrots, and peppers.

Fruits

• Eat 2 - 4 servings a day: one serving equals 1 medium whole fruit (such as a banana, apple, or orange); 1/2 cup chopped, frozen, cooked, or canned fruit; or 3/4 cup fruit juice.
• Choose whole fruits more often than juices. They have more fiber. Citrus fruits, such as oranges, grapefruits, and tangerines, are best. Opt for fruit juices without added sweeteners or syrups.
• Choose fresh fruits and juices, which retain more of their nutritional value than frozen or canned varieties.

Milk and dairy

• Eat 4 servings a day: one serving equals 1 cup milk or yogurt, 1 1/2 oz. natural cheese, or 2 oz. processed cheese.
• Choose low-fat or nonfat milk or yogurt. Yogurt has natural sugar in it, but it can also contain added sugar or artificial sweeteners. Yogurt with artificial sweeteners has fewer calories than yogurt with added sugar.
• Dairy products are a great source of protein, calcium, and phosphorus (to keep calories and cholesterol in check, though, choose low-fat dairy products).

Protein (meat, fish, dry beans, eggs and nuts)

• Eat 2 - 3 servings a day: one serving equals 2-3 oz. cooked meat, poultry, or fish; 1/2 cup cooked beans; 1 egg; or 2 tablespoons peanut butter
• Choose fish and poultry more often. Remove the skin from chicken and turkey. Select lean cuts of beef, veal, pork or wild game.
• Trim all visible fat from meat. Bake, roast, broil, grill, or boil instead of frying.
• Foods from this group are excellent sources of B vitamins, protein, iron, and zinc.

Sweets

• Sweets are high in fat and sugar, so keep portion sizes small.
• Eat sweets that are sugar-free.
• Ask for extra spoons and forks and split your dessert with others.

Fats

• Go easy on butter, margarine, salad dressing, cooking oil, and desserts. But don't cut fats and oils from your diet entirely. They provide long-term energy for growth and are essential for brain development.
• In general, you should limit your intake of fatty foods, especially those high in saturated fat such as hamburger, cheese, bacon, and butter.

Expect this diet to change periodically to meet the changing nutritional needs of your pregnancy.

Other lifestyle changes
Your doctor, nurse, or dietitian may ask you to keep track of what you eat. You may also be told to take a prenatal vitamin everyday, possibly with iron and calcium supplements.

It is important for all people with diabetes to monitor their blood (sugar). Your doctor may ask you to check your blood sugar (glucose) every day or several times per day. You may also be asked to check for ketones in your urine.

You should avoid alcohol during pregnancy.

Your doctor may also suggest a safe exercise plan. Walking is usually the easiest type of exercise, but swimming or other low-impact exercises can work just as well. Exercise is an important way to keep blood sugar in control, and physical activity in pregnancy has been found to decrease the risk of developing gestational diabetes.

References
American Diabetes Association. Standards of medical care in diabetes -- 2009. Diabetes Care. 2009;32:S13-S61.

Metzger BE, Buchanan TA, Coustan DR, et al. Summary and recommendations of the Fifth International Workshop-Conference on Gestational Diabetes Mellitus. Diabetes Care. 2007 Jul;30 Suppl 2:S251-60.

American Diabetes Association. Nutrition recommendations and interventions for diabetes: a position statement of the American Diabetes Association. Diabetes Care. 2008;31:S61-S78.

Cunnigham FG, Leveno KL, Bloom SL, et al. Diabetes. In: Cunnigham FG, Leveno KL, Bloom SL, et al, eds. Williams Obstetrics. 22nd ed. New York, NY: McGraw-Hill; 2005:chap 52.

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