Treating gestational diabetes without going low-carb: Is it possible?

Gestational diabetes (GDM) impacts more and more women globally and in the United States. A lack of international standards surrounding GDM has led to a lack of standardized treatment protocols. The only part of GDM treatment universally recognized is that nutrition interventions are the primary interventions—but there is no evidence-based consensus as to what these interventions are.

Historically, a low-carb diet is recommended for women with GDM to attain blood glucose control. In theory, when thinking of GDM through the framework of Type 2 diabetes, this makes sense. But in practice, this nutrition intervention backfires, potentially complicating GDM management. Why is that?

• A low carbohydrate diet is hard to follow—especially for pregnant women dealing with cravings.
• It takes a long time to adjust to monitoring carbohydrate intake, time pregnant women don’t have.
• The nutrition education and diet counseling are often inaccurate or insufficient and not provided by a registered dietitian.
• Decreasing carbohydrate intake can lead to an increase of high-fat food intake.
• Pressure to succeed for the health of the pregnancy increases anxiety and stress.

If the low carbohydrate diet is so difficult to follow for women with GDM and most moms-to-be will still need medication management of their blood glucose, then why are we continuing to recommend this diet? Thankfully, researchers are asking the same questions, and here is what they have uncovered.

• A customized, individualized diet plan works better for blood glucose control than having everyone follow the same diet.
• Women don’t have to follow a low-carb diet to reduce their blood glucose.
• More than simply reducing carbs, any changes made to improve the nutritional quality of the diet also improve blood glucose.
• Multiple diets including the Mediterranean diet, DASH (Dietary Approaches to Stop Hypertension) diet, and higher carbohydrate diets can lead to reduced blood glucose.
• The type and nutritional quality of carbohydrates matter, not just the total amount.

So it is possible for women to manage their GDM without going low-carb! Women with GDM need to see a registered dietitian within one week of their diagnosis for their nutrition education and diet counseling. The RD can evaluate the baseline diet, goals, capabilities, and knowledge to determine what the best nutrition interventions are for each individual woman with GDM. If you have GDM and are stressing over eating low-carb, don’t! Find an RD who can help you navigate what diet is best for you and the health of your pregnancy. Want to learn more?

If you have more questions about gestational diabetes, it’s always a great idea to speak with a registered dietitian. Registered dietitians are the only credentialed experts qualified to address your unique health questions.

References:

National Institute of Diabetes and Digestive and Kidney Diseases (2017). Gestational Diabetes. Retrieved from: https://www.niddk.nih.gov/health-information/diabetes/overview/what-is-diabetes/gestational/all-content

Farabi, S. S., & Hernandez, T. L. (2019). Low-Carbohydrate Diets for Gestational Diabetes. Nutrients, 11(8), 1737. https://doi.org/10.3390/nu11081737

Yamamoto, J. M., Kellett,, J. E., Balsells, M., García-Patterson, A, et al. (2018). Gestational Diabetes Mellitus and Diet: A Systematic Review and Meta-analysis of Randomized Controlled Trials Examining the Impact of Modified Dietary Interventions on Maternal Glucose Control and Neonatal Birth Weight. Diabetes Care, 41(7).1346-1361

Dolatkhah, N., Hajifaraji, M., & Shakouri, S. K. (2018). Nutrition Therapy in Managing Pregnant Women With Gestational Diabetes Mellitus: A Literature Review. Journal of family & reproductive health, 12(2), 57–72.

Nutrition Care Manual (2020). Gestational Diabetes. Retrieved from: https://www.nutritioncaremanual.org/topic.cfm?ncm_category_id=1&lv1=5517&lv2=18188&lv3=273823&ncm_toc_id=273823&ncm_heading=Nutrition%20Care

Teri L. Hernandez, T. L., Brand-Miller, J. C. (2018). Nutrition Therapy in Gestational Diabetes Mellitus: Time to Move Forward. Diabetes Care, 41(7), 1343-1345

Assaf-Balut, C., Garcia de la Torre, N., Durán, A., Fuentes, et. al. (2018). Medical nutrition therapy for gestational diabetes mellitus based on Mediterranean Diet principles: a subanalysis of the St Carlos GDM Prevention Study. BMJ open diabetes research & care, 6(1), e000550. https://doi.org/10.1136/bmjdrc-2018-000550