How important is your diet after gestational diabetes?

Living through a pregnancy with Gestational Diabetes Mellitus (GDM) or gestational diabetes is a huge achievement. But what do you eat now? Should you continue the gestational diabetes diet?

From dealing with the unwarranted guilt that many women feel, through to possibly needing to take medication or inject insulin, it can be physically and emotional demanding.

Remember that you are not alone during or after the arrival of your baby. Your healthcare team is always available for support and guidance.

 Your gestational diabetes diet

Women living with gestational diabetes may be guided by their healthcare team (ie, diabetes educator or dietitian) to adjust several aspects of life, including their diet. Mainly this focuses on their carbohydrate intake.

This advice can include eating specific carbohydrate amounts, which may include needing to learn to carbohydrate count. It also could be gaining a better understanding of different carbohydrate types (higher fibre and or lower Glycaemic Index types).

Together these concepts can help your body manage and use the carbohydrates eaten during pregnancy.

WHY?

Pregnancy hormones from the placenta, which are unique to each pregnancy, help the baby to grow and develop, and are also responsible for causing gestational diabetes. These hormones block the action of the mother’s insulin. Insulin is a hormone that allows glucose broken down from carbohydrate-rich foods to get into cells to create energy.

If glucose cannot get into cells, this leaves the mother without energy and too much glucose remains in her blood stream. The baby then has to access the mother’s blood glucose, as this crosses the placenta, resulting in the baby often growing too large, (macrosomia), for both the baby and the mother.

High motivation

Naturally mothers are very motivated to do whatever they can to help manage gestational diabetes and keep their baby and themselves as healthy and safe as possible.

However, once the baby safely arrives and gestational diabetes disappears, the baby can become the centre of attention and the mother can be left unclear on what needs to be adjusted for life after gestational diabetes; What are the checks and health behaviours which should continue and which ones can be relaxed or stopped?

What do I eat after I’ve had the baby?

One common question for women affected by gestational diabetes is whether they still need to tightly manage their carbohydrate intake after the birth of their baby. For example, do they need to eat specific amounts of carbohydrates at each meal or snack?

Nutrient needs increase after birth

Once discussed with their healthcare team, most women who have lived with gestational diabetes can relax. They can stop tightly managing their carbohydrate intake after the birth of their baby.

It can actually be harmful for the mother and baby, especially if breastfeeding, to continue restricting carbohydrates as their energy and other nutrient needs increase.

Restricting dietary intake can result in low breastmilk production and quality, leading to poor growth and development of the baby, and create energy and nutrient deficiencies for the mother. This can increase the mother’s risk of malnutrition and unintentional weight loss, not to mention the potential unnecessary mental health impacts of continuing to tightly restrict dietary intake.

Healthy diet after gestational diabetes

Many carbohydrate rich foods, are also nutrient-dense foods. This means they not only provide the preferred energy source (glucose) of the brain and body, but other health-supporting nutrients such as proteins, fibres, unsaturated fats, vitamins (b-vitamins and vitamin C), minerals (iron, zinc, and calcium) and important plant chemicals (antioxidants).

Nutrient-dense carbohydrate foods include:

• wholegrains and wholegrain products
• starch-rich vegetables (potato, corn and legumes)
• fruit
• milk
• yoghurt.

While added ‘sugar and starch’ foods such as pastries, biscuits, cakes, lollies and soft drink are also carbohydrates, they are not rich in health-supportive nutrients. If eaten in large amounts they may decrease the quality of a person’s dietary intake and harm their health.

Know your risk

Diabetes Australia’s Position Statement on Gestational Diabetes in Australia (August 2020) suggests that women with gestational diabetes are seven times more likely to develop type 2 diabetes later in life.

Health-supportive behaviours that can help reduce the risk of type 2 diabetes include:

• Mental health wellbeing behaviours such as talking to social and health supports including:
  • family
  • friends
  • healthcare team e.g. psychologist
  • PANDA and or Gidget Foundation Australia
  • taking medication if required
  • working towards improving sleeping patterns and habits
  • reducing stress and building resilience with mindfulness exercises and or environments (i.e. spending time in nature)
• Participating in enjoyable regular movement
• Staying hydrated
• Enjoying a wide variety of nutrient-dense foods including carbohydrates
• Building or maintaining healthy relationships with food, your body and mind, and other people.

After your gestational diabetes diet

If you have any questions about what to eat, including your carbohydrate requirements, please speak with your healthcare team.

The National Diabetes Services Scheme (NDSS) website has many helpful resources also, including an online BABY STEPS program which supports and empowers women previously diagnosed with gestational diabetes to continue to implement lifestyle changes to reduce the risk of type 2 diabetes.

Finally, the NDSS Helpline on 1800 637 700  has diabetes educators, exercise physiologists and dietitians available to guide and support you on your diabetes prevention or management journey. Please reach out if or when you need us.

By Linda Uhr

Credentialled Diabetes Educator and Accredited Practicing Dietitian