- What is GDM?
- What causes GDM?
- What symptoms might I feel?
- What are the risks during pregnancy for someone who has GDM?
- What can I do to lower the risks for my baby and myself?
- What is hypoglycemia (low blood sugar)?
- What is hyperglycemia (high blood sugar)?
- Will I have diabetes after pregnancy?
- How can I lower my chances of getting Type 2 diabetes?
- How do I get rid of my lancets?
- What is gestational diabetes?
- Blood sugar control during pregnancy
- Diabetes management
- How does diabetes affect the baby?
- Foetal Macrosomia
- Risk factors for developing diabetes during pregnancy
- 9 Gestational Diabetes Dos and Don’ts
- Managing Gestational Diabetes Naturally
- Gestational Diabetes
- 5 Natural Ways to Manage Gestational Diabetes Symptoms
- Evaluating Traditional Chinese Medicine and Herbal Products for the Treatment of Gestational Diabetes Mellitus
- What is the best diet for gestational diabetes?
What is GDM?
Gestational diabetes (GDM) is a type of diabetes you can only get during pregnancy. It often appears in the last half of pregnancy. If you are diagnosed early in your pregnancy, you may have had diabetes before you became pregnant.
What causes GDM?
When you eat, your body breaks down food into glucose, also called blood sugar, and uses it as energy. Insulin is a hormone made by the pancreas. It acts like a key to open the door to the body’s cells. The sugar can then move out of the blood and into the cells to be used for energy. With GDM, your body is not able to make enough insulin to use sugar in the normal way.
During pregnancy, the baby’s placenta makes hormones that do not let you use the insulin your pancreas makes as well. This is called insulin resistance. This causes sugar to build up in your blood and leads to GDM.
Glucose and other nutrients are sent to your baby through your blood and the placenta. A change in your blood sugar level will cause a change in your baby’s blood sugar level. The goal is to keep your blood sugar within normal levels.
What symptoms might I feel?
Most women with GDM feel healthy and have no signs.
What are the risks during pregnancy for someone who has GDM?
- Polyhydramnios (too much amniotic fluid around the baby)
- Pre-eclampsia (high blood pressure)
- Macrosomia (large baby)
- Need for a cesarean section delivery (if the baby is too large and labor is too long)
- Hypoglycemia (low blood sugars for the baby after delivery)
- Respiratory distress syndrome (breathing problems for the baby after delivery)
- Fetal death (It is rare, but a baby may die before delivery for reasons that are not always known.)
What can I do to lower the risks for my baby and myself?
To meet the goals for a healthy pregnancy with GDM, you will be asked to:
- Check your blood sugar levels
- Follow a meal plan
- Keep all of your doctor appointments
Blood sugar monitoring
A nurse will teach you how to check your blood sugar levels. Check them four times a day. Your levels should be within these ranges:
- Fasting (in the morning before eating): 60 to 95
- One hour after the start of each meal: less than 140
Eat and drink foods that are healthy and taste good while keeping your blood sugar levels in the needed range. Your blood sugar level is affected by all the foods you eat, not just those high in sugar, such as candy, cake, and pie.
A dietitian will talk with you about your dietary needs and will help you make a plan that is right for you.
Exercise, such as walking after meals, will help lower blood sugar levels. Exercise at the same time each day to help your blood sugar levels stay steady. Check with your doctor to make sure it is safe for you to exercise during pregnancy.
- Keep your heart rate below 140 beats per minute during exercise.
- Wear diabetes identification.
- Carry sugar with you, such as hard candy, in case exercising causes your blood sugar to drop too low.
You may need to take medicine. Your doctor will talk with you and write any needed prescriptions.
Keep all of your doctor’s visits. Call the clinic if you need to reschedule.
What is hypoglycemia (low blood sugar)?
It is when the sugar level in your blood is low. In pregnancy, a blood sugar below 60 mg/dl is too low.
Signs of a low blood sugar may include:
- Racing heart
- Blurred vision
- Dizziness or feeling faint
- Numb lips or tongue
- Slurred speech
What is hyperglycemia (high blood sugar)?
It is when the sugar level in your blood is above your target range. You may not be able to feel when your blood sugar is high.
Signs of a high blood sugar may include:
- Dry mouth
- Drowsiness (more tired than normal)
- Weight loss
- Frequent urination
- Increased appetite (more hungry than normal)
- Urination overnight
- Blurry vision
Will I have diabetes after pregnancy?
Most women with GDM no longer have diabetes after they deliver their baby. You may eat and drink as you did before your pregnancy. A two-hour glucose tolerance test will be done at the first doctor visit after you have your baby to find out if you have Type 2 diabetes. Fast (do not eat) for eight hours before this test.
How can I lower my chances of getting Type 2 diabetes?
- Control your weight. If you are overweight lose 5 to 7 percent of your body weight.
- Exercise for 30 minutes five times each week.
- Have your fasting blood sugar checked at least one time every three years.
How do I get rid of my lancets?
It is best to put your lancets in a container that is used only for this purpose to prevent injury, illness, and pollution. Use a coffee can or hard plastic bottle, such as an empty bleach or liquid detergent bottle.
Do not use a container:
- That will be returned to a store or recycled
- Is glass
- Is clear plastic
Seal the lid with heavy-duty tape when the container is full. Call your waste collection agency to learn how to get rid of your used syringes safely.
Do not take used lancets, insulin syringes, or needles to the hospital.
Keep all sharps out of the reach of children.
Blood glucose control is one of the most important factors during pregnancy. Tight blood glucose control, helps to ensure the best chance of a successful pregnancy.
Diabetes control is important for people who have diabetes going into their pregnancy as well as people who develop diabetes during their pregnancy (gestational diabetes).
What is gestational diabetes?
It has been reported that on average 2% to 4% of women develop temporary diabetes also known as gestational diabetes
This happens because they are unable to produce an increased amount of insulin to overcome the resistance levels.
In gestational diabetes there is not normally any show of external symptoms normally recognised as characteristic of the disease for example excessive thirst, tiredness and increased urination.
Blood sugar control during pregnancy
Good blood glucose control reduces the risks of complications developing for the mother and baby.
The target HbA1c for mothers before and during pregnancy is 6.1% (or 43 mmol/mol).
People with diabetes before their pregnancy will be advised to keep excellent control of their blood sugar before and throughout the pregnancy.
The first eight weeks of the pregnancy are a critical period and so it is highly recommended that strong control is achieved prior to becoming pregnant wherever possible.
Mothers who develop gestational diabetes will be treated initially with diet and exercise but may be put onto oral hypoglycaemics (tablets) or insulin injections if blood sugar levels remain high.
To help you to meet the challenging blood glucose targets, you will be expected to test your blood glucose before each meal and 1 hour after eating.
People taking insulin for their diabetes will also need to test before bed each night.
You will have blood tests performed at various intervals during your pregnancy to check your diabetes is under good control.
Diabetes can be present before pregnancy or may develop during pregnancy itself. If you develop diabetes during pregnancy, in most cases this will be a specific type of diabetes known as gestational diabetes.
Blood sugar levels are important for all mothers to be with diabetes –as well controlled blood glucose levels can significantly increase the likelihood of having a healthy baby. The NHS advises the target HbA1c for mothers before and during pregnancy is 43 mmol/mol (or 6.1%).
If you have diabetes prior to your pregnancy, the NHS advises achieving the target HbA1c before conceiving.
The target HbA1c target may require dedication to reach, but its important that you strive to achieve it. You might find that, Regular blood glucose testing, including before each meal and 1 hour after will help you to keep your blood glucose levels under control.
If blood glucose levels are higher than recommended, you may need to change your medication regime to help lower your sugar levels Your health team will provide you with advice for managing your blood glucose levels throughout your pregnancy.
Sometimes, The emphasis on achieving tight blood glucose control may bring on hypoglycemia, particularly amongst those using insulin. Your health team should ensure you know how best to spot and treat hypoglycemia.
You should expect to receive a high standard of care from your health team throughout your pregnancy and should have the opportunity to ask any questions you may have about achieving your health targets.
How does diabetes affect the baby?
There have been reports that diabetes during pregnancy brings increased chances of having a bigger babies and birth defects.
Infant mortality and birth defects
There is a slight increase in the risk of infant mortality or birth defects in baby’s of mother with diabetes than without, however preconception care can reduce this risk by ensuring the mother is as healthy as possible before and through out pregnancy
In addition to this if a woman has diabetes before pregnancy, diabetes related complications can worsen; this includes things like hypertensio, kidney disease, nerve damage and retinopathy which is a form of diabetic eye disease.
The baby of a woman with diabetes often produces excess insulin in response to high blood glucose levels within the body of the mother.
In type 1 diabetes no significant extra insulin will be produced by your body so you may see your insulin requirements increased. Your health team should be able to advise with the best way to manage your diabetes.
At birth the baby’s blood glucose levels may be hypoglycemic ; the blood glucose level is reduced as a result of the removal of the maternal glucose source.
This is detected by a heel stick blood test and can be restored to a normal level with either oral or intravenous glucose. In addition to this a further glucose tolerance test should be done at the six-week postnatal check in order to establish whether any further treatment needs to be considered.
When a pregnant woman has an abnormally high level of blood glucose, the baby will naturally store excess glucose as body fat. For this reason, the baby will be larger than average upon reaching the gestation date.
This is a condition known as foetal macrosomia
If a woman has gestational diabetes, there have been reports that 50% of these women will go on to develop type 2 diabetes within 10 to 15 years.
Risk factors for developing diabetes during pregnancy
There is an increased risk of diabetes during pregnancy if:
- The woman is overweight
- The woman is a smoker or around smokers more than average
- The woman is older (over 30)
- There is a family history of diabetes
- The woman is from an ethnic minority
- There is previous history of the birth of a large baby (more than 4.5 kg or 10lbs)
There is a routine antenatal test used to measure glucose levels in urine; however it has been noted it is relatively unreliable for diagnosing diabetes.
Therefore blood sugar levels are checked between 26 and 30 weeks of gestation. This is done of two separate occasions using one of two tests, either the fasting glucose test or the random glucose test. In addition to this if there are any abnormal results of these tests or there is a family history of diabetes, or a woman is regarded as obese she will be offered a glucose tolerance test.
Often with gestational diabetes, the woman is advised to take a number of steps to change their diet and exercise habits to ensure the best possible pregnancy.
It is reportedly advisable to increase participation in low-impact activities such as walking, swimming, yoga and pilates. In addition to this it is advisable to eat regular meals watching the amount of fat being eaten, remembering it is controlling the amount of fat not cutting it out of the diet completely.
Also reducing the amount of salt in the diet and ensuring that plenty of fruit and vegetables are included in the diet.
9 Gestational Diabetes Dos and Don’ts
Pregnancy already comes with a long list of things that you should and shouldn’t do to achieve the best outcomes for you and your baby. But if you’ve been diagnosed with gestational diabetes (diabetes that develops during pregnancy), then you need to learn some more dos and don’ts to keep your blood sugar under control and make sure that diabetes doesn’t harm your pregnancy.
You will need to learn about a gestational diabetes diet — foods and lifestyle habits that help stabilize your blood sugar — as well as, possibly, gestational diabetes treatment. This may include diabetes medications your doctor prescribes during pregnancy to keep your blood glucose under control.
It is possible to have a healthy pregnancy with gestational diabetes, but you must take care of yourself to reduce your risk of the following:
- An overly large baby
- Cesarean delivery (C-section)
- Preeclampsia (pregnancy-related high blood pressure)
- Preterm delivery
- Other poor health outcomes for your baby
- Long-term health effects for you
Controlling your blood glucose is important for everyone, young and old. But for pregnant women, good blood sugar control is important before, during, and after pregnancy to reduce the chance of diabetes complications.
According to the Mayo Clinic, good blood sugar control during pregnancy can help prevent or reduce these risks:
- Prevent complications for the baby
- Prevent complications for the mother
- Reduce the risk of birth defects
- Reduce the risk of excess fetal growth
- Reduce the risk of miscarriage and stillbirth
- Reduce the risk of premature birth
To keep blood glucose under control during pregnancy, it’s important to check your blood sugar level frequently. If you are not sure how to check your blood sugar with a blood glucose meter, ask your doctor or diabetes nurse educator to show you.
In addition, take diabetes medications if your doctor has prescribed these and exercise regularly, as this helps manage blood sugar spikes. The Mayo Clinic recommends at least 30 minutes of moderate exercise 3 times a week during pregnancy.
It’s important to stay on a healthy diet for gestational diabetes that includes plenty of fruits, vegetables, and whole grains. If your physician or diabetes dietitian recommends changes to your diet during pregnancy, follow their advice. Follow your doctor’s instructions when it comes to taking prenatal vitamins that contain folic acid to prevent neurological defects, such as spina bifida.
To help you through this time, listen to your healthcare team and follow this suggested gestational diabetes diet plan and list of gestational diabetes dos and don’ts.
Managing Gestational Diabetes Naturally
Once you have learned that you have gestational diabetes, it is up to you to handle your blood sugar levels. The American Diabetes Association states that there is no known cure for gestational diabetes, but that treating the condition is done in two ways: Diet and Exercise.
Even if you are required to monitor your glucose levels daily and administer insulin shots, you will still be asked to change your diet and increase your exercise level. (Always ask to alter your lifestyle and retest before accepting insulin shots.)
As a chiropractor, I have had the opportunity to discuss this topic in length with many clients. I’m going to break down my gestational diabetes diet and exercise recommendations into easy to manage ideas that you can incorporate into your daily life without feeling deprived, and at the same time lower your chances of having a c-section. Remember to consult your midwife or doctor before altering your lifestyle drastically.
The Standard American Diet (SAD) does not meet our nutritional needs. 6-11 servings of breads and grains per day? Are you kidding? That’s a diabetic’s nightmare. It’s easy to see just why so many people are experiencing conditions such as gestational diabetes. We are addicted to sugar and other foods that break down into sugar. We cannot let go of dairy or pesticide-sprayed gluten and wheat. We can’t put down the GMO-filled, processed products. But we are suffering. Not only are we suffering, but our children are too – even in utero.
You do not have to wait until the diagnosis has been handed to you before you change your diet. Ideally, you should alter and follow a healthier diet and lifestyle before you are pregnant, or at least once pregnancy is confirmed. But, if you are now wondering how to help manage your condition, then it is definitely time to reevaluate your diet:
DROP ALL PROCESSED FOODS. If it comes in a box or bag, drop it.
Stay away from sugar.
Eat every 2-3 hours – including a midnight snack. It is recommended to eat small meals every 2-3 hours so your body becomes used to regularly processing and absorbing nutrients, which helps to prevent the highs and lows of blood sugar levels that characterize diabetes.
Keep carbohydrates to a minimum and eat them in the middle of the day. Complex carbohydrates break down to more valuable forms of sugar that are harder to digest and have less of an impact on the insulin fluctuations in your body. Eliminating simple carbohydrates could help prevent or treat gestational diabetes.
Increase your protein. One of the important functions of protein is to help break down carbohydrates. Eating at least 85-120g of protein a day is essential for optimal pregnancy health and fetal development. If you are eating whole-food carbohydrate, pair it with protein. This will ease the digestive process and regulate your metabolism to only release or utilize the necessary amounts of insulin.
Follow the Brewer’s Pregnancy Diet or other high protein, low carbohydrate/sugar diet. This will give you a great way to track your food and influence your decisions.
Increase your fiber. Fiber can stimulate the activity of insulin receptors and can also inhibit the release of excess insulin into the bloodstream, helping to balance the levels of insulin and prevent the onset of diabetes.
Foods to include:
- Flaxseed (fiber)
- Brewer’s Yeast (natural chromium)
- Eggs (Free range, organic if possible – 1-2 each day): Eggs are high in choline, which helps promote baby’s growth and brain development.
- Whole Fat Yogurt (or greek yogurt): avoid added fruits and sugars
- Grass Fed Meat (local or organic if possible)
- Grass Fed Butter
- Wild Caught Fish (salmon especially): high in omega-3’s
- Tomatoes: The main antioxidant in tomatoes is Lycopene, which has been linked to the reduction of preeclampsia.
- Sweet Potatoes: Full of antioxidants, vitamins A, C and B6, folate and fiber
- Dark, Leafy Greens: Full of antioxidants, vitamins and minerals. Spinach is also a great source of non-dairy calcium and fiber.
- Beans: Full of fiber, protein, folate, iron, calcium and zinc.
- Apples (Pair with a protein like peanut butter)
- Citrus Fruits
- Green Beans
- Chia Seeds
- Fats/Oils: animal fats, coconut oil, olive oil, olives, avocados, fish oils, etc. should be high quality.
Note that some fruit and vegetables effect blood sugar levels more than others. For example, the following should be eaten with protein:
- Ripe Bananas
Foods to Avoid:
- White Foods – White potatoes, white rice, white bread, white pasta.
- Candy, Cookies, Cakes – Sweets in general.
- Processed Products: Processed, packaged, and most restaurant food quality is impossible to predict.
Supplements to Consider: (Again, talk to your doctor before adding or altering your diet or supplements.)
- Vitamin D
- Vitamin C
- Chromium – it is used up whenever sugar or flour is digested. It naturally runs low in the third trimester, but an unhealthy diet completely depletes it. (Some people have seen drastic results in their glucose numbers with two weeks of supplementing with chromium.)
- Inositol- studies show improved insulin sensitivity and decreased glucose levels with the use of inositol while pregnant.
- Dandelion Herb
- Astragalus – Research shows that astragalus (along with traditional treatments for gestational diabetes) is linked to significantly better blood sugar control and milder symptoms of gestational diabetes.
One hour of exercise each day, even broken into two 30 minute sessions is enough to help raise the heartrate for the body to manage weight gain, prevent or manage gestational diabetes, and help maintain a healthy pregnancy overall. While walking technically is exercise, you need to make sure that it is more than a leisurely stroll. The body doesn’t truly recognize your normal walking pace as needing an increased heartrate.
Great ways to exercise while pregnant:
- Continue your normal exercise routine, if you have been active.
- Enroll in prenatal classes, such as bootcamps, yoga, aerobics, or basic prenatal fitness.
- Walk farther and quicker than your leisurely pace, trying to break a small sweat.
- Elliptical or other stationary equipment
- Strength Training with or without weights
It is also worth northing that Berberine has been shown to regulate glucose and lipid metabolism in vitro.
Dr. Sarah Cimperman, ND
“You have an entirely different body now,” my midwife said at a routine prenatal visit during my second trimester. While that’s not completely true – I would jump at the chance to trade in the bulging disc in my lumbar spine for a new, healthy one – it is partially accurate. The pregnancy hormones that drive the growth and development of a baby can alter the environment inside the mother’s body in unpredictable and unwanted ways. Among these, the body may change how it makes and utilizes insulin, which creates problems controlling blood sugar levels. Approximately one in ten pregnant women develop gestational diabetes and it’s becoming increasingly common.1
On this particular day at my midwife’s office I was trying to get out of taking a glucose tolerance test. I wasn’t happy about swallowing a sugar solution and sitting around a lab waiting to give blood samples when I had more important things to do, but my biggest objection was that it was unnecessary. I believed that it was impossible for me to have high blood sugar. After all, I wrote the book – literally – on preventing and reversing prediabetes with dietary and lifestyle changes in The Prediabetes Detox2 and I follow my own advice. I eat an anti-inflammatory diet that includes good quality protein, plenty of fiber, and healthy fat. I eat little or no refined carbohydrates like pasta, bread, potatoes, rice, and sweets, aside from seasonal whole fruit and an occasional square of 85% dark chocolate. I drink mostly water and lots of it. I get plenty of sleep, practice relaxation, and exercise more than I ever did before I was pregnant. Because exercise has been the only effective method of controlling my back pain, most days I walk 10,000 steps or more and spend 45 to 60 minutes exercising in the pool or on the elliptical machine. Never in my life have I had blood sugar problems and routine test results have always been well within the normal range. My weight gain during pregnancy has been on the low end of normal and the baby is healthy. Surely I was immune to gestational diabetes.
None of these arguments got me out of taking the test. As a physician myself, I understand why it’s important to test pregnant women for gestational diabetes and why we can’t just take a patient’s word for it that their blood sugar levels are normal. Some women show signs like excess weight gain or have risk factors like a family history of diabetes, but many women don’t have any symptoms at all. We can’t feel how much sugar is in our blood so the only way to know is to test it.
Identifying gestational diabetes is important because it puts the baby at risk for preterm birth, excessive birth weight, shoulder dystocia during delivery,3 low blood sugar shortly after birth, and newborn respiratory distress syndrome. Gestational diabetes also increases the risk of preeclampsia, a condition characterized by high blood pressure, organ damage, and potentially life-threatening complications for both mother and baby. And blood sugar problems during pregnancy makes it more likely that mother and baby will develop type two diabetes and/or obesity in the future.4 (On the bright side, moms with gestational diabetes who breastfeed for at least three months reduce their risk of type two diabetes and some studies show that for every year a woman breastfeeds, her risk goes down by fifteen percent regardless of body mass index, diet, exercise, and smoking.4)
When my test results came in, I was shocked to learn that some of the measurements were abnormal. They were only slightly elevated, but I was still concerned. So I started tracking my blood sugar levels daily, upon waking and two hours after meals. I soon realized that within the context of my regular diet and lifestyle, my glucose levels are always normal. It was only when I was given a large dose of sugar for testing purposes that my body was unable to metabolize it efficiently. So the solution was to continue what I was already doing: avoiding sweets and starches, exercising regularly, and making time for rest and relaxation.
These are the same strategies I recommend to my patients, whether the goal is to prevent gestational diabetes, control high blood sugar, or simply have a healthy pregnancy. The five guidelines below will help you optimize your diet, exercise routine, and lifestyle. If you’ve been diagnosed with gestational diabetes, talk to your midwife or doctor about how often you need to monitor your blood sugar and whether additional interventions are necessary.
#1 | Control your carbohydrate intake.
One simplest ways to lower levels of sugar in the blood is to eat less sugar. This includes sweet foods and beverages as well as starches, which includes grains like rice, root vegetables like potatoes, and foods made from flour like bread, pasta, crackers, processed breakfast cereal, muffins, cakes, cookies, and other baked goods. It also includes processed fruit like jelly, jam, canned fruit with syrup, fruit concentrates, and extracted fruit juices.
#2 | Exercise almost every day.
Exercise helps prevent and reverse gestational diabetes by lowering blood sugar, making cells more sensitive to insulin, reducing inflammation, and boosting levels of serotonin, which helps prevent food cravings.5 It also reduces the risk of excessive weight in newborn babies, helps prevent preeclampsia, and improves cardiovascular function, blood pressure, fitness, and self image. And it helps treat lower back pain, constipation, bloating, fatigue, and insomnia.6 The best forms of exercise for pregnant women are moderately-intense, low-impact activities like swimming, water aerobics, brisk walking, and cycling. Before you exercise, get permission from your midwife or obstetrician. If you aren’t already physically active, consider meeting with a personal trainer who has experience working with pregnant women and can put together a routine for you, familiarize you with exercise equipment, and make sure that you’re doing the exercises correctly.
#3 | Get plenty of sleep.
Short sleep cycles can increase the risk for diabetes by raising blood sugar levels and causing cells to lose sensitivity to insulin.7 Lack of sleep can also trigger sugar cravings and prompt you to eat more sweets and starches.8 Pregnant women should get at least eight hours of sleep each night in the summer and at least nine hours in the winter, and take naps as needed. If you struggle with insomnia, talk to your naturopathic doctor about natural remedies and sleep hygiene strategies like avoiding electronics before bed, sleeping in complete darkness, and eliminating sugar, caffeine, and alcohol from your diet.
#4 | Manage stress.
When we’re exposed to stress, whether physical or mental, real or imagined, levels of stress hormones like cortisol go up. As a natural survival mechanism, high levels of stress hormones trigger high levels of blood sugar. Over time, this can increase the risk of developing diabetes.9 High cortisol levels also deplete serotonin, causing us to crave sweet and starchy foods. One of the best ways to keep cortisol levels low is to find activities that help us manage stress effectively. Exercise is a good one, but other options exist: yoga, meditation, guided imagery, breathing exercises, progressive muscle relaxation, qigong, and massage. Like any skill, relaxation requires practice, focus, and concentration, and the more you do it, the easier it will be. Pick activities that feel right to you and practice them daily or whenever the need arises.
#5 | Avoid cigarette smoke.
For lots of reasons, pregnant women shouldn’t smoke and shouldn’t be exposed to secondhand smoke. Smoking cigarettes raises blood sugar levels and increases the risk of developing diabetes (as well as other illnesses like cardiovascular disease and cancer).10 Even if you don’t smoke, being around people who do can have a similar effect. Studies show that people exposed to secondhand smoke have higher levels of fasting blood sugar and hemoglobin A1C, more insulin resistance, and a higher incidence of diabetes.12 When it comes to quitting, close to 90 percent of successful long-term quitters stopped smoking abruptly, and this cold turkey method has been shown to be twice as effective as nicotine replacement therapy and medications that are taken to reduce cravings.11
Sarah Cimperman, ND is the author of the new book, The Prediabetes Detox: A Whole-Body Program to Balance Your Blood Sugar, Increase Energy, and Reduce Sugar Cravings. She graduated from NCNM in 2002 and has a private practice in New York City. Her expertise has been featured on Fox News and Huffington Post and in Natural Health magazine, Whole Living magazine, and the Well Being Journal, among other publications. Dr. Cimperman also writes two blogs, A Different Kind Of Doctor and The Naturopathic Gourmet.
1 DeSisto CL, Kim SY, and Sharma AJ. Prevalence Estimates of Gestational Diabetes Mellitus in the United States, Pregnancy Risk Assessment Monitoring System (PRAMS), 2007–2010. Preventing Chronic Disease. 2014;11:130415.
2 Cimperman S. (2013). The prediabetes detox: A whole-body program to balance your blood sugar, increase energy, and reduce sugar cravings. Oakland, CA: New Harbinger.
3 Lim JH, Tan BC, Jammal AE, and Symonds EM. Delivery of macrosomic babies: management and outcomes of 330 cases. Journal of Obstetrics and Gynaecology. 2002;22(4):370-4.
4 Much D, Beyerlein A, Roßbauer M, Hummel S, and Ziegler AG. Beneficial effects of breastfeeding in women with gestational diabetes mellitus. Molecular Metabolism. 2014;3(3):284–292.
5 Thomas DE, Elliott EJ, and Naughton GA. Exercise for Type 2 Diabetes Mellitus. Cochrane Database of Systematic Reviews. 2006;(3):CD002968.
6 Padayachee C and Coombes JS. Exercise guidelines for gestational diabetes mellitus. World Journal of Diabetes. 2015;6(8):1033–1044.
7 Knutson KL and Van Caute E. Associations Between Sleep Loss and Increased Risk of Obesity and Diabetes. Annals of the New York Academy of Sciences 2008;1129:287–304.
8 Van Cauter E, Holmback U, Knutson K, Leproult R, Miller A, et al. Impact of Sleep and Sleep Loss on Neuroendocrine and Metabolic Function. Hormone Research. 2007;67(Suppl 1):2–9.
9 Godfrey KM, Inskip HM, and Hanson MA. The Long-Term Effects of Prenatal Development on Growth and Metabolism. Seminars in Reproductive Medicine. 2011;29(3):257–65.
10 Rafalson L, Donahue RP, Dmochowski J, Rejman K, Dorn J, and Trevisan M. Cigarette Smoking Is Associated with Conversion from Normoglycemia to Impaired Fasting Glucose: The Western New York Health Study. Annals of Epidemiology. 2009;19(6):365–71.
11 Tweed JO, Hsia SH, Lutfy K, and Friedman TC. The Endocrine Effects of Nicotine and Cigarette Smoke. Trends in Endocrinology and Metabolism. 2012;23(7):334–42.
12 Dorana CM, Valenti L, Robinson M, Britt H, and Mattick RP. Smoking Status of Australian General Practice Patients and Their Attempts to Quit. Addictive Behaviors. 2006;31(5):758–66.
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What is gestational diabetes?
Gestational diabetes is the development of diabetes during pregnancy. Although the symptoms disappear after the baby is born, according to the U.S. Centers for Disease Control, about half of all women diagnosed with gestational diabetes will develop type 2 diabetes later in life. Diabetes occurs when the body does not produce or properly use insulin, a hormone necessary to convert sugar, starches and other food into the energy needed for daily life. According to the National Institutes of Health, gestational diabetes occurs in about 5 percent of all pregnancies in the United States, resulting in about 200,000 cases a year.
What are the symptoms?
Most women have no symptoms at all, although in rare cases, excessive thirst and increased urination may occur. However, when gestational diabetes develops, women are at increased risk of high blood pressure throughout the pregnancy as well as at increased risk of having a large baby and needing a cesarean section at delivery.
All women receiving prenatal care are tested for gestational diabetes between the 24th and 28th weeks of pregnancy, although those at higher than average risk may be tested sooner. In some cases, high-risk women are tested as soon they learn they are pregnant. The test measures blood glucose (sugar) levels to make sure they fall in a normal range and aren’t elevated. This may be done after a four-to-eight hour fast and again after consuming a sweet drink. Alternatively, your blood glucose may be checked an hour after you drinking a sugary concoction. If your blood sugar is normal, you probably don’t have gestational diabetes. If it is high, you may be retested after fasting.
What are the causes?
Hormones produced by the placenta to sustain pregnancy can make cells throughout the body more resistant to insulin. The placenta produces more and more of these hormones as pregnancy progresses making it harder for insulin to “unlock” cells so that glucose can enter. Gestational diabetes is most likely to develop during the last three months of pregnancy when hormone production by the placenta is at its highest.
Risk factors for gestational diabetes (besides being pregnant) include being overweight (the more overweight you are, the higher your risk), a family history of diabetes, your age (women over 25 have a higher risk), having had gestational diabetes during a previous pregnancy, having had a stillbirth or a very large baby with a previous pregnancy, or a history of abnormal glucose tolerance. In addition, the following ethnic groups are at high risk for diabetes of all types: Hispanic, African-American, Native American and Pacific Islander.
What is the conventional treatment?
Treatment involves dietary measures, exercise and, in some cases, insulin injections. Your doctor may refer you to a dietician or diabetes educator who will design a meal plan to help keep blood sugar in your target range. This may involve:
- limiting sweets and other carbohydrate-rich foods.
- eating three small meals and one to three snacks daily.
- making sure that you get fiber with your meals in the form of fruits, vegetables and whole-grain cereals, crackers and breads.
Your doctor may also recommend walking, swimming or other form of aerobic activity to help bring maintain glucose levels within your goal range. You may also have to give yourself insulin injections and to monitor and record your blood glucose levels four or five times a day with the aid of device called a blood glucose meter.
What therapies does Dr. Weil recommend for gestational diabetes?
- Dietary changes: Since being overweight can cause cells to become resistant to insulin, not gaining excessive weight during pregnancy can make a big difference. In addition, try to keep your blood sugar in a healthy range by eating small frequent meals. Learn about the glycemic index of carbohydrate foods and choose foods that are low on that scale. Mostly that means avoiding refined and processed carbohydrates. Also learn about glycemic load.
- Exercise: Regular physical activity is the single most important thing you can do to support a healthy pregnancy. Every pregnancy is unique, and there are stages of pregnancy when particular exercises will be especially helpful, and when some types should be avoided. Talk with your OB-GYN about his or her recommendations and any restrictions.
- Supplements: All pregnant women should be taking a prescribed pre-natal vitamin, and should also supplement with fish oil or another source of omega-3 fatty acids to help support the nervous system of their developing child. In addition, if you are at risk for, or develop gestational diabetes, you should speak to your OB-GYN about using the following, all of which are helpful for control of blood sugar.
- GTF (glucose tolerance factor) chromium: This trace element plays a role in blood sugar regulation by working with insulin to help transport glucose into cells. Take 1,000 mcg daily.
- Alpha-lipoic acid: This antioxidant can enhance glucose uptake, inhibit glycosylation (the abnormal attachment of sugar to protein), and help promote and maintain eye and nerve health. Start with 100 mg a day. Higher doses (600 mg a day) help treat and prevent diabetic neuropathy (nerve damage from impaired microcirculation).
- Magnesium: To help promote healthy insulin production, take 400 mg daily. Magnesium glycinate is a good form with less of a laxative effect than other forms of magnesium.
- Coenzyme Q10: This is a powerful antioxidant that may help maintain a healthy heart. Take 60-100 mg of a softgel form with your largest meal.
- Bitter melon (Momordica charantia)
- Gurmar (Gymnema sylvestre)
- Prickly-pear cactus (Opuntia spp)
- Also: Insulin may be used when appropriate in cases of gestational diabetes.
You may have heard from your doctor or midwife that gestational diabetes increases your risk of complications during pregnancy — such as miscarriage, the baby being born too early or delivery by cesarean section But did you know that gestational diabetes is also associated with Type 2 diabetes and cardiovascular disease after pregnancy?
It’s true that gestational diabetes is a dangerous condition that develops during pregnancy, but there are ways to prevent and manage it. Your first line of defense is to follow a diabetic diet plan and make lifestyle changes, like adding in physical activity. There are also certain nutrients that can help to reduce your risk of gestational diabetes and maintain glycemic control.
The key to managing gestational diabetes is to become educated about the foods you should and shouldn’t eat during pregnancy, what everyday lifestyle changes you can make to maintain normal blood sugar levels, and where to get support if you need it. If you are diagnosed with gestational diabetes, you need to take action immediately, as the adverse effects are serious. But know that there are professionals who can help you to develop an effective treatment plan.
What Is Gestational Diabetes?
Gestational diabetes is the most common medical issue affecting pregnant women. It’s a type of diabetes that’s actually diagnosed between the 24th and 28th weeks of pregnancy. It occurs when a pregnant woman has blood sugar levels that are too high. This can lead to a number of problems for the unborn baby, like being born too early, having problems with breathing, weighing too much and having low blood glucose levels after birth. (1)
Gestational diabetes is also dangerous for the baby because high blood glucose levels can increase the chance of having a miscarriage or stillborn birth (when the baby dies after 24 weeks of pregnancy). Although insulin secretion increases in early pregnancy, insulin sensitivity is usually unchanged. But at mid-pregnancy, insulin sensitivity starts to decline progressively. The decline becomes worse as the pregnancy progresses. This is why gestational diabetes usually develops in the late second trimester and then disappears instantly after delivery.
For pregnant women, gestational diabetes may predispose them to develop diabetes after giving birth. Women with gestational diabetes are also more likely to develop preeclampsia, a condition that involves the abnormal development of the placenta, high blood pressure during pregnancy and high levels of protein in your urine. Preeclampsia — also known as toxemia — can cause serious pregnancy complications, including damage to vital organs like the brain, liver and kidneys. Gestational diabetes can also increase a mother-to-be’s chances of having a cesarean section because the baby often gains too much weight.
And a recent study, published in December of 2017 in JAMA Internal Medicine, found that gestational diabetes is positively associated with cardiovascular disease later in life. Over 89,000 pregnant women who were free of cardiovascular disease when the study began participated in questionnaires that evaluated their cardiovascular health after pregnancy. Researchers found that women with a history of gestational diabetes had a 43 percent greater risk of developing cardiovascular disease. They also indicate that this relationship between gestational diabetes and cardiovascular disease — particularly the incidence of heart attack and stroke — is possibly mediated, at least in part, by weight gain and lack of healthy lifestyle during and after pregnancy. (2)
Data shows that the prevalence of gestational diabetes varies from 1–20 percent and continues to rise worldwide. And the amount of gestational diabetes varies in direct proportion to the commonality of Type 2 diabetes in a given population, with the rates being higher among African, Hispanic, Indian and Asian women than for Caucasian women. (3)
Gestational Diabetes Symptoms & Glucose Screening Tests
Women with gestational diabetes usually don’t experience any symptoms. Most of the time, the barely noticeable symptoms of gestational diabetes are very similar to normal pregnancy symptoms. You may notice that you’re feeling: (4)
- tired and fatigued
- very thirsty
- the need to urinate often
Because there are no noticeable gestational diabetes symptoms, pregnant women go through a routine glucose screening test that’s done between 24 and 28 weeks of pregnancy. For women who have high glucose levels in their urine during their routine prenatal visits, they my be tested for gestational diabetes sooner.
The test requires you to drink a sweet liquid that contains glucose. Then you have your blood drawn one hour later to measure how the glucose solution affected your blood glucose levels. The normal result for this kind of test is a blood sugar level that’s 140 milliliters per deciliter or less one hour after drinking the glucose solution. If your blood levels are too high for the one-hour test, you will be asked to return for a three-hour glucose tolerance test. (5)
For the three-hour test, you cannot eat or drink anything, other than a few sips of water, for eight–14 hours beforehand. You will drink a sweet liquid containing glucose, then wait an hour and have your blood drawn in order to check your blood glucose levels. This needs to be repeated three times. (6)
Although it’s not common to feel symptoms of gestational diabetes, drinking the sugary liquid may make you feel lightheaded and nauseated, especially if you aren’t able to eat or drink anything beforehand. Don’t worry; these symptoms will pass once the test is over and you are able to enjoy a full meal.
Causes & Risk Factors
It’s not exactly clear why some pregnant women develop gestational diabetes and others don’t. Gestational diabetes is caused by high blood sugar levels. Normally, when you eat something, your body digests that food to produce glucose. The glucose enters your bloodstream. With the help of your pancreas, it then moves into your body’s cells so that it can be used for energy. During pregnancy, however, the placenta produces high levels of insulin-counteracting hormones. These hormones impair the action of insulin in your body’s cells, thereby raising your blood sugar levels.
Some women only experience modest elevations of blood sugar after eating, which is completely normal during pregnancy. But others are affected by the growth of the placenta and rise of hormones. These women go on to develop gestational diabetes, usually around 24 weeks of pregnancy.
There are risk factors that put pregnant women at a greater risk of developing gestational diabetes. The most common risk factors include:
- High BMI: Research shows that a higher BMI before pregnancy and a higher BMI at 28 weeks of pregnancy are strongly related to increased insulin resistance. A BMI of 30 or higher can increase your risk of developing gestational diabetes. (7)
- Ethnicity: Studies show that African-American, Hispanic, Asian and Native American women living in the United States have a higher risk of developing gestational diabetes than Caucasian women in the U.S. (8)
- Age: If a pregnant woman is over the age of 25, she is at a greater risk of developing gestational diabetes.
- History of Diabetes: Women who have already had gestational diabetes, or those with prediabetes symptoms before pregnancy, are at a greater risk of developing gestational diabetes again. If you have a family history of diabetes, such as a parent or sibling having Type 2 diabetes, you are also at an increased risk of gestational diabetes.
- Polycystic Ovary Syndrome: A nationwide population-based survey published in PLoS ONE indicates that a history of polycystic ovarian syndrome (PCOS) is a significant and independent risk factor for the development of gestational diabetes. About 50 percent of women with PCOS experience metabolic disturbances, which is why they are often monitored closely during pregnancy to ensure that they they follow a strict diet and don’t gain too much weight. (9)
There are a number of conventional treatments for gestational diabetes. Along with dietary changes and increased physical activity, the following medications or forms of therapy may be utilized: (10, 11)
Insulin Therapy: Insulin injections may be needed to lower your blood sugar levels. Insulin therapy is utilized when dietary and lifestyle changes alone do not maintain glycemic control during pregnancy.
Glyburide: Glyburide is an oral antidiabetic agent that is often used as a first-line agent for gestational diabetes or as an alternative to insulin therapy.
Metformin: Metformin is another oral anti-diabetic drug that’s used to fight gestational diabetes. According to researchers, there is now a reasonable amount of data to support that both metformin and glyburide can be useful for women with gestational diabetes. The safety and efficacy of these drugs, compared to insulin therapy, are still being researched. (12)
Women with gestational diabetes will have to monitor their blood sugar levels to make sure that they stay in a healthy range. To do this, you simply draw blood from your finger and place it on a test strip that serves as a blood glucose meter. The meter will measure and display your blood sugar levels so that you can be sure they’re normal in the morning and after meals.
5 Natural Ways to Manage Gestational Diabetes Symptoms
1. Nutritional Therapy
Your pregnancy diet is the most important factor in preventing and managing gestational diabetes. Pregnant women need to eat a diet that provides adequate nutrition in order to support their baby’s and their own well-being. It’s very important that women who are pregnant don’t consume too many calories, especially empty calories that come from processed and packaged foods, junk food, baked goods and sweetened beverages. Achieving appropriate weight gain is one of the most important ways to prevent and manage gestational diabetes. During pregnancy, excessive weight gain can lead to adverse outcomes for both the mother and baby. Plus it can even lead to childhood obesity for your little one. (13)
Here are some dietary tips for managing gestational diabetes:
- Your carbohydrate intake should only be 35 percent to 45 percent of your total calories per day. Distribute your carb intake over three meals and about two to three snacks. Avoid eating meals that are carb-heavy, like a bagel, a bowl of pasta, a plate of pancakes or a bowl of fruit.
- Make sure you’re eating plenty of high fiber foods, which can help to slow down or decrease the release of insulin into the bloodstream. Include fiber in all of your meals and snacks throughout the day. Some of the best options include avocados, squash, beans, lentils, chia seeds and flax seeds.
- Pair your carbohydrates with good quality protein so that your body can more easily break down the carbs. Some of the best high protein foods to include in your diet include grass-fed beef, organic chicken, wild-caught salmon, eggs, yogurt, nuts and bone broth.
- Use healthy fats in your recipes, like coconut oil, ghee and grass-fed butter. These foods help to burn fat and balance your blood glucose levels.
- Avoid sugary foods that will throw off your blood sugar levels. Simple, refined sugars that are found in soda, fruit juice and other sweetened beverages are some of the worst culprits for women with gestational diabetes because they lead to rapid blood glucose spikes.
2. Physical Activity
Research shows that exercise can improve glycemic control in women with gestational diabetes. Moderate physical activity for 30 minutes a day or more is recommended for all pregnant women and especially those with gestational diabetes, as long as there aren’t any medical or obstetric complications. (14)
Some beneficial exercises for women with gestational diabetes includes brisk walking, arm exercises while seated in a chair and prenatal yoga. Engaging in these types of physical activity at least 10 minutes after each meal can help to reduce the rise of glucose levels, helping women with gestational diabetes to reach their glycemic goals.
3. Stress Management
Research shows that women with gestational diabetes often experience stress and anxiety that’s related to feeling like they’re losing control of their condition, having trouble sticking to dietary changes, and experiencing fear of maternal and infant complications. (15)
A 2012 study conducted at the National University of Ireland found that when 25 women with gestational diabetes were compared to 25 women without gestational diabetes, those with the condition were more likely to become depressed and experienced diabetes-related distress. Women with gestational diabetes also felt like they didn’t have enough social support from outside their family. (16)
This risk of increased stress, anxiety and signs of depression during pregnancy is problematic because these mental health issues can affect your hormone levels, including your insulin levels. Plus, studies show that stress, anxiety and depression during pregnancy is associated with lower birth weight for infants and potential issues with infant development. Experiencing stress and depression during pregnancy also increases your risk of suffering from postpartum depression after giving birth. (17)
To manage your stress levels, start by finding a support group, a nutritionist, dietitian, health coach or even a friend who has experience with gestational diabetes and can help you to find comfort and stay on track with your diet plan. You should also focus on relieving stress and anxiety by making small lifestyle changes, like taking walks outside every day, trying prenatal yoga, meditating or practicing silent prayer, journaling or taking a warm bath with lavender oil. These little changes can help you to stay focused on getting well and maintaining your health for the duration of your pregnancy.
4. Vitamin D
A number of scientific studies show an association between vitamin D deficiency and gestational diabetes. Vitamin D insufficiency is also related to maternal obesity and adverse outcomes for both the mother and child. Although the data isn’t completely conclusive yet, there have been studies that suggest that vitamin D supplementation can reduce the risk of developing gestational diabetes and help to improve glycemic control in pregnant women who are diabetic and have low vitamin D levels. (18)
According to research published in Public Health Nutrition in 2017, higher dietary calcium intake was inversely associated with the risk of gestational diabetes. Compared with women who consumed less calcium, those with higher calcium levels had a 42 percent lower risk of gestational diabetes. And researchers found that among women with a calcium intake below 1,200 milligrams per day, a 200 milligram increase in daily intake was associated with a 22 percent reduction in gestational diabetes risk. (19)
The best way to increase your calcium levels is to eat calcium-rich foods like yogurt, cheese, cooked kale, broccoli and almonds. There is mixed research about the safety of calcium supplements and consuming very high levels of calcium, so talk to your doctor before using supplements to increase your levels.
Are you thinking about becoming pregnant and want to prevent the development of gestational diabetes? It’s smart to start thinking about the threat of gestational diabetes before you’re pregnant or during the early stages of pregnancy, especially if you are overweight, have a history of gestational diabetes or prediabetes, have family members with Type 2 diabetes symptoms or have PCOS.
The best way to prevent gestational diabetes is to reach your ideal weight before getting pregnant. Losing extra weight and increasing physical activity are sure ways to reduce your risk of gestational diabetes. This will allow your body to improve how it uses insulin for energy and it will help you to maintain healthy blood sugar levels. If you are already pregnant, it’s not recommended that you try to lose weight. But you can focus on eating nourishing, nutrient-dense foods so that you don’t gain too much weight during your pregnancy.
The amount of weight that you should gain during pregnancy depends on your BMI before getting pregnant. Women at a normal weight before getting pregnant should gain between 25 and 26 pounds, and those who were overweight should only gain 15 to 25 pounds during pregnancy. (20)
If you have been diagnosed with gestational diabetes, it’s important that you work with your health care provider to manage your condition until the end of your pregnancy and even after giving birth. Work with your doctor or a nutrition expert to set up a dietary and lifestyle plan. If you plan to use these natural ways to manage your gestational diabetes, do it under the care of your doctor. Gestational diabetes can lead to many adverse effects for you and your baby, so it’s important that it’s treated properly as soon as you’re diagnosed.
- Gestational diabetes is the most common medical issue that affects pregnant women. It occurs when a pregnant woman’s blood sugar levels are too high and the condition is usually diagnosed after 24 weeks of pregnancy.
- Women with gestational diabetes usually don’t experience any symptoms, but they may notice signs like fatigue, feeling very thirsty and needing to urinate frequently. These signs are normal for any pregnant woman, so a glucose screening is necessary around your 24th week of pregnancy.
- Gestational diabetes is caused by high blood sugar levels. Because your placenta produces high levels of insulin-counteracting hormones during pregnancy, this impairs the action of insulin in a pregnant woman’s body, leading to increased blood sugar levels. It’s not exactly clear why some women get gestational diabetes and others don’t. But women with a high BMI, those over the age of 25, women with PCOS, and those with a family or personal history of diabetes are at a greater risk.
- The first line of defense for gestational diabetes is dietary and lifestyle changes. When these changes don’t work to maintain glycemic control, insulin therapy or oral anti-diabetic agents are used.
5 Natural Ways to Manage Gestational Diabetes Include:
- Nutrition therapy
- Physical activity
- Managing stress
- Increasing vitamin D intake
- Increasing calcium intake
Read Next: 3 Steps to Treat Obesity Naturally
Evaluating Traditional Chinese Medicine and Herbal Products for the Treatment of Gestational Diabetes Mellitus
Gestational diabetes mellitus is the most common metabolic disorder during pregnancy with health consequences for both lives during and after pregnancy. Studies found that many pregnant women turn to complementary and alternative medicine for health maintenance or symptom relief, such as herbal medicine and acupuncture from traditional Chinese medicine. With the growing popularity of traditional Chinese medicine, we conducted a systemic search in PubMed, Web of Science, and Embase databases on research studies that investigated traditional Chinese medicine during pregnancy. The resultant hits were further searched in relation to all diabetes mellitus. In total, we found three major herbal medicine/herbal products that were associated with glycemic control in gestational diabetes, including Zuo Gui Wan, red raspberry leaves, and Orthosiphon stamineus. We further reviewed them and their relatives in relation to type 2 diabetes mellitus and found more evidence of metabolic benefits. None of the herbal medicine and products examined reported toxicity in the experimental models. Overall, treatments of gestational diabetes by western or alternative interventions are grossly understudied. It is critical to have a standardized protocol when evaluating efficacy of herbal medicine and produce quality results for women and their health-care providers to make informed treatment decisions.
Pregnancy is a unique period during a female’s life characterized by a series of physiological and metabolic changes. The maternal metabolism starts out with early anabolic accumulation of adipose tissue and progresses to late-stage catabolic release to accommodate feto-placental needs from organogenesis to fetal maturation and growth . In the last trimester, anti-insulin hormones, growth factors, and cytokines released by the placenta produce an insulin resistance-like state, which is further exacerbated for those with excess weight, increased maternal age, polycystic ovarian syndrome, and family history of diabetes . Health issues that arise during this period put both the mother and the fetus at greater risk of complications during and after pregnancy.
Gestational diabetes mellitus (GDM) is the most common metabolic complication for pregnant women, which positively correlates with type 2 diabetes mellitus (T2DM) later in life . In 2017, about 1 in 7 births is affected by GDM globally . The prevalence of GDM is especially high among the Asian population . In China, the most updated research found that on average, 14.8% of women develop GDM, and the risk increases significantly in older (26.7%) and overweight/obese women (30.3%) . The continued increase of GDM posts heavy strain on the health-care system and calls for immediate action. GDM is often diagnosed between 24- and 28-week gestation (second or third trimester of pregnancy) and shares many pathological similarities with T2DM. Glucose is the primary fuel for the fetus and placenta. Under GDM, maternal insulin resistance increases the flux of glucose to the fetal circulation and contributes to increased fetal glucose uptake and growth . During delivery, the mother may experience more respiratory distress, birth injuries, and cardiac abnormalities as well as preterm delivery. Babies born to GDM mothers are prone to congenital abnormalities such as macrosomia. While GDM often goes away after delivery, both the GDM mother and baby are now at an increased risk of developing T2DM later in life. Current treatments for GDM include diet, lifestyle intervention, and antihyperglycemic medications, and insulin is prescribed when the aforementioned fail to control blood glucose. In fact, insulin is one of the most commonly used prescription medications reported in pregnant women between 15 and 44 years of age . It has been found that GDM women on insulin have progressive increments in insulin dependence as pregnancy advances . Concerns still remain about the long-term safety of such treatment for the mother and child due to lack of quality research. A meta-analysis found poorly reported results and potential bias from randomized trials comparing treatments for GDM . On the other hand, about half of pregnant women visit complementary and alternative medicine practitioner for pregnancy-related health conditions . Women who visit their general practitioners and midwives more frequently are also more likely to visit acupuncturists for conditions such as gestational diabetes . They are reportedly motivated by factors such as a sense of self-determination, pursue of natural and safe childbirth and a deeply personal and positive therapeutic experience . Yet, there are extremely little research on both mainstream and alternative GDM treatments, which severely limits the ability for women and their health-care providers to make informed treatment decisions. It is also important to note that the placenta becomes thinner as gestation progresses and is permeable to certain drugs; and, the fetal liver has limited capacity to metabolize them . One study suggests that metformin, the most prescribed antidiabetic drug, is weakly toxic towards embryonic stem cells, and should be prescribed with caution to pregnant women . Therefore, it is absolutely critical to understand drug metabolism in adults as well as fetuses when treating GDM.
2. Traditional Chinese Medicine
Traditional Chinese Medicine (TCM) is a popular naturopathic medicine that advocates the balance of two opposing yet complementary forces: Yin and Yang, and the maintenance of Qi (the natural flow of energy). This branch of medicine presents a different point of view in understanding human physiology based on historical precedence and cumulative observations, which dates back to more than two millennia ago. TCM puts emphasis on modulating the body’s own resistance against disorders and produces highly individualized treatment plan according to syndrome differentiation. TCM practitioners long ago have referred to diabetes mellitus as the Xiao-Ke diseases (wasting and thirst) and described its pathogenesis as the deficiency of Yin and stagnation of Qi, which lead to excess heat and dryness. Symptoms recorded in The Yellow Emperor’s Classic of Internal Medicine described diabetes mellitus as “three excess” and “one loss,” which correspond to excess in thirst, hunger and urination, and loss in weight . The major organs affected are the lung, spleen, and kidney; therefore, TCM treatment for diabetes mellitus centers on ways to tonify Yin and resolve heat and dryness in these organs. According to TCM, pregnancy is the union of Yin and Yang, where Yin represents rest, accumulation, and storage, while Yang is required during birth. The spleen is considered the origin of fetal growth and development, and the kidneys store essence that nourishes the fetus . Both organs are implicated in GDM.
Among the modern methods of TCM, herbal medicine is the more commonly accepted practice, and it is utilized throughout human history in many parts of the world. It is estimated that more than 80% of the world’s population rely on herbal medicinal products as a source of primary healthcare . Herbal medicine in TCM is prescribed as a carefully selected formula of plant products, including leaves, stems, flowers, roots, and seeds, each with many active components. Nowadays, the scope of herbal medicine has extended to include minerals and animal products. The goal is to maximize therapeutic effects and minimize toxicity. Decoction or steeping in ceramic containers is the most common form of dose preparation, which evenly draws out the therapeutic constituents of the herbs. Though TCM, herbal medicine prescriptions rely heavily on experience and observations and research efforts have been put in to unveil the pharmacological underpinnings. A prime example is demonstrated by the discovery of artemisinin from a Chinese herbal medicine compound, sweet wormwood (Artemisia annua) by the 2015 Nobel Prize winner, Youyou Tu. A Chinese pharmacologist in training, Tu’s discovery is the perfect synthesis of historical treatises of Chinese herbs and modern scientific analysis and clinical approach.
Although TCM has enormous potential, philosophical and cultural differences and a lack of consistent and rigorous evidence-based studies still result in a general lack of acceptance by the western medical community. Multiple studies on the safety of Chinese herbal medicine during pregnancy was also inconclusive due to poor experimental stratifications . In this review, we aim to identify available studies that specifically focus on herbal medicine treatment of GDM. A systematic literature search was conducted in PubMed, Web of Science, and Embase databases using different combinations of keywords, including gestational diabetes, traditional Chinese medicine, Chinese herbal medicine, antidiabetic, and hyperglycemia. The resultant hits were then further searched in relation to diabetes mellitus in general. With the growing popularity of complementary and alternative medicine worldwide, it is necessary to review and revise future approaches.
2.1. Zuo Gui Wan (Zuo Gui Pill)
Zuo Gui Wan is a Ming dynasty (1368 to 1644 A.D.) formula used to nourish Yin and tonify the kidney. The tablet form consists of a proprietary blend of 8 ingredients listed in Table 1. In a streptozotocin-induced rodent model of GDM, Zuo Gui Wan treatment reduced fasting blood glucose, body weight, total cholesterol, and serum insulin level of mice fed on high fat and sugar diet . Furthermore, the same group found that when the offspring of Zuo Gui Wan-treated GDM mice were fed a high fat and sugar diet, they were protected against high levels of fasting plasma glucose, insulin, leptin, total cholesterol, and low-density lipoprotein . These results suggest a cross-generational effect of Zuo Gui Wan on GDM mother and offspring through an unknown mechanism. A recent study found direct benefits of Zuo Gui Wan to fetal development and metabolism under high glucose stress when it was supplemented to cultured blastocysts . Another study showed that Zuo Gui Wan facilitated ribosomal and mitochondrial functions in two-cell mouse embryonic cells during sugar metabolism, thus protecting them against cell death induced by glucose loading . A related compound, Zuogui Jiangtang Jieyu Fang (with antidepressive property), also has well-documented glucose-lowering effect . Other than its antidiabetic property, Zuo Gui Wan is implicated in a wide range of disorders in reproduction , bone metabolism , the immune system , and others that arise from the underlying diagnostic pattern according to TCM. Given its dual benefits for both the mother and fetus, Zuo Gui Wan may be a good therapeutic alternative or an augmentation to western medicine for GDM patients.
Table 1 The medicinal constituents of Zuo Gui Wan.
2.2. Rubus Idaeus (Red Raspberry Leaf)
Rubus idaeus belongs to the Rosaceae family, which is a diverse group of flowering plants that are used by many traditional medicine practitioners . In one case study, researchers examined the consumption of red raspberry leaf tea by a pregnant woman with GDM and revealed properties of glycemic control of the herb . This GDM patient experienced hypoglycemia after consumption of two servings of raspberry leaf tea for 3 days and resulted in a reduction in insulin requirements. The causal relationship was further supported by the patient’s self-withdrawal and reintroduction of the herb. Metabolic exams and fetal surveillance revealed no abnormalities. While this isolated study sets precedence for Rubus idaeus in lowering blood glucose in humans, other identified benefits of the plant may help indirectly reduce GDM occurrence and severity. Chemical profiling of Rubus idaeus found the highest total phenolic and flavonoid contents in the leaves, which exhibit antioxidant activities and inhibit digestive enzymes, α-glucosidase, and α-amylase from producing monosaccharides . Consumption of Rubus idaeus fruit in diabetic (db/db) mice reduced proinflammatory plasma interleukin 6 and may protect against diabetes-induced oxidative stress .
Other members of the same genus (listed in Table 2) also have documented hypoglycemic effect. For example, in rats fed a standard diet, Rubus fruticosus extract increased lipolysis of adipose tissue and enhanced insulin sensitivity, which was more pronounced in females . In diabetic rats induced by either alloxan or streptozotocin, oral administration of Rubus fruticosus aqueous extract elicited hypoglycemic effects . The acute toxicity test found the lethal dose 50% (oral) for the aqueous extracts to be 8.1 g/kg, which makes the plant safe for consumption. However, several other studies could not find any glycemic properties of Rubus fruticosus using in vitro glucose absorption model and in diabetic mice . Preparation of the medicinal plant and the duration of treatment may have contributed to these inconsistencies. The Rubus plant documented in TCM is Rubus chingii, which functions to tonify the kidneys and preserve Qi. Ellagitannins from the unripe fruits of Rubus chingii has remarkable inhibitory activities against α-glucosidase and α-amylase . Furthermore, the methanolic extract of Rubus chingii fruits was found to have enhanced inhibitory activities against protein tyrosine phosphatase 1B, a negative regulator of leptin and insulin signaling pathways . On the other hand, the methanolic extract of Rubus grandifolius exhibits strong inhibition of glucosidases and prevents protein glycation with no cytotoxicity towards cultured cells . A clinical study also supported the in vivo benefits of a North American relative, Rubus occidentalis, in controlling glycemia and vascular inflammation in prediabetic patients .
Table 2 List of plants in the Rubus genus with potential antidiabetic properties.
2.3. Orthosiphon stamineus
Orthosiphon stamineus is commonly known as the cat whisker and is the main ingredient of Java tea. In addition to its diuretic effect, a recent review also praised the antimicrobial, antioxidant, cytotoxic, and anti-inflammatory activities of Orthosiphon stamineus . In both nonpregnant and pregnant diabetic rats, oral administration of Orthosiphon stamineus stimulated glucose-induced insulin secretion, which translated to an increase in ghrelin and glucagon-like peptide 1, and an overall lowering of glucose . Pancreatic islets incubated with Orthosiphon stamineus also were significantly more sensitive to glucose-stimulated insulin release . Urine metabolomics of diabetic rats treated with aqueous extract of Orthosiphon stamineus showed better regulation of the tricarboxylic acid cycle, glycolysis/gluconeogenesis, and lipid and amino acid metabolism . From another study, the aqueous extracts (0.2-1.0 g/kg) significantly decreased plasma glucose concentration in a dose-dependent manner in both normal and diabetic rats . The highest dose had comparable effect as the T2DM medication, glyburide. Plasma analysis revealed reduced triglyceride and elevated HDL-cholesterol concentration in the extract-treated diabetic rats, indicating an improved lipid profile . Another chloroform extract from the plant also displayed antidiabetic effect through extrapancreatic mechanisms . A developmental toxicity study was conducted on Orthosiphon stamineus; out of the 4 doses (250, 500, 1000, and 2000 mg/kg/day) tested, there was no clinical signs of maternal toxicity, weight gain, and prenatal growth retardation. The highest dose did increase anogenital distance due to possible androgenic effect .
3. Concluding Remarks
In this review, we sample the web for TCM and herbal medicine specifically aimed at treating GDM. Zuo Gui Wan, red raspberry tea, and Orthosiphon stamineus displayed promising effect in lowering glucose and alleviating the associated pathophysiology of GDM with minimum toxicity to the mother and fetus. These findings hold certain inspiration and clinical significance for the research and treatment of GDM. There are other herbal formulae used in Chinese clinics that aim to resolve specific pathology in GDM such as Qi deficiency and weakness in the spleen and stomach or as adjunctive therapy to insulin. For instance, Qiwei Baizhu powder has demonstrated effectiveness against GDM of spleen deficiency type and decreased postprandial blood glucose . Huang Qi (Astragalus), another commonly used TCM herb, has shown to reduce blood lipids and enhance the antioxidative activity in conjunction with insulin treatment . Further experimental studies would help strengthen these observations. In general, treatments for GDM by mainstream or alternative interventions are grossly understudied. Given the biggest concern for pregnant mothers is the safety of therapies, there has been no data on the long-term risk assessment of various antiglycemic formulations and strengths in human pregnancy. Comparison of the effectiveness between insulin and other interventions was also inconclusive due to poorly reported evidence . As TCM gains global popularity and new medicinal products are constantly introduced into the market, public health concerns surrounding their safety are also increasingly recognized. While few complications have been reported from the use of herbal products as many constituents are regularly consumed, the holistic approach of herbal formula may cause possible interference with existing prescription or unknown and unwanted side effects with serious consequences. A few reviews have attempted to quantify the benefits of other TCM practices such as acupuncture and Qi Gong on diabetes. A randomized trial that looked at pregnancy outcomes of women with or without acupuncture treatment during their IVF treatment did not find any significant difference between occurrence of gestational diabetes and hypertensive disorder, or any of the parameter measured . In a recent review examining the safety and effectiveness of acupuncture for T2DM, reviewers again did not find convincing evidence but indicated that acupuncture may be recommended to patients as a supplementary treatment . Another review found that practice of Qi Gong produced an overall positive outlook on T2DM, but there was a large variation in styles and definitions of qigong of the studies reviewed . In conclusion, the lack of knowledge and inconsistent data are the biggest hurdles in understanding the efficacy of TCM in a variety of disorders. Overall, it is hard to conclude a definitive benefit of TCM practice for GDM per se based on lack of direct studies.
Conflicts of Interest
All authors declare no conflict of interest.
What is the best diet for gestational diabetes?
Following a healthful diet is important during pregnancy, and particularly so if a woman develops gestational diabetes.
High blood sugar levels may be harmful to the woman and the growing fetus. To help manage blood sugar levels, it is important to monitor how many, what type, and how often carbohydrates are consumed. Keeping a food diary may make this easier.
Share on PinterestEating complex carbs rather than simple carbs is recommended.
Spacing meals and snacks containing carbohydrates evenly throughout the day can help avoid spikes in blood sugar. The American Diabetes Association recommend that women with gestational diabetes should eat three small-to-moderate meals and two to four snacks per day.
Other ways to help regulate blood sugar include:
- avoiding eating too many carbohydrates at one time
- sticking to complex carbohydrates that are high in fiber
- combining carbohydrates with protein or healthy fat
- not skipping meals
- eating a protein-rich and fibrous carbohydrate breakfast
Eating low glycemic index foods
Eating foods that have a low glycemic load is another crucial factor in a gestational diabetes diet.
The glycemic load is calculated by multiplying the grams of carbohydrate in a serving of a particular type of food by that food’s glycemic index (GI). This number gives a more accurate picture of a food’s real impact on blood sugar.
Foods with a low glycemic load are broken down more slowly than simple carbohydrates, which are typically considered high GI foods.
A glycemic load of 10 or below is considered low and is ideal for those with gestational diabetes who are trying to manage blood sugar.
Low glycemic load foods to eat include:
- 100 percent wholegrain breads and cereals
- non-starchy vegetables
- some starchy vegetables, such as peas and carrots
- some fruit, such as apples, oranges, grapefruit, peaches, and pears
All of these low GI foods release sugar into the blood slowly, helping to keep blood sugar levels stable.
Eating more protein
Eating protein alongside carbohydrates, or choosing carbohydrates that also have protein in them, helps to balance blood sugar levels. Women with gestational diabetes should try to eat lean, protein-rich foods, such as:
- fish, chicken, and turkey
Choosing unsaturated fats
Unsaturated fats are also part of any healthful diet. Examples of unsaturated fats include:
- olive oil
- peanut oil
- most nuts and seeds
- chia seeds