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The International Diabetes Federation recently reported that globally, 1 in 6 live births had a GDM diagnosis.
With the due date coming closer, careful monitoring of blood glucose levels and management becomes especially important to ensure that both the mother and baby are safe.
Blood Sugar Level Goals in GDM
According to the American Diabetes Association, the blood sugar level goals for people with GDM are:
- Before meal ≤ 95 mg/dL
- 1 hour after meal ≤ 140 mg/dL
- 2 hours after meal ≤ 120 mg/dL
Risk Factors for Gestational Diabetes
- Obesity
- Family history
- Older age
- Previous history of GDM
- Polycystic ovary syndrome (PCOS)
- Hypertension
Complications Of GDM If Not Managed
- Large birth weight (macrosomia)
- Early labour
- Low blood sugar in a newborn
- Preterm delivery
- Difficulty in labour due to the large size of the baby
Types of Gestational Diabetes (A1 vs A2)
Gestational diabetes is divided into 2 classes based on its management. They are:
Class A1: GDM Controlled with Diet
Class A2: GDM not controlled with diet, so medications are required (tablets or insulin injections)
How to Manage Gestational Diabetes
GDM management begins with lifestyle changes, including dietary management and exercise. It also includes monitoring your blood sugar levels and baby movements on a daily basis. Also, you need to have frequent check-ups to keep track of gestational diabetes.Gestational Diabetes Diet
Dietary management is the cornerstone of GDM management.
According to the American Diabetes Association (ADA), for all women with gestational diabetes, it’s important to get an individualised diet plan from a dietitian.
They’ll help you plan meals that give you enough calories and nutrients for your baby’s growth, while also keeping your blood sugar levels in a healthy range.
Low-glycemic index foods such as oats, chickpeas, broccoli, beans and cherries can help manage your gestational diabetes by causing a slow, steady rise in blood sugar levels.
Frequency & quantity of meals
Daily intake of 3 main meals combined with 2-3 small meals/snacks is recommended to avoid an increase in blood glucose level after a large single meal.
Energy
Care should be taken to avoid excess weight gain. Restrict calorie intake in women who are overweight & who have already gained the recommended weight in pregnancy.
Carbohydrate
Recommended minimum intake of carbohydrate is 175g/day for those with GDM. Take carbohydrates with low GI, which cause a slow, steady rise in blood sugar. It includes:
- Whole grains - oats, quinoa, barley
- Legumes - beans, chickpeas, lentils
- Vegetables- spinach, lettuce, Broccoli
- Fruits - apples, cherries,
Protein
Recommended daily intake of protein is 71g/day. Lean meat, fish, and plant-based protein should be given priority. Avoid intake of red & processed meat.
Fat
Consume foods rich in Omega-3 fatty acids, like salmon and mackerel. Seeds & nuts, including flaxseed, chia seeds & walnuts, help manage GDM. Limit intake of saturated fat like butter, cheese & fatty meats.
Water
Drink at least 2-2.5 L of water every day. Drinking water at regular intervals can help manage GDM by removing excess glucose from the blood through urine.
Foods to Avoid
These foods can cause rapid increases in your blood sugar levels, which leads to weight gain for the mother and the baby.
Physical Activity
Light activity, such as daily walks and yoga, helps manage your gestational diabetes by improving blood glucose levels
Exercise helps to manage blood glucose levels in GDM. For those who are new to exercise, starting gradually is advised.
Research suggests that women with GDM should do both aerobic & resistance exercise at a moderate intensity, a minimum of 3 times a week for 30-60 minutes each time.
Walking, yoga or stretching promotes metabolism & aids in weight loss. It is advised to consult your gynaecologist before taking up any form of exercise.
Monitoring Blood Sugar and Baby Movements
Monitoring blood sugar levels & baby movements are crucial, especially when you have GDM. Women with GDM should perform home glucose monitoring with a glucometer.
It’s recommended to check your glucose levels 4 times a day. A first morning glucose level can rule out fasting blood sugar. After that, check blood glucose levels one or two hours after meals (postprandial).
Track a record of blood sugar levels & baby movements, as both are very interconnected. High blood glucose levels in blood decrease fetal movements due to decreased oxygen availability.
If you notice high blood sugar levels & decreased baby movements, immediately contact your doctor.
Medical Management (Insulin & Medication)
In the majority of pregnant women with GDM, blood glucose levels can be managed by a combination of diet modification, exercise, monitoring blood glucose levels & baby movements.In cases where there is no improvement with diet and exercise, medicines are included in the treatment plan by the doctor.
Insulin therapy remains the gold standard for treating gestational diabetes because it doesn’t cross the placenta and is safe for the baby. Oral medications like metformin are also used in some selected cases.
Managing gestational diabetes in your third trimester requires teamwork between the mother and her healthcare providers. Remember that self-care is the most important part of your GDM management. With consistent glucose monitoring, diet modification, exercise, and taking medical support when needed, women can face gestational diabetes confidently.
Whether you’re pregnant, a new mom, or navigating postpartum, you don’t have to do it alone. Join our support group to connect, share, and support one another.
FAQs on Management of Gestational Diabetes in the Third Trimester of Pregnancy
- Can gestational diabetes be controlled with diet and exercise in the third trimester?
Many women can manage gestational diabetes with diet management and exercise. If your blood sugar levels show no improvement with these, then your doctor may recommend insulin or other medicines to keep levels safe for you and your baby. - What is the drug of choice for gestational diabetes?
Insulin is the drug of choice for treating gestational diabetes because it doesn’t cross the placenta and is safe for the baby. - How often should the blood sugar levels be checked?
It’s advised to check your blood glucose levels four times a day. A first morning glucose level to rule out your fasting blood sugar. After that, check blood glucose levels one or two hours after meals (postprandial).
