I am not a nutritionist or dietician. I have not taken any nutrition classes ever in my life. I did study prenatal nutrition in my midwifery education, but that was the most basic of the basic. I’m a Licensed and Certified Professional Midwife with personal and professional experience working with women who have had very large babies (over 9 to 9.5 pounds) and/or Gestational Diabetes Mellitus. I have attended and assisted at far too many shoulder dystocias, including having had one myself, so know first-hand the most dreaded complication macrosomic babies might endure.
Over the years, I’ve helped women tweak their diets, using information from a variety of sources, but mostly from clients’ personal experiences – anecdotal evidence, which, in no way, is scientific or even universally accepted by other midwives. It does seem each midwife has her own beliefs regarding Large for Gestational Age (LGA) babies.
Here’s the finale to the above disclaimer: Talk with your care provider before changing your food plan, especially if s/he has given you a plan already. These food ideas do not replace medications if you have been prescribed them. Use your common sense. Research things yourself. But, most of all, take responsibility for growing a healthy child by eating the best and most colorful foods you can find… colorful, locally and organic/pesticide-free if possible.
And walk your butt off.
- Eat tree-bark carbs. While carbohydrates can wreak havoc on blood glucoses, the more complex they are, the easier they are on the pancreas. If a carb tastes like tree-bark, it’s a good one to have in your diet. Eat whole grain breads and pastas; not whole wheat, but whole grain. The crunchier the better. The faster it spoils out of the refrigerator, the better. What’s great about tree-bark carbs is you will eat much less of it than spongy carbs… and your pancreas will, once again, thank you.
- No soft fruits. Eat hard fruits and berries; these are much easier on the pancreas. Soft fruits (peaches, nectarines, bananas, etc.) elevate glucoses more than the harder ones. Extremely simplistically speaking, when your glucose skyrockets, your pancreas squirts out huge doses of insulin to try and metabolize the food. What can happen over time is the pancreas gets tired, thereby not giving out as much insulin is as needed, so the extra sugars go to your belly and hips. When the pancreas still works, but gets tired, this is Insulin Resistance (IR), a precursor to Diabetes. It isn’t uncommon to have IR for 10-15 years before Diabetes kicks in.
- No sugar! This might seem obvious, but many people overlook it. No soda, no candy, no cake, no ice cream.
- No juice. Juices are nearly pure sugar and have none of the good things your body needs. It takes about 6 apples to make one 8 oz. glass of apple juice. Can you imagine eating 6 apples in one sitting? When eating the fruit itself, you get the very important fiber. Fiber has a role in slowing down the zipping sugars so they can be metabolized more efficiently.
- (This seems to be a Net Rumor, so take it with a grain of salt.) No Aspartame/Nutrasweet. Mind you, this was lost on me for a couple of decades, but when I saw several very trusted doctors explain that Aspartame, several hundred times sweeter than sugar, tricks the pancreas into thinking a huge amount of sugar has been dumped into the body. The pancreas then goes into overdrive to metabolize it, but cannot keep up, making the cycle of sweet causing sugar crash (hypoglycemia) causing hunger all over again. Since I’ve stopped drinking Diet Coke, my glucoses are, for the first time in a very long time, back to normal. This might be one of the best parts of the entire recipe. Please adhere to this one! (My own experience mirrors what I say here, but I'll be darned if I can find one study that proves this!)
- Very limited dairy, especially for the last 6-8 weeks. Yes, that means yogurt, too. Standard dairies use hormones to grow their cows giant and to make them grow giant very quickly. Ingesting that, hypothetically, can help your baby grow bigger than s/he should, too. If you choose hormone-free dairy, that is better, but know that lower-fat types of dairy are actually higher on the Glycemic Index (GI) than full-fatted ones. So, there’s a trade-off… higher GI? Or more fat. If your diet, overall, is meticulous, some dairy wouldn’t be the worst thing. Ice cream should be ignored except in the absolute most celebratory event.
- Walk after every meal. The pancreas loves help and walking is the other part of the equation, besides food choices, that helps your pancreas be more efficient and not get overly-tired. I encourage women to walk at least 10-15 minutes after every meal. A regular exercise regimen is fantastic, too, but the walking after meals can make an enormous difference in how your body processes glucose.
- Just because you “pass” your Glucose Tolerance Test (GTT) doesn’t mean you aren’t having glucose issues. The common refrain after someone announces their big baby’s weight is, “And I didn’t have Gestational Diabetes (GD)! I passed my GTT!” The GTT is an archaic method of determining how the pancreas is doing during pregnancy. Insulin Resistance is a fairly new piece of the pancreatic puzzle and the tests for that are not a part of testing in pregnancy. While testing glucoses 4 times a day can give you some good information, the BGs fluctuate throughout the day and night and can affect you (and the baby) even though all screens/tests say the contrary. Someday, we’ll have a continuous “glucometer” that can be implanted in at-risk folks (and I bet pregnant women will all be considered “at risk”) and that mechanism will be able to determine the minute details of a woman’s daily glucose ups and downs, helping her to create a much more accurate plan to stay healthy.
- Ask for a Hemoglobin A1c at the beginning of pregnancy. The HbA1c can “see” what glucoses have been for the previous 8-12 weeks. The HbA1c is not used to diagnose Gestational Diabetes Mellitus (GDM), but that first A1c can offer a glimpse into the pre-pregnancy pancreas’ ability to process glucose. Some midwives will do three HbA1c’s, when mom first enters care, around 28 weeks and then again at the end of pregnancy. However, the pancreas can go from IR to GDM very quickly and by the time the HbA1c sees the change, the pregnancy might be over and the effects already completed. However! If you are able to continue eating great foods that come from as close to the earth as possible and walking after every meal, you will be far ahead of the game if you do choose to do the GTT at your 28-week visit, the first HbA1c offering a sort of baseline to your mid-pregnancy levels.
- Take your Vitamin D. What does Vitamin D have to do with GDM? Growing bodies of research are demonstrating that many diseases and complications are arising because of Vitamin D deficiency. You can ask for a Vit D test at your first prenatal to see where you are, but know that the lab’s recommended levels are far below what the newer research shows, yet even with the old levels, as many as 70% of pregnant women are terribly deficient in Vitamin D. The standard dose for adults is 400 IU a day, but plenty of experts say that is at least 10 times too little, and probably more. I have my clients taking 6000 IU a day and they are doing very well… shorter and less painful labors (Vit D helps the uterus to work more efficiently) and if they have GDM, it has been fairly easily controlled. Many ask about going out in the sun for Vit D instead of a supplement. The rule for getting enough Vit D in the sun is: you have to live below the middle of the country, be outside for at least 20 minutes every single day of the year and bare your entire chest, back, arms and face. If you are able to do that, great! If not, you need supplementation.
I hope this helps those of you looking for more information besides the "Gestational Diabetes Diet" they hand out in nearly useless classes. I welcome other ideas as well.