For women, pregnancy is a journey full of unknowns, an expectation and a challenge, I once made up a term: PCT (Pregnancy Challenge Test). If there is a problem with an organ or system during pregnancy, the probability or risk of problems with that organ or system will rise significantly after entering the age of 40-50, and GDM is a good case in point.
It is now recommended that every pregnant woman be screened for GDM in mid-pregnancy because many women with normal blood sugar in non-pregnancy will develop abnormal glucose metabolism after pregnancy. In recent years, changes in the diagnostic criteria for GDM have led to a significant increase in its incidence. Before the adoption of the new diagnostic criteria, the incidence of GDM in the country was about 5%, but after the implementation of the new criteria, the incidence of GDM jumped to about 18%. Of course, these figures will vary slightly in different regions.
The purpose of adjusting the diagnostic criteria for GDM is not to make 1 in 5 pregnant women a patient, it is to give a warning, to remind people of the need to adjust their lifestyle, and to allow them to prevent possible immediate and long term adverse outcomes.
After being diagnosed with GDM, some people are very nervous and go to buy blood glucose meters to monitor fasting and postprandial blood glucose at home every day; some people don’t care, whatever your doctor says, I should do what I do. In fact, the scientific and reasonable approach to GDM is: to pay attention to, but do not worry too much, most through diet adjustment and moderate exercise can be well controlled.
The immediate and long term effects of GDM on mother and child
Theoretically, GDM leads to an increased incidence of macrosomia, increased perinatal complications and mortality, and an increased incidence of other maternal complications. However, in most cases, the near-term outcome for mothers and children with GDM is good, as the number of pregnant women with truly poor glycemic control is still a minority.
After delivery, the majority of pregnant women with GDM will return to normal blood glucose, but without dietary modification and moderate exercise, the probability of developing type II diabetes in the future increases significantly. Research data shows that women with GDM have a 5-10 times higher risk of developing type II diabetes in the future compared to women without GDM, with a 30-50% probability of developing type II diabetes in the next 5-10 years (different studies have different data).
For pregnant women with GDM, it is important to control blood glucose levels not only to reduce the immediate adverse effects on themselves and the fetus, but also to reduce the long-term adverse effects on the offspring. This is because the high glucose environment in the uterus can have adverse effects on the offspring’s glucose metabolism, which becomes more pronounced with the age of the offspring. The cumulative risk of type II diabetes in the offspring approaches 15% at age 20 years, increasing to more than 30% at age 24 years, and the magnitude of this increase is positively correlated with the mother’s glucose level at the end of pregnancy.
Suggestions for self-management of pregnant women with GDM
If you see a diabetes specialist/GDM specialist or a nutrition specialist, in addition to regular blood glucose monitoring, they will give you a lot of detailed specialist advice and a lot of recipe choices and suggestions. These recommendations are very professional and have a lot of scientific basis and evidence-based medical evidence, as well as professional calculation formulas and a large number of recipes to help you choose and adjust.
However, in the face of these systematic, comprehensive and scientific requirements, many “sugar mothers” are unable to do so, which makes experts and “sugar mothers” very helpless and hurt. In fact, for most pregnant women with GDM, it is not necessary to go to a specialist or nutrition expert, as long as you can follow my self-management advice below, most of them can get good results. If you follow my “foolish” advice and still can’t control your blood sugar and weight gain well, then you should go see a specialist.
Keep your mouth shut
For pregnant women with GDM: in principle, you can let go of vegetables and eat as much as you want; protein intake should be moderate, but not excessive. If you are not interested in meat and seafood, you can eat dairy products or eggs; the main thing to control is carbohydrates, including staple foods, snacks and sugary drinks.
Do not eat very full, eight minutes full is about the same, in order to reduce hunger, change the three meals a day to four meals a day, to eat less and more meals. It is best to give up desserts and sugary drinks, fruit should not eat more, if you want to eat as little sugar as possible (next time I will write a special article “it’s the fruit that causes the trouble”).
Open your legs
In addition to controlling your diet, it’s also a good idea to get your legs moving and get a certain amount of exercise every day. For pregnant women, the easiest and safest way to exercise is to walk, 30-60 minutes a day or every other day. At first, you can walk, and then gradually transition to brisk walking according to their own situation, the standard of effective exercise is to have a significantly faster heartbeat, to have the feeling of sweating. Of course, the premise of safety, exercise should not make themselves uncomfortable, do not cause obvious contractions, the general physiological contractions do not matter.
Control goals
Through exercise and diet control, it is best to achieve the three “targets”: blood sugar target, own weight gain target, and fetal weight gain target. In the middle and late pregnancy, it is not recommended to gain more than one pound per week, and for some overweight or obese GDM mothers, it may be required that the weight gain should not exceed half a pound per week; the birth weight of the baby should be controlled at about 6 pounds.
Diet diary
For GDM mothers with poor self-control, or GDM mothers with less effective control, you need to carefully keep a daily diet diary. This means recording every bite of food and drink you eat every day, along with your weight gain and blood glucose test results.
One is for yourself, you will find that you eat a lot more than you think you do, so you will have to cut back the next day. The second is for your doctor, who will give you scientifically sound advice based on your situation.
What you should know about GI and GL
GI (GlycemicIndex) refers to the “glycemic index”, which is an indicator of the degree to which food causes the body’s blood sugar to rise. For example, the GI value of glucose = 100, foods with GI > 70 are high GI foods, foods with GI < 55 are low GI foods, and foods with GI values below 40 are generally safe for GDM patients to eat.
Foods with high GI can easily lead to an increase in blood sugar because they are digested quickly and absorbed well after entering the intestine, and glucose can enter the bloodstream quickly. While foods with low GI can prevent both hyperglycemia and hypoglycemia because they stay in the intestine for a long time and release slowly, and the peak of glucose entering the blood is low, causing less postprandial blood sugar reaction.
Foods with high GI mainly include cakes, cookies, desserts, potatoes (watery and battered), delicate foods, and ready-to-eat foods that are refined and have high sugar content.
Foods with low GI include coarse grains, beans, dairy, potatoes (raw or cold), fruits with more fruit acids (apples, cherries, kiwis, etc.), whole grains or high-fiber foods, etc.
The GI of each food can be found on the Internet, and those who are interested in this can look it up themselves, so I won’t list them all.
GL (glycemic load) refers to “glycemic load”, GI can only tell us the speed and ability of carbohydrates in food into glucose, but not the real situation of blood sugar response caused by the intake of a certain amount of food.
GL combines the quantity and quality of carbohydrates in food to express the magnitude of the effect of a certain weight of food on human blood glucose, GL per serving = GI of food × exchange weight (g) × percent carbohydrate content of food M100, which integrates the “quality” and “quantity” of food on blood glucose. “It takes into account the effect of food quality and quantity on blood sugar, and is a better calculation method for diabetic diet.
GI and GL are good reference tools, but we don’t need to be so precise in the specific dietary control process. You are eating food, not science! Don’t forget to enjoy life in the process of diet control, Life is too short, live a little before it’s too late!