Gestational diabetes

What is gestational diabetes?

The body needs more insulin during pregnancy. Insulin is a hormone produced in the pancreas that helps move the sugar from the carbohydrates we eat to the cells where it is used as energy.   

Gestational diabetes occurs if the body is unable to produce enough insulin, resulting in elevated blood sugar levels.  

Gestational diabetes rarely causes any symptoms. Most pregnant women are therefore offered the opportunity to be tested for gestational diabetes.   

Although pregnant women with gestational diabetes are at greater risk of developing complications during pregnancy and childbirth, the majority give birth to healthy babies. Proper management of gestational diabetes reduces the risk of: 

• high blood pressure and pre-eclampsia (in Norwegian) 
• a large baby and difficult childbirth
• caesarean section
• premature birth 

Treatment for gestational diabetes

Gestational diabetes can be managed by your GP or midwife or at a hospital outpatient clinic. In the first instance, the treatment consists of three parts: 

1. measuring blood sugar levels before and after meals 
2. change in diet 
3. daily physical activity

How to measure your blood sugar level 

You will be given training on how to measure your blood sugar to make sure it is not too high. 

During the first 1-2 weeks, we recommend measuring your blood sugar before breakfast (fasting blood sugar) and two hours after you have finished your breakfast and evening meal (and after lunch if necessary). The frequency of your measurements can then be adjusted according to how the condition manifests itself for you.  

After adjusting your diet and daily activity levels, your blood sugar measurements should be as follows: 

• Fasting blood sugar: below 5.3 mmol/L 
• Two hours after the start of a meal: below 6.7 mmol/L 

If you have more than two measurements above these levels in any week, you should be referred to a hospital outpatient clinic to get help with managing your diet and activity levels, as well as an assessment of whether you need drug treatment to lower your blood sugar (metformin or insulin). 

Dietary advice if you are diagnosed with gestational diabetes

The purpose of the diet that is recommended for people with gestational diabetes is to ensure that you and your unborn child both get enough of the nutrients you need and to prevent your blood sugar level from becoming too high.   

It is easier to avoid high blood sugar levels if you eat frequent, small meals rather than infrequent, large meals. You could for example try eating three main meals and two or three snacks. If there is a long gap between your breakfast and evening meal (more than 10-12 hours), it may be a good idea to have a small evening meal containing some carbohydrates and protein. 

You can use the plate model for your lunch and dinner: 

• 1/2 plate of vegetables 
• up to 1/4 plate of a high-fibre carbohydrate source (wholegrain pasta, wholegrain rice, wholemeal pita bread, boiled potatoes) 
• 1/4 plate or more of a protein source (fish, chicken, meat, legumes, tofu) 

Food containing carbohydrates 

Your blood sugar will rise when you eat food containing carbohydrates. How high your blood sugar rises depends on the type of carbohydrates present in the food, how much you eat and the composition of your meal.  

Limiting the amount of carbohydrates you eat during breakfast is particularly recommended, as insulin often does not tend to work optimally in the morning.  

You should ideally choose:  

• high-fibre foods which result in a slow rise in blood sugar, such as wholegrain products, beans, lentils, nuts and vegetables  
• products containing wholegrains and seeds based on 75-100% wholegrain (4 squares on the whole food scale)  
• bread/crispbread made from rye, barley, wheat and wholemeal flour with a low fine-ground flour content  
• wholegrain pasta and wholegrain rice instead of regular types   

The amount of wholegrain products you eat should be adjusted according to your blood sugar measurements. A suitable amount per meal might be: 5 tablespoons of boiled rice or pasta, 1 slice of bread, 1/2 a pita bread, 30 g of muesli or 110 g of cooked porridge. 

Avoid consuming food and beverages with a lot of added sugar, little fibre and low nutritional value, as these can lead to a rapid and substantial increase in blood sugar. Such foods include cakes and sweet baked goods with yeast, most types of biscuits, crisps, waffles/pancakes, white bread/pizza, white rice, rice porridge, yoghurt with added sugar, breakfast cereals with added sugar or a low fibre content (choose the ones that display the keyhole symbol), fruit/vegetable juice, drinks with added sugar, sweets, jam and honey.  

Use sweeteners to sweeten your food and choose foods made with artificial sweeteners ahead of foods made with added sugar.  

Drink water when thirsty!  

If you want to eat dessert or something else with a high sugar content now and again, try to have a small portion at the end of a meal.

Vegetables, fruits and berries 

Pregnant women should eat 500-800 grams of vegetables, fruit and berries every day.  

Fruits contain useful vitamins, minerals and fibre, but are also high in natural sugar. Eat one to three portions of fruit every day, but limit your fruit intake to one portion per meal. Some people may need to avoid fruit, especially in the morning. One portion could for example be ½-1 apple, pear or orange or 100-200 ml of berries. Fruits such as bananas, mangoes, pineapples and grapes have higher levels of natural sugar than other fruits and should be eaten in moderation. You should also avoid dried fruits.  

• You can eat as much cauliflower, broccoli, lettuce, spinach, tomatoes, cucumber, peppers, celery and similar as you want  
• Include vegetables in all main meals  
• It can be a good idea to have raw vegetables rather than boiled/mashed vegetables, as your blood sugar will increase less when you eat them raw  

Dairy products 

Dairy products are an important source of calcium, iodine and proteins, among other things. Milk, yoghurt without added sugar and kefir all contain lactose and should be limited to one glass per meal. Cheese contains low levels of lactose and has limited impact on blood sugar levels.  

Foods containing protein and fat 

Protein has limited impact on blood sugar levels and you should make sure you eat foods that contain protein as part of most meals and snacks. This could include lean meat and chicken, fish, eggs, cottage cheese, Greek yoghurt, cheese, beans, lentils, seeds and nuts.  

Minced meat, sausages and other processed meat products contain higher levels of saturated fats and should therefore be limited. Processed meat products also contribute to weight gain in many people.  

Fat does not increase blood sugar levels, but it does contain a lot of calories and should therefore be consumed in moderate amounts to avoid excessive weight gain. Eat small amounts of healthy fats such as nuts, seeds, avocados, olives, olive oi/rapeseed oil/sunflower oil, soft plant-based margarine and fatty fish. 

Read more about the types of fish you should avoid eating while pregnant (in Norwegian). 

Physical activity and gestational diabetes

Physical activity helps insulin work more effectively and is therefore considered a central element in the treatment of gestational diabetes.  

Try to be physically active for at least 150 minutes each week, exerting yourself enough to make you breathe faster and start sweating a little.  

Regular daily physical activity can also help you feel better both physically and mentally. 

• Undertaking physical activity after meals will help limit the increase in your blood sugar levels.  
• You can divide your physical activity up into individual ten-minute sessions, for example.  
• If you are not normally physically active, it may be a good idea to aim to go for a 30-minute walk most days during the week. 

Read more about physical activity during pregnancy (in Norwegian). 

After childbirth

Gestational diabetes usually disappears after childbirth, but women who have had gestational diabetes are at greater risk of developing type 2 diabetes (in Norwegian) later in life. Your risk of developing type 2 diabetes will be significantly reduced if you follow the Norwegian Directorate of Health’s dietary recommendations (in Norwegian) and physical activity (in Norwegian) and your body weight is normal.   

If you have had gestational diabetes, you should have a check-up with your GP around four months after giving birth, and then once a year to check that your blood sugar levels are still normal.   

If you have had gestational diabetes, you will be at greater risk of developing gestational diabetes again during any future pregnancies. The factors that protect the most against getting gestational diabetes again is to try to have a normal body weight before getting pregnant and that you do not gain too much weight during pregnancy.