Gestational Diabetes Nutrition: All the Best Advice for Diet, Prevention, and Management with Leslee Flannery, Registered Dietician

Show Notes:

[2:02] Our Reviewer of the Week, LMPfromMI, said: "I wanted to reach out and personally thank you for all of the work that you put into your web course and podcast. I listened to your podcast every day throughout my recent pregnancy and I know that it made a significant difference in my pregnancy and labor. I am a first time mama and got to have the home birth of my dreams next to my husband, mom (and doula) and midwife. Throughout my first trimester, I was so anxious about labor and delivery and was so uneducated in all aspects of birth. Thanks to your podcast, not only was I empowered to have my baby at home, but it was unmedicated too! And despite complications and almost needing to transfer to hospital, I had so much peace and confidence throughout every contraction. My whole labor was only 9 hours, with pushing for just over one hour. My midwife said if baby hadn’t been in a posterior position, she would have missed my birth! I know not everyone gets to have a birth like this, but I know my experience is thanks to the preparations I made from listening to your online course and podcast. Thank you!"

[3:23] Our interview today is with Leslee Flannery, a Registered Dietitian, specializing in helping women with Gestational Diabetes lower their blood sugar and deliver a healthy baby. She currently runs a successful Gestational Diabetes nutrition coaching program, The Better Blood Sugar Method, that has helped over 300 (and counting) women deliver healthy babies!

[5:19] What is gestational diabetes? Gestational Diabetes is insulin resistance in pregnancy brought on by placental hormones, which makes us more insulin resistant. Once you deliver your baby and your placenta, the gestational diabetes resolves itself.

[5:57] What is diabetes? Diabetes is insulin resistance. Your pancreas might not be releasing enough insulin or it's just not moving efficiently enough to pull the blood sugar from your bloodstream and put it into your cells. When you eat something, carbohydrates, specifically, they break down into glucose, which is our body's main source of fuel. After you eat carbohydrates, you'll see your blood sugar go up a little bit, totally normal. Then your body's insulin is supposed to come along and go into your bloodstream and remove the glucose and put it into your cells for energy. In diabetes, the process is a little bit slowed down and the blood sugars just stay elevated longer. The problem with elevated sugar levels for pregnancy specifically, is that those blood sugars go through the placenta to the baby. When blood sugars are high constantly as a trend, then the baby can start to grow bigger, the baby can start to produce more insulin, and it affects the baby's health while in utero.

[7:42] When do moms get tested and find out? Screening is typically between 24 and 28 weeks. During that process, you take a one-hour glucose screening test where you drink 50 grams of liquid sugar, a glucola drink, and if that comes back high, then you will go on to take a three-hour glucose tolerance test. In the three hour test, it's a hundred grams of liquid sugar, so it's quite a heavy load of carbohydrates, and then they test your blood sugar one hour after the drink, two hours after the drink, and then three hours after the drink. For the three hour test, it's confirming that that one hour test is accurate. If you have two elevated blood sugars out of the four that they check, then that is officially a diagnosis of gestational diabetes. 

[8:56] Why wait until 28 weeks? The placental hormones are really what make us more insulin resistant in pregnancy. They don't really start to pick up until the end of the second trimester. So around that time is where we start to see more insulin resistance.

[11:28] Are there factors to look out for that may indicate gestational diabetes? Certain ethnicities, (Asian, Pacific Islander) have a higher risk of gestational diabetes, mamas over the age of 30, women having PCOS, pre-diabetic, any family history of type 2 diabetes, if you've had a previous gestational diabetic pregnancy, and a high BMI. 

[14:46] What do you do if you've been diagnosed with gestational diabetes? It is really common to think that you need to give up carbohydrates, but it's our body's main source of fuel, and you're also growing a human. If you take away carbohydrates, you're taking away energy and and nutrients, but also calories. It's important how you portion and pair your carbs too!

[17:11] Typically, 15 grams of carbs is really the magic number you're looking for. So if you were eating a cookie, for example, and it was a large cookie that was 30 grams of carbs, just have half of it and do 15 grams of carbs from that cookie, and then you're going to have some protein and fiber to go along with it.

[17:48] Nutrition is going to be personal for each woman. In general, eating about every two to three hours is key and having about three meals and three snacks a day. Some women may be able to take out like a morning snack and have no other issues with her blood sugars. But for the most part, we want to eat about every two to three hours because that keeps blood sugars most stable across the board without dipping low and then spiking high. 

[18:29] The tracking of the blood sugar is going to be at home four times a day. You'll test your fasting blood sugar and then either one or two hours after breakfast, lunch, and dinner. After eating, hypothetically, our blood sugar is going to be the highest that it would get one hour after eating. Then at two hours after eating, the number is looking more at, is your insulin doing its job, your body's insulin, doing its job to lower your blood sugar. After one hour, your blood sugar needs to be under 140, two hours under 120. The most standard goal for fasting is under 95. 

[22:20] A lot of things in pregnancy and birth are subjective when it comes to your provider. This whole idea of fitting people into kind of a box of "you were diagnosed with this, so we're going to treat you this way." "We're going to treat everybody that has gestational diabetes this exact way" is sometimes frustrating to me because if you were to maybe take a look at their growth scans or their ultrasounds and see that everything looks wonderful, the baby's overall size is measuring normal, their abdominal circumference, which is important for gestational diabetes, it's measuring proportionately, the amniotic fluid is great, you know, there are no issues. Then to me, you know, just logically that would say that your blood sugar numbers, even if there's a couple that are over, don't look to be impacting the baby's overall growth at this point.

[28:11] How will having gestational diabetes affect my birth? Research says with diet control, gestational diabetes, that it's recommended to deliver by 39 and 6. This is something you should definitely verify with your doctor, but that's basically 40 weeks. A lot of times when women are getting the diagnosis, back at 26 weeks, and being told that day, "Okay, well, we're going to have to induce you," that's a red flag. They shouldn't be telling you that you're going to automatically be induced because you could manage your blood sugars beautifully and not need that induction when time comes. It really depends on what your blood sugars look like, what baby's growth looks like, blood pressure, and if you have a higher risk to have higher blood pressure with gestational diabetes. Advocate for yourself. 

[29:44] Does being on insulin = instant induction? It also doesn't mean instant induction, it's how well are your blood sugars being managed, really with either option, whether diet controlled or on insulin. Different women, all on insulin and have different results with blood sugars, have different things going on with their history and their, their health.

[30:31] What are providers measuring to determine baby is big or not? And then at which point can mom trust that? What should mom be looking for as markers to tell her that my baby is actually at a point that is unsafe for my body to give birth at? Ultrasounds are not 100% accurate. What we worry about with a large baby, as far as Gestational Diabetes goes, is shoulder dystocia at delivery. Babies with Gestational Diabetes can deposit fat differently than a baby without it. Ultrasounds are just looking at the overall size. Genetics also play a role in baby's overall size.

[34:34] What is your very best advice for moms who are looking to avoid or have been newly diagnosed with gestational diabetes? For those who are looking to maybe prevent gestational diabetes, starting with balanced nutrition, hydrating, making sure you're taking good supplements that you may need, getting exercise, but nothing too strenuous. For those women who are newly diagnosed, you know, this might not be what you'd expect a dietician to say, but have grace with yourself because it is hard, and it's overwhelming. A lot of women are frustrated, confused, worried, feeling guilty. It's not your fault and it's something brand new you've never had to learn before so give yourself some grace. Give yourself some grace to learn it, to figure it out piece by piece, take a deep breath. Having high blood sugars doesn't mean you're a bad mom or that you're doing anything wrong. Just really take some time to be positive to yourself.

36:24 - Where to find Leslee and her work:

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