Expand All  |  Collapse All

• Home
• Recent Issues
• Sections
• Our Magazines
  • About Us
  • Editorial Advisory Board
  • Advertising
  • Circulation
  • Editorial Information
  • Guidelines for Authors
  • Subscriptions
• Contact

Family Health Magazine
DIABETES

Life After Gestational Diabetes
Caring for yourself and your new baby

Gestational diabetes is a type of diabetes that appears only during pregnancy. It affects two to four per cent of expectant mothers. If you have had it, you are much more likely to develop type 2 diabetes later. Your child will also be at risk later in life.

In diabetes, the body is unable to use glucose (sugar) normally. Glucose is the body’s source of energy. Your brain, muscles and body need it to function. Developing babies also require it. Your body uses the insulin hormone to process glucose. After 24 weeks of pregnancy, the placenta produces higher levels of pregnancy hormones. If they cause insulin’s normal function to decline, gestational diabetes results and can last until the baby is born.

Diabetes is a serious, lifelong health condition.

A healthy lifestyle after gestational diabetes will be an important part of preventing type 2 diabetes, both in you and in your child. Long-term complications associated with diabetes can affect the kidneys, eyes, nerves and blood vessels. By controlling your blood glucose levels through good nutrition and physical activity, you can prevent long-term risks to your health.

After the pregnancy

Once your baby is born, you still must take action to prevent diabetes. If you used insulin during your pregnancy to control blood glucose, you no longer need to take it. Once the placenta leaves your body, it no longer produces high pregnancy hormones. Your delivery team will check your blood glucose levels to make sure they are within target range. Since your insulin sensitivity will likely improve, the insulin your body normally produces will effectively control your blood glucose.

To be sure that your insulin sensitivity has returned to normal, you will need to do an oral glucose tolerance test (OGTT). It should be done within six weeks to six months of your pregnancy. You had this same orange sugar drink during your pregnancy at 24 to 28 weeks.

If you are planning another pregnancy, keep your family doctor and gestational diabetes team involved with your glucose control. Your family doctor will review the results of any blood work you have done. Even if your family is now complete, it is still important to have a yearly follow up appointment with your family doctor.

Achieving a healthy weight and waist circumference

To lower your chances of developing type 2 diabetes, you need to return to a healthy weight after your pregnancy. Physical activity and a healthy diet are the best way to reach this goal. To get an idea of your suggested weight, look up your BMI (body mass index).

A healthy waist circumference is another great target. Achieving this will help reduce your risk of heart disease and other chronic conditions.

Weight loss after pregnancy is different for each woman and with each pregnancy. It depends on your pre-pregnancy weight, your age, the amount of weight and how you gained it during your pregnancy.

Activity and exercise

Being active is a great way to reduce your weight and get in shape. Still, do not rush into heavy exercise too soon after the birth of your child. Give your body some time to recover. Walking is a safe activity with which to start, but don’t overdo it. Once your doctor gives you the go-ahead, begin by exercising your pelvic floor and tummy muscles. Check with your doctor or obstetrician before trying other forms of exercise. They may suggest waiting for six weeks before starting a new exercise routine.

Healthy eating

Ideally, healthy eating and exercise are the best ways to maintain a healthy weight. Continue eating a healthy diet after the birth of your child. Remember to choose whole grains, fruits, vegetables and lean proteins. Small frequent meals during the day are best. This helps reduce the amount of glucose entering your body at one time, making it easier for your insulin to do its job. Although your pregnancy hormones are gone, your body may still be partially insulin resistant or not produce enough insulin.

Your daily calorie needs after pregnancy will be similar to those during the second and third trimesters, especially if you are breastfeeding. An additional 400 to 600 calories support the production of breast milk. If you bottle-feed your baby, the extra nutrients help assist the healing process in the first six weeks after birth.

Your excess fat stores provide some of the additional calories needed. Plan to include an average of 300 additional calories in your diet, and allow the remaining 200 calories to come from fat stores. This will help in losing weight. After six weeks, you can further reduce calories to encourage a gradual weight reduction of one or two pounds per week.

See the sidebar the the right for healthy snack ideas.

If you do not get enough calories, you may feel tired, dizzy and weak. This can affect your milk production and lower the amount of antibodies in the breast milk. These antibodies enhance the baby’s immune (defence) system, and are important in the first months of life. It is essential to drink plenty of fluids, water being the first choice.

Adequate calcium-containing foods maintain your bone strength and calcium storage. Dairy products, kale, almonds, and canned salmon including the bone are all rich calcium sources. See Canada’s Food Guide for more information on including a variety from each of the four food groups each day.

Spread out foods containing glucose in small, frequent meals and snacks:

• Two to three grains and starches at each meal and one milk and/or fruit.
• One to two servings of grains and starch at each snack and one fruit or milk serving.
  Tip: vegetables and lean proteins will not increase your blood glucose, but provide you with healthy nutrients and energy

Blood glucose control tips

Balancing your meals increases the fibre rich foods, proteins and healthy fats you take in. This slows down the digestion and absorption of sugars and starches.

• For fibre, include high fibre cereals (greater than five grams of fibre per serving), beans and lentils, raw veggies, whole grain breads and pastas, and seeds and nuts.
• For protein, use lean meats like chicken breast (boneless and skinless), lean turkey meats, trimmed ham, eggs, low fat cheese, unsalted nuts, natural nut butters (such as peanut or almond), cottage cheese, beans and lentils.
• Healthy fats include plant oils (olive, canola, safflower oils), avocado,
  olives, nuts and seeds.

Future pregnancies

If you are planning another pregnancy, you must first gain good control of your blood glucose. Continue using birth control until you have reached your goals. As well, be sure to:

• attain and maintain a healthy weight
• eat a healthy well balanced diet rich in fruits, vegetables, dairy products, whole grains and lean proteins
• start taking a prenatal vitamin and a folic acid supplement. Women with diabetes should use between 1 and 5 mg/day (1000 to 5000 µg) of folic acid. Check with your doctor for the correct amount for you. Health Canada recommends at least 0.4 mg (400 µg) per day for all women.
• begin or continue a low-impact exercise routine to follow through your next pregnancy
• keep cool and well-hydrated during exercise
• have a complete physical done by your family doctor.

If you are planning another pregnancy, ask for a referral to the Diabetes in Pregnancy (DIP) clinic.

You will not need to have the OGTT during this pregnancy. An early start with the DIP clinic may help improve your blood glucose control and reduce any complications that could be associated with your pregnancy.