The first line of treatment for control of gestational diabetes – GDM (Diabetes in Pregnancy) is lifestyle management.
It includes:
- Medical nutrition therapy
- Exercise
- Weight management depending on prepregnancy weight.
Studies suggest that upto 70-85% of women with GDM can control GDM with lifestyle changes alone.
Medical nutrition therapy (MNT)
Medical nutrition therapy is nothing but an individualized food plan supervised by a registered dietician.
- It should provide adequate nutrients for a healthy pregnancy and proper weight gain and should achieve and maintain normal glucose levels.
- It should take into account calorie intake, carbohydrate content in meals, and distribution of meals throughout the day.
- A typical meal plan includes three small to moderately sized meals and 2-3 snacks.
- In general, you should avoid simple sugars like sweets, starchy foods, potatoes, bread and baked products, and fatty foods.
- The source of carbohydrates you eat should be from peas, beans, whole grains, and vegetables.
Exercise
Exercise like walking at a pace, arm exercises should be performed for 30 min daily for atleast five days in a week if there are no obstetric contraindications.
Weight management
Excessive weight gain during pregnancy should be avoided as it hampers the benefit of glucose control in pregnancy.
Moderate restriction of calories (1/3rd reduction) is appropriate for overweight and obese GDM women.
- Self blood glucose monitoring should be done to evaluate the effectiveness of lifestyle management — Monitor glucose at fasting and 2hrs after meals.
- If glucose control is not achieved through lifestyle modification, medications should be added.
- Insulin is the drug of choice for treating high glucose levels in GDM as it does not cross the placenta.
- Metformin and glyburide should not be used as first-line agents, as both crosses the placenta to the fetus.
