Managing

Gestational

Diabetes

A PATIENT’S

GUIDE TO A

HEALTHY

PREGNANCY

U.S. Department of Health and Human Services

National Institutes of Health

Eunice Kennedy Shriver National Institute of Child Health 

and Human Development
Dear Patient, 

The feelings that surround pregnancy—excitement, anxiety, and hope—often 

give way to many questions. Will my child’s eyes be blue or brown? 

When will I have my baby? How big will my baby be? What does the future 

hold for my family? 

Finding out that you have a “condition,”even a manageable one,can raise

a different set of questions. Will my baby be healthy? Will the condition affect 

my ability to have other children? What can I do to ensure my own health 

and the health of my baby? 

For the last 40 years, the Eunice Kennedy Shriver National Institute of Child 

Health and Human Development (NICHD) has been working to answer 

these types of questions through research and clinical practice to improve 

the health of mothers, children, and families. 

Managing Gestational Diabetes: A Patient’s Guide to a Healthy Pregna

ncy provides some general guidelines for keeping yourself healthy and for

promoting the best outcomes for your baby if you have gestational

diabetes. The booklet describes gestational diabetes, its causes, and its

features and includes a general treatment plan to help control the 

condition. 

Using this information, you and your family can make informed decisions 

about your care. You will also be better able to work with your health care 

provider to develop a treatment plan that addresses your specific needs 

situation to ensure that you and your baby are healthy. 

I hope this booklet helps you meet the challenges of gestational diabetes 

that you will face over the next few months, and that you will enjoy the new

addition to your family when he or she arrives. 

Sincerely yours, 

Alan E. Guttmacher, M.D. 

Director, NICHD 
Managing 

Gestational

Diabetes

A Patient’s Guide to 

a Healthy Pregnancy
Table of contents
 

What is gestational diabetes? ....................................................................................2
 

What is diabetes?..........................................................................................................................2
 

Why didn’t I have diabetes before? ...........................................................................3
 

Why isn’t the insulin doing its job? .....................................................................................3
 

Will gestational diabetes hurt my baby? ..................................................................5
 

Will gestational diabetes affect my labor or delivery? ............................................7
 

Will I have diabetes after I have my baby?................................................................8
 

What should I do if I have gestational diabetes?......................................................9
 

Know your blood sugar level and keep it under control ......................................10
 

Eat a healthy diet, as outlined by your health care provider...............................13
 

Get regular, moderate physical activity..........................................................................20
 

Maintain a healthy weight gain..........................................................................................22
 

Keep daily records of your diet, physical activity, and glucose level ...............26
 

Take insulin and/or other medications as prescribed.............................................27
 

Your health care provider might also tell you to:......................................................31
 

Test your urine for ketones if needed.....................................................................................31
 

Have your blood pressure checked as indicated...................................................................32
 

What should I do after my baby is born? ................................................................33
 

How can I tell if I am likely to develop diabetes in the future? .............................34
 

Plan your next pregnancy. .......................................................................................35
 

You can control gestational diabetes!.....................................................................35
 

Where can I go for more information about gestational diabetes? .....................36
 

Appendix A: High­fiber foods .................................................................................38
 

Appendix B: Sample menu ......................................................................................39
 

Appendix C: Sample glucose monitoring record sheet ........................................42
 

Appendix D: Sample food and physical activity record sheet..............................43
 

Managing 

Gestational

Diabetes

A Patient’s Guide to 

a Healthy Pregnancy

Gestational diabetes (pronounced jess-TAY-shun-ul die-uh-BEET-eez) 

is one of the most common health problems for pregnant women. It affects

about 5 percent1 of all pregnancies, which means there are about 200,000

cases each year. If not treated, gestational diabetes can cause health problems

for mother and fetus.

The good news is that gestational diabetes can be treated, especially if 

it’s found early in the pregnancy. There are some things that women with

gestational diabetes can do to keep themselves well and their pregnancies

healthy. Controlling gestational diabetes is the key to a healthy pregnancy.

This booklet gives women who have been diagnosed with this condition the

information they need to talk to health care providers, dietitians, and family

members and friends about gestational diabetes.
      

      

        

   

  

    

         

What is gestational diabetes?

Gestational Diabetes is a kind of diabetes that only pregnant women get.

In fact, the word gestational means “during pregnancy.” If a woman gets

diabetes or high blood sugar when she is pregnant, but she never had it

before, then she has gestational diabetes. Its medical name is gestational

diabetes mellitus (pronounced MELL­eh­tiss) or GDM. To learn what gestational

diabetes is, you need to know a few things about diabetes in general.

What is diabetes?

Diabetes means your blood sugar is too high. Diabetes is a disease of

metabolism, which is the way your body uses food for energy and growth.

Your stomach and intestines break down (or digest) much of the food you eat

         

     
      

     

  

            

        

   

  

   

  

                        

    

          

       

           

     

    

   

   

why          didn’t I have diabetes before? 3

After digestion, the glucose passes into your bloodstream, which is why

glucose is also called blood sugar. This booklet uses the terms glucose 

and blood sugar to mean the same thing. Once in the blood, the glucose is

ready for your body cells to use. But your cells need insulin (pronounced

IN­suh­lin), a hormone made by your body, to get the glucose. Insulin “opens”

your cells so that glucose can get in. When your metabolism is normal, your

body makes enough insulin to move all the glucose smoothly from your

bloodstream into your cells.

If you have diabetes, your insulin and glucose levels are out­of­balance. Either

your body isn’t making enough insulin, or your cells can’t use insulin the way

they should. Without insulin, the glucose that can’t get into your cells builds

up in your bloodstream. This is called high blood sugar or diabetes. After

a while, there is so much glucose in the blood that it spills over into your urine

and passes out of your body. The medical name for diabetes, diabetes mellitus,

means “sweet urine.”

If not treated, gestational diabetes can lead to health problems, some of them

serious. The best way to promote a healthy pregnancy if you have gestational

diabetes is to follow the treatment plan outlined by your health care provider.

Why didn’t I have diabetes before?

Remember that only pregnant women get gestational diabetes. When you’re

pregnant, your body goes through a lot of changes. In this case, being

pregnant changed your metabolism. Now that you’re pregnant, the insulin in

your body can’t do its job. Your body can’t get the sugar out of your blood

and into your cells to use for energy.

Why isn’t the insulin doing its job?

The placenta, the system of vessels that passes nutrients, blood, and water

from mother to fetus, makes certain hormones that prevent insulin from

working the way it is supposed to. This situation is called insulin resistance.

To keep your metabolism normal, your body has to make three times its normal

amount of insulin or more to overcome the hormones made by the placenta.
why          didn’t I have diabetes before?

   

      

        

   

     

   

      

   

      

     

  

  

   

   

   

       

    

       

   

       

       

   

          

       

For most women, the body’s extra insulin is enough to keep their blood sugar

levels in the healthy range. But, for about 5 percent of pregnant women, even

the extra insulin isn’t enough to keep their blood sugar level normal. At about

the 20th to the 24th week of pregnancy, they end up with high blood sugar or

gestational diabetes.

It takes time for insulin resistance to affect your body in a way that health care

providers can measure, which is why tests for gestational diabetes are usually

done between the 24th and 28th week of pregnancy.

Who can I go to for help with gestational diabetes?

Women who have gestational diabetes benefit most from a team approach to treatment, with each

team member playing a specific role in the management and treatment of the condition. However,

the specific members of the team will vary.

In general, women have a number of choices in how they get prenatal care. They might go to an

obstetrician/gynecologist (OB/GYN), a nurse­midwife, a family physician, or another health care

provider. These health care providers are usually the first line of defense against gestational

diabetes because they do the initial testing for the condition.

Once you are diagnosed with gestational diabetes, these providers may decide to stay on your

team, working with other providers to manage your care, or they may suggest that one of the

following specialists leads your team:

A maternal­fetal medicine specialist—a doctor who cares for a woman during pregnancy, labor,

and delivery only; or

Another doctor who specializes in treating pregnant women with high­risk conditions.

Should you need more extensive treatment and management to keep your gestational diabetes

under control, it is likely that you will have to see one of these specialists to help ensure a healthy

pregnancy.

You should also have a registered dietitian, a person with a bachelor’s degree or higher in dietetics

who is registered with the American Dietetic Association (ADA), on your team. Your health care

provider can recommend a dietitian, or you can call the ADA at 1­800­366­1655 to find one.

In addition, you may have one or both of the following providers on your team:

A diabetes specialist—a diabetologist (a doctor who specializes in diabetes care), endocrinologist

(a doctor who specializes in treating hormone­related conditions, like diabetes), or another

medical doctor who provides health services specifically for diabetics.

A diabetes educator—a certified diabetes educator (CDE), nurse educator, registered nurse (RN),

or another health care provider who can explain gestational diabetes and help you manage your

condition during your pregnancy.

Keep in mind that your treatment and management team may include other members, too. This

booklet uses the term health care provider to describe your doctor and the other members of your

health care team.

4
Will gestational diabetes hurt my baby?

Most women who have gestational diabetes give birth to healthy babies,

especially when they keep their blood sugar under control, eat a healthy diet,

get regular, moderate physical activity, and maintain a healthy weight. In some

cases, though, the condition can affect the pregnancy.

Keeping glucose levels under control may prevent certain problems related to

gestational diabetes.

Below are some conditions that can result from your having gestational

diabetes. Keep in mind that just because you have gestational diabetes does

not mean that these problems will occur.

Macrosomia (pronounced mak­row­SOHM­ee­uh)—Baby’s body is larger

than normal. Large­bodied babies sometimes get injured by natural delivery

through the vagina; the baby may need to be delivered through cesarean

section. The most common complication for these babies is shoulder dystocia

(pronounced dis­TOE­shee­uh).

Hypoglycemia (pronounced high­po­gl­eye­SEEM­ee­uh)—Baby’s blood

sugar is too low. You may need to start breastfeeding right away to get more

glucose into the baby’s system. If it’s not possible for you to start feedings,

the baby may need to get glucose through a thin, plastic tube in his or her

arm that puts glucose directly into the blood.

Jaundice (pronounced JAWN­diss)—Baby’s skin turns yellowish; white parts

of the eyes may also change color slightly. If treated, jaundice is not a serious

problem for the baby.

Respiratory Distress Syndrome (RDS)—Baby has trouble breathing.

The baby might need oxygen or other help breathing if he or she has RDS.

  

  

  

         

Low Calcium and Magnesium Levels in the Baby’s Blood—Baby

could develop a condition that causes spasms in the hands and feet, or

twitching or cramping muscles. This condition can be treated with calcium

and magnesium supplements.

will gestational diabetes hurt my baby? 5
6 will          gestational diabetes hurt my baby?

         

  

    

                      

                   

                     

            

        

   

           

       

   

Could gestational diabetes hurt my baby in other ways?

Gestational diabetes usually does not cause birth defects or deformities.
 

Most developmental or physical defects happen during the first trimester
 

of pregnancy, between the 1st and 8th week. Gestational diabetes typically
 

develops around or after the 24th week of pregnancy. Women with gestational
 

diabetes usually have normal blood sugar levels during the first trimester,
 

allowing the body and body systems of the fetus to develop normally.
 

The fact that you have gestational diabetes will not cause diabetes in your
 

baby. But, your child is at higher risk for developing type 2 diabetes later
 

in life. As your child grows, things like eating a healthy diet, maintaining 

a healthy weight, and getting regular, moderate physical activity may help 

to reduce that risk.
 

If your baby was macrosomic, or large­bodied at birth, then he or she is at
 

higher risk for childhood and adult obesity (being extremely overweight).
 

Large­bodied babies are also at greater risk for getting type 2 diabetes 

and often get it at an earlier age (younger than 30) than those who were 

small­bodied babies.
 
will              gestational diabetes affect my labor or delivery? 7

Will gestational diabetes affect my

labor or delivery? 

Most women with gestational diabetes can make it to their due dates safely

and begin labor naturally. In some cases, though, gestational diabetes could

change the way you feel or how your baby is delivered. Again, keep in mind

that just because you have gestational diabetes does not mean that you will

have any change in delivery. Talk to your health care provider about

ANY concerns you have about labor or delivery.

If you have gestational diabetes, there are some things you should keep in

mind about delivery:

Blood Sugar and Insulin Balance—Keeping your blood sugar level

under control during labor and delivery is vital to your own health and to

your baby’s health. If you do not take insulin during your pregnancy, you

probably won’t need it during labor or delivery. If you do take insulin during

your pregnancy, you may receive an insulin shot when labor begins, or you

may get insulin through a thin, plastic tube in your arm that goes into your

bloodstream during labor.

Early Delivery—Gestational diabetes puts women at higher risk than

women without the condition for developing preeclampsia (pronounced

pree­ee­KLAMP­see­uh), late in their pregnancies. Preeclampsia is a

condition related to a sudden blood pressure increase; it can be serious.

(For more information on preeclampsia, go to the Your health care provider

might also tell you to:  Have your blood pressure checked as indicated section of

this booklet.)  The only way to cure preeclampsia is to deliver the baby; but

delivery may not be the best option for your health or for the health of the

baby. Your health care provider will keep you under close watch, possibly at

the hospital, and will run multiple tests to determine whether early delivery

is safe and needed. Your health care provider will give you more information

about early delivery, should it be necessary.

Cesarean Delivery—This is a type of surgery used to deliver the baby,

instead of natural delivery through the vagina. Cesarean delivery is also

called a cesarean section, or "C" section. Simply having gestational diabetes

is not a reason to have a C section, but your health care provider may have

other reasons for choosing a cesarean delivery, such as changes in your

health or your baby’s health during labor.
                

   

     

                   

                     

                      

                   

                           

                   

                     

Will I have diabetes after I have my baby?

Once you have the baby, your body should be able to use its insulin more

effectively. Shortly after the baby is born, the placenta is “delivered.” (This 

is sometimes called the afterbirth.)  Because the placenta causes insulin

resistance, when it’s gone, gestational diabetes usually goes away, too.

If you have gestational diabetes, you are at higher­than­normal risk for

developing type 2 diabetes later in your life. Type 2 diabetes, like gestational

diabetes, occurs when the body doesn’t use its insulin properly. Keeping your

weight within a healthy range and keeping up regular, moderate physical

activity after your baby is born can help lower your risk for type 2 diabetes.

Following a healthy diet and physical activity program, maintaining a healthy

weight, or taking certain medicines can help people control type 2 diabetes.
               

   

   

  

    

    

  

   

           

        

   

What should I do if I have 

gestational diabetes?

Many women with gestational diabetes have healthy pregnancies and healthy

babies because they follow the treatment plan that their health care providers

set up for them.

This booklet gives you general guidelines for how to stay healthy with

gestational diabetes.Your health care provider can build a treatment program

to meet your specific needs. Remember that the most important person in the

treatment plan is YOU. You are the one who will be doing the work to keep

yourself healthy. Make sure you feel comfortable asking questions and talking

to your health care provider about any worries that you have.

One of the most important things you can do to help ensure a healthy

pregnancy is to make regular health care appointments and to keep them.

In this way, your health care provider can catch any problems before they

become major health issues.

A general treatment plan to control gestational diabetes

may include these items:

Knowing your blood sugar (also called glucose) level and keeping 

it under control
 

Eating a healthy diet, as outlined by your health care provider

Getting regular, moderate physical activity

Maintaining a healthy weight gain

Keeping daily records of your diet, physical activity,

Taking insulin and/or other medications as prescribed

Your health care provider might also tell you to:

Test your urine for ketones, if needed.

what should I do if I have gestational diabetes? 9

Have your blood pressure checked as indicated.

What are these things? Why are they important? How do you do them?

When do you do them? How do you know if you’re doing them right? To

answer these questions, let’s look at each one more closely.
know                  your blood sugar level and keep it under control

what                should I do if I have gestational diabetes?

  

   

   

     

            

     

       

  

   

             

        

      

                          

                           

                          

                             

Know your blood sugar level and keep it under control

What is it?

The first step in this general treatment plan has two parts: 1) Knowing your

blood sugar level—means you test to see how much glucose is in your blood;

and 2) Keeping your blood sugar level under control—means you keep the amount

of glucose within a healthy range at all times, by eating a healthy diet as

outlined by your health care provider, getting regular physical activity,

and taking insulin, if needed.

Why do I have to do it?

Your blood sugar level changes during the day based on what foods you eat,
 

when you eat, and how much you eat. Your level of physical activity and when
 

you do physical activities also affect your blood sugar levels.
 

By getting to know your body and how it uses glucose during the day, you can
 

help your health care provider to adjust your treatment program. Measuring
 

your glucose level every day, and many times during the day, helps pinpoint
 

when you need to eat, how much you should eat, and what kinds of foods are
 

best for you. Knowing if your glucose level is in the healthy range also tells
 

you whether or not it is safe for you to do physical activity.
 

As you get closer to your due date, your insulin resistance could increase.
 

If that happens, you might need to take insulin shots to help keep your glucose
 

level under control. Knowing your glucose levels at specific times of the day will
 

allow your health care provider to figure out the right amount of insulin for you.
 

Measuring your blood

sugar will give you

information about...

The amount of food 

you can eat

Foods that affect your

glucose level

Times when your glucose

level is high or low

Times that physical

activity is more likely to

keep your glucose level

in the target range

For example...

Can you have that extra 1/2 bagel at breakfast?

Does your body process different foods differently?

You might have high blood sugar in the morning after

breakfast.Other women’s levels are highest after dinner.

Does walking for 20 minutes after breakfast or dinner

help to keep your glucose level within the healthy range?

10
know your blood sugar level and keep it under control 11

How do I do it?

Your health care provider will show you how to test your glucose level and will

give you detailed information about glucose testing. The steps below are only

meant to give you a basic idea of what is involved in testing: 

1. Wash your hands with warm water and soap.

2. Prick your finger with a small needle called a lancet

(pronounced LAN-sett). Squeeze out a drop of blood.

(Note: The illustration above shows someone getting 

blood from an index finger, but you can prick any finger 

to get a drop of blood.) 

3. Place the drop of blood on the target spot of a special

testing device called a glucose meter, or onto the 

paper strip that fits into the meter. Because each glucose

meter is different, your health care provider will show you

how to use your specific meter and will explain how the

meter works. 

4. Wait a few minutes (Note: How long you have to wait

depends on the type of meter you have). The meter will

give you a number for your blood sugar level, like 128. 

Use each lancet only once and be careful when you throw

away used lancets. Ask your health care provider how to

safely throw away testing supplies, like lancets.

Your health care provider will watch you do the test before you do it 

by yourself or try it at home. Take your glucose testing items with you 

when you go for health care appointments. 

You can get supplies for testing your glucose level, like lancets and glucose

meters, in most drug stores, pharmacies, and medical supply stores. Your

health insurance plan might cover the cost of these supplies. You might 

also be able to rent a glucose meter from a medical supply store. Renting

might be a better option for you because you will probably need the device 

only while you’re pregnant. Ask your pharmacist for more information.

what should I do if I have gestational diabetes?
                 

   

  

   

   

       

  

      

    

what                should I do if I have gestational diabetes?

When do I do it?

Follow your health care provider’s advice about when to test your glucose

level. You might have to test four times a day:

Fasting glucose level—first thing in the morning, before you eat

1 or 2 hours after breakfast

1 or 2 hours after lunch

1 or 2 hours after dinner

You might also need to test your glucose level before you go to bed at night.

This test is called your nighttime or nocturnal (the word nocturnal means

nighttime) glucose level.

How do I know that I’m doing it right?

Even though your glucose level changes during the day, there is a healthy

range for these levels. The goal is to keep your glucose level within this range.

The following chart shows the healthy “target”range for each time you test.

H EALT H Y TAR G E T R A N G E F O R G LU CO S E L E V E L S 2 , 3

Fasting glucose level

One hour after eating

Two hours after eating

No higher than 95

No higher than 140

No higher than 120

Time of Blood Sugar Test Healthy Target Levels (in mg/dl)#

Talk to your health care provider about what to do if your glucose level is

outside the healthy target listed here. You may have to adjust your treatment

plan to get your levels back in range.

12 know your blood sugar level and keep it under control
eat                    a healthy diet, as outlined by your health care provider 13

what                should I do if I have gestational diabetes?

             

  

   

    

  

          

  

   

   

   

Eat a healthy diet,as outlined by your health care provider

What is it?

A healthy diet is one that includes a balance of foods from all the food

groups, giving you the nutrients, vitamins, and minerals needed for a healthy

pregnancy. For women with gestational diabetes, such a diet also helps to

keep blood sugar levels in the healthy target range.

Women with gestational diabetes have special dietary needs.

Because eating a healthy diet is such an important part of a treatment plan 

for gestational diabetes, women should not try to create their own diets.

To promote health throughout your pregnancy, it is essential that you work

with your health care provider to create a plan for your healthy diet. It is also

important that you follow the plan as outlined by your health care provider.

The information in this booklet is specific to women who have been

diagnosed with gestational diabetes. These guidelines are not appropriate for

all pregnant women, nor do they apply to women who are not pregnant or

who have other types of diabetes.

Carbohydrates are often at the center of a healthy diet for a woman with

gestational diabetes.

Carbohydrates are nutrients that come from certain foods, like grain

products, fruits, and vegetables. During digestion, your body breaks down

most carbohydrates into simple sugars, like glucose, which is your body’s

main source of energy.
14 eat                    a healthy diet, as outlined by your health care provider

what                should I do if I have gestational diabetes?

Eating carbohydrates affects your blood sugar level. For instance, if you eat a

small amount of carbohydrate at a meal, your blood sugar level goes up a

small amount. If you eat a large amount of carbohydrate at a meal, your

blood sugar level goes up a large amount.

You and your health care provider will need to find a balance between

eating enough carbohydrates to get the energy and glucose you need, and

limiting the carbohydrates you eat to control your blood sugar level.

There are a few things you should know about carbohydrates and your

healthy diet:

Your health care provider will come up with a healthy diet for you that includes

the proper amount of carbohydrates to maintain a healthy pregnancy.

Some women who have gestational diabetes may need to eat fewer

carbohydrates than they did before they were pregnant to lower their total

amount of carbohydrates.

Some women with gestational diabetes may need to avoid high­sugar foods,

like sweets and desserts, to keep their carbohydrate levels in line. But, even

though these foods have more carbohydrates and sugars in each serving

than other foods do, they can still be worked into a plan for healthy eating 

in most cases.

Not getting enough carbohydrates can also cause problems. So, you should only

limit your carbohydrate intake if advised to do so by your health care provider.

Most women with gestational diabetes follow a meal plan to make sure they

are getting the nutrients they need. Types of meal plans may include:

Carbohydrate counting—For this meal plan, you count the number of

grams of carbohydrates that you eat at each meal and snack to make sure

you are within a certain range, as determined by your health care provider.

Your meal plan may be specific, giving you definite amounts for each meal 

or snack, or it may be more general, with a daily carbohydrate total. A

slightly different version of this meal plan changes the grams of

carbohydrates into “points.” Then you have to make sure you stay within a

certain range of carbohydrate points for each meal or each day.   

The exchange system—The exchange system has food groups that are

slightly different than the food groups in the U.S. Department of Agriculture
eat                    a healthy diet, as outlined by your health care provider 15

            

    

         

      

          

         

        

   

      

       

   

        

       

  

   

   

  

   

  

        

  

        

   

  

       

                        

what                should I do if I have gestational diabetes?

Food Guide Pyramid: breads/starches, fruits, vegetables, proteins, milk, and

fats. Each food within an exchange group has about the same amount of

carbohydrate, fat, protein, and calories, but the amounts of vitamins and

minerals may vary among foods within each group. To follow the plan, you

count the number of items from a food group that you eat at each meal.

You can “exchange”one food item in a group with another item in a group

without changing your plan. For instance, you can choose one (1) meat

exchange (a protein) or one (1) tofu exchange (also a protein) without

changing the amount of carbohydrate or calories in your meal.

Your health care provider may also tell you to get more fiber in your diet. Fiber

is the part of plant foods that your body can’t digest, like skins, seeds, and bran.

Because fiber slows down digestion and absorption of nutrients, it can also

help to control your blood sugar level. Foods that are part of a healthy diet,

like fruits, vegetables, and legumes (beans and peas), are also good sources of

dietary fiber. Some foods that are high in fiber, like whole grain products, such

as cereals and some breads, also help prevent constipation. (See Appendix A:

High­Fiber Foods for a list of foods that contain high fiber.)

Why do I have to do it?

All pregnant women need to eat healthy diets, as laid out by their health care

providers, to help them get the right nutrients, in the right amounts. When you

have gestational diabetes, a healthy diet also helps to keep blood sugar in the

healthy range. Following a healthy diet is one of the best ways to promote a

healthy pregnancy.

How do I do it?

Women who have gestational diabetes should not try to create a healthy diet

on their own. They should work closely with their health care provider to make

sure they are getting proper nutrition.

The table on the next page describes the Food Groups that your health care

provider will use to build your diet. He or she will tell you how many servings

of each group you should have in a day.

If one of the foods that you normally eat does not appear on this table, ask

your health care provider what group that food belongs to. You should also

ask about the serving size, so that you know how much of that food you can

eat. Every question you have is important, so don’t be afraid to ask.
16 eat                    a healthy diet, as outlined by your health care provider

what                should I do if I have gestational diabetes?

Food Groups4

Please note that this booklet presents only general guidelines for a healthy

diet for women with gestational diabetes. Use the chart below to talk to your

health care provider about eating. This chart is not meant to take the place of

your health care provider’s recommendations.

FOOD GROUP

Fats and Oils

DESCRIPTION AND TIPS

These foods give you essential

fatty acids and vitamins.

Choose a diet that is low in

saturated fat, trans­fats, and

cholesterol and moderate in

total fat. Use vegetable oils

rather than solid fats (such as

those in meat or dairy foods

and shortening).

WHAT ARE SOME FOODS

IN THIS GROUP?

• Salad dressing

• Butter/ margarine

• Mayonnaise

• Vegetable oil,

canola oil, olive

oil, soybean oil,

sunflower oil

• Spray vegetable oil

•

•

•

HOW MUCH IS ONE (1) SERVING?*

1 tsp butter, margarine, or oil

1 TBSP regular salad dressing or

mayonnaise

2 TBSP low­fat or light salad

dressing

Milk,Yogurt,

and Cheese Milk and milk foods give you

carbohydrates, proteins, and

vitamins and minerals.

Choose milk, cheese, and

yogurt products that are 

fat free or low fat (1%).

•

•

•

•

•

Milk, powdered

milk, condensed

milk, buttermilk

Lactose­free milk

Cheese

Plain yogurt

Frozen yogurt

•

•

•

•

•

1 cup fat­free or low­fat (1%) milk

2 ounces fat­free or low­fat cheese

1 cup lactose­free milk

1 cup fat­free plain yogurt

1/3 cup powdered, non­fat milk

Meat, Poultry,

Fish,Dry Beans,

and Nuts

These foods provide protein,

vitamins, and minerals.

Trim extra fat off meats,

including the skin. Use

broiling, grilling, and roasting

to cook meats without adding

fat or cholesterol.

•

•

•

•

Lean beef, poultry,

pork, seafood, lamb,

meat substitute

Eggs, egg substitute

Tofu

Peanut butter and

peanuts

•

•

•

•

3 ounces cooked lean meat,

chicken, fish, or pork

1/2 cup tofu

1 egg

2 TBSP peanut butter

Vegetables Vegetables, either raw or

cooked, give you

carbohydrates, vitamins,

minerals, and fiber. They are

usually very low in fat, unless

they are cooked with butter,

margarine, salad dressing,

cream sauce, or other high­fat

ingredient.

•

•

Carrots, celery,

okra, Brussels

sprouts, asparagus,

cauliflower,

broccoli,

mushrooms,

peppers, squashes,

tomatoes, onions,

cucumbers

Leafy vegetables:

lettuce, spinach,

cabbage

•

•

•

•

1 cup raw vegetables

1/2 cup cooked vegetables

1 cup leafy, raw vegetables

1/2 cup tomato or vegetable juice
eat                    a healthy diet, as outlined by your health care provider 17

* tsp. = teaspoon TBSP = tablespoon

Fruits Fruits give your body

carbohydrates, vitamins,

minerals, and fiber.

Choose fresh fruits, fruits

canned in their own juices or

in water, or frozen fruits.

• Bananas, apples,

berries, mango, plums,

peaches,figs, pears,

grapes, prunes

• Citrus fruits: oranges,

tangerines, grapefruit,

kiwi, pineapple

• Melons: watermelon,

cantaloupe, honeydew

•

•

•

•

•

1 piece small­to­medium whole

fruit (about 1/2 cup of cut

pieces)

1 slice of melon

1/2 cup canned or

fresh fruit pieces

1/2 cup or 4 fl.oz.

fruit juice

1/2 banana

Bread, Cereal,

Rice, and Pasta

This group gives your body

carbohydrates, vitamins,

minerals, and fiber. Whole

grain products are high in

these nutrients.

Avoid high­fat or fried starchy

vegetables and grain products.

Use seasonings and fat­free or

low­fat toppings and sauces to

add flavor.

• Bread: sandwich and

dinner breads, bagels,

flour tortillas, pita,

rolls, pizza crust,

cornbread,taco shells

• Starchy vegetables:

white or sweet

potatoes

•Legumes (peas,corn,

beans)

• Rice, noodles, pasta

(spaghetti/macaroni),

dry or cooked cereal,

oatmeal

• Crackers, pretzels,

unbuttered popcorn,

breadsticks

•

•

•

•

•

•

•

•

•

•

•

1 slice whole grain bread

1/2 bagel, English muffin, or

six­inch flour tortilla

1 small muffin or

waffle

2 pancakes

5 crackers

1/3 cup cooked rice

1 small baked

potato (plain)

1/2 cup cooked cereal,

pasta, mashed potatoes

1/2 cup cooked beans or lentils

1/2 cup sweet potatoes, yams,

peas, or corn

3/4 cup dry, unsweetened cereal

“Free” Foods “Free”foods are those that

have less than 20 calories.

You can often eat free foods

without having to account 

for them in your meal plan.

Water is considered a “free”

food; you can drink as much

water as you want. In fact,

most health care providers

recommend that you drink 

a lot of water when you are

pregnant.

• Rawvegetables:

cabbage (all varieties),

celery,cucumber, endive,

lettuces(all varieties),

mushrooms,peppers,

radishes,spinach

• Drinks:sugar­free/

unsweetened and lowsalt versions of broth,

bouillon,consommes,

mineralwater,club soda.

• Condiments­Group 1:

ketchup,fat­free cream

cheese, horseradish,

fat­free mayonnaise,

fat­free margarine,

reduced­fat margarine,

mustard,fat­free or

reduced­fat sour cream,

taco sauce; Group 2:

salsa; Group 3: soy

sauce, non­stick

cooking spray

• Seasonings­garlic,

herbs,flavoring agents,

pimento,spices (Note:

”salt”seasonings are

high in sodium and

should be used only in

small amounts.)

•

•

•

•

•

•

•

Up to 2 cups raw vegetables

Drinks: 8 fluid ounces

1 TBSP Group 1 condiments

1/4 cup Group 2 condiments

Group 3 condiments—no limit

2 to 3 dashes of seasonings

Water

FOOD GROUP DESCRIPTION AND TIPS WHAT ARE SOME FOODS IN

THIS GROUP?

HOW MUCH IS ONE (1) SERVING?#
                    

  

  

what                should I do if I have gestational diabetes?

You might also have to include these changes in your eating habits5 to help

keep your blood sugar level under control:

Eat meals and snacks (as allowed on your meal plan) on a regular

schedule throughout the day. Researchers recommend that women

with gestational diabetes eat at least three small­ to medium­sized meals

and two to four snacks every day.

Eat smaller amounts of carbohydrates at each meal. Rather than

eating a large amount of carbohydrate at a single meal, your health care

provider may suggest that you spread out your carbohydrates throughout

the day. Because eating carbohydrates directly affects your blood sugar

level, eating a small amount of carbohydrate all through the day will help

keep your blood sugar from rising too high after a meal.

Add a nighttime snack to your meal plan. You may need to add a

snack of one to two servings of carbohydrate before you go to sleep to keep

your blood sugar at a healthy level overnight. Some examples of healthy

snacks include: a piece of fruit, a handful of pretzels, or crackers.

To give you an idea of what a meal plan for one day might look like, there is a

menu sample at the back of this booklet. This sample menu is not meant to

replace your health care provider’s recommendations. (See Appendix C:

Sample Menu for more information.)
eat                    a healthy diet, as outlined by your health care provider 19

what                should I do if I have gestational diabetes?

Whole Milk, Fat­free Milk, 1% Milk, or 2% Milk—How do you decide?

Health care providers recommend that pregnant women increase the amount 

of milk they drink to make sure they get enough calcium. Milk is one of the best

sources of calcium and of other nutrients that help the body absorb calcium. In

most cases, fat­free or low­fat milk and milk products are the best calcium options

because they contain the calcium and other nutrients, without the added fat. Fatfree and 1% milk are among the suggested options.

If you are lactose intolerant or you have trouble digesting milk products, many

lactose­free products provide calcium and other nutrients without the milk sugar.

Following a meal plan and eating a healthy diet may seem like a lot of work

at first. You might have to measure food before you eat it, or not eat certain

foods while you are pregnant; you might have to count carbohydrates, servings,

or exchanges. Don’t give up! Sticking to your meal plan is one of the most

effective ways to control gestational diabetes.

When do I do it?

Eat a healthy diet or follow a meal plan for your entire pregnancy to improve

your health and to help ensure a healthy pregnancy. If you need to make

changes to your diet or meal plan to keep your glucose level in the healthy

range, your health care provider will help you do so.

How do I know that I’m doing it right?

One sign that your diet or meal plan is successful is that your glucose level will

usually stay within the healthy range (see the Healthy Target Range for Blood

Sugar table on Page 12). Talk to your health care provider about what to do if

you have abnormal blood sugar numbers.

Maintaining a healthy weight gain and not having ketones in your urine are other

signs that your diet or meal plan is working. For more information about healthy

weight gain, see the Maintain a Healthy Weight Gain section of this booklet. For

information about ketones,go to the section titled Your health care provider might

also tell you to: Test your urine for ketones, if needed found later in this booklet.
                       

                  

                 

                   

   

         

             

      

     

        

    

          

   

       

     

   

      

       

   

   

    

20 get        regular, moderate physical activity

what                should I do if I have gestational diabetes?

Get regular, moderate physical activity
 

What is it?

Moderate physical activity is not the same as daily,routine activities, such as

shopping, doing household chores, or washing dishes. Women with gestational

diabetes often need regular, moderate physical activity, such as walking,

prenatal aerobics class, or swimming,to help control blood sugar levels.

Your health care provider may tell you not to do any moderate physical

activity because of other health conditions you have or because of

complications with your pregnancy. Do not begin any physical activity

without talking to your health care provider first.

Why do I have to do it?

Moderate physical activity is an important part of any healthy pregnancy.

For women with gestational diabetes, it also helps their bodies’ insulin 

work better, which is an effective way to help control blood sugar2,6 levels.

How do I do it?

Researchers are uncertain about the amount of physical activity that best

helps a woman with gestational diabetes to control her blood sugar. The

specific amount of physical activity that you need depends on how active you

were before you were pregnant, and whether or not you have any other health

concerns. For some women with gestational diabetes, regular, moderate

physical activity includes walking, swimming, or light running. For other

women, only slow walking is recommended. Talk to your health

care provider about what activities you should do, how

often, and for how long.

One thing you need to watch is your level of

effort, called your exertion (pronounced

ecks­ER­shun) level. If you can talk

easily while doing an activity, instead

of gasping for air, your level of

exertion is good. If you cannot talk

easily, or find yourself coughing or

gasping for air, you need to lower

your level of exertion by slowing

down or stopping for a while. Your

health care provider can advise you

on the best level of exertion for you.
get        regular, moderate physical activity 21

    

   

  

     

      

      

   

   

what                should I do if I have gestational diabetes?

When do I do it?

Most women can stay active throughout their pregnancies. However, your

health care provider may recommend that you become less active as you get

closer to your due date. Keep in mind that it may take two to four weeks for

your physical activity to have an effect on your blood sugar levels.

How do I know that I’m doing it right?

Listen to your body—Your body will tell you how much activity is enough. It

will also let you know when you are doing too much. Quit when you feel tired.

If you feel faint, dizzy, or extremely hot, you should stop the activity

immediately.

If you are taking insulin, see the Take medications and/or insulin as prescribed

section of this booklet for tips about physical activity and insulin.

The general guidelines listed below will help to ensure safety while doing

physical activity.

G E N E R AL G U I D E L I N E S F O R P H YS I C AL AC T I V I T Y 7

Do Don’t

Complete moderate and regular

physical activity unless your health 

care provider tells you not to.

Choose activities like swimming,that

don’t require a lot of standing or balance.

Wear loose, light clothing that won’t make

you sweat too much or get too hot.

Drink a lot of water before, during, and

after your activity.

Eat a healthy diet and gain the right

amount of weight.

Watch your level of exertion (Can you

talk easily?).

Get too tired while working out or

doing physical activity.

Do any activity while lying on your back

when you are in your 2nd or 3rd

trimester of pregnancy.

Perform activities in very hot weather.

Perform activities that may bump or

hurt your belly, or that may cause you

to lose your balance.

Fast (skip meals) or do physical activity

when you are hungry.

Over­exert yourself.
22 maintain        a healthy weight gain

what                should I do if I have gestational diabetes?

           

       

    

   

          

        

      

Maintain a healthy weight gain

What is it?

Healthy weight gain can mean either your overall weight gain, or your

weekly rate of weight gain. Some health care providers focus only on

overall gain or only on weekly gain, but some keep track of both types of

weight gain. First, let’s look at overall weight gain.

The amount of weight gain that is healthy for you depends on how much 

you weighed before you were pregnant. Find your pre­pregnancy weight 

and height in the table on page 23. Then look at the bottom row of the table 

to find your overall healthy weight gain goal.

If you are expecting twins, an overall weight gain of 35 to 45 pounds7 is

considered healthy.

Remember that these goals are only a general range for overall weight gain.

Your health care provider will let you know if you’re gaining too much or too

little weight for a healthy pregnancy. Weight loss can be dangerous

during any part of your pregnancy. Report any weight loss to your

health care provider right away.
maintain        a healthy weight gain 23

   

    

       

      

   

     

  

       

what                should I do if I have gestational diabetes?

                               

                               

# You may also fall into this category if you are a teenager or if you smoke.

* The weight gain goal for women in this category may range from 40 to 45 pounds.

O V E R AL L W E I G H T G AI N G OAL S

( b y p r e p r e g n a n c y h e i g h t a n d w e i g h t) 8

H E I G H T

(Without Shoes)

W E I G H T S TAT U S C AT E G O RY

(Weight in pounds, in light, indoor clothing)

ft. in. B C D

4 9 92 or less 93­113 114­134 135 or more

4 10 94 or less 95­117 118­138 139 or more

4 11 97 or less 98­120 121­142 143 or more

5 0 100 or less 101­123 124­146 147 or more

5 1 103 or less 104­127 128­150 151 or more

5 2 106 or less 107­131 132­155 156 or more

5 3 109 or less 110­134 135­159 160 or more

5 4 113 or less 114­140 141­165 166 or more

5 5 117 or less 118­144 145­170 171 or more

5 6 121 or less 122­149 150­176 177 or more

5 7 124 or less 125­153 154­181 182 or more

5 8 128 or less 129­157 158­186 187 or more

5 9 131 or less 132­162 163­191 192 or more

5 10 135 or less 136­166 167­196 197 or more

5 11 139 or less 140­171 172­202 203 or more

6 0 142 or less 143­175 176­207 208 or more

Your overall

weight gain

goal is:

 

35­40* 30­35 22­27 15­20

Why do I have to do it?

Usually, people gain weight because the amount of fuel they take in, as food,

is higher than the amount they use up, as energy. When you have gestational

diabetes, if you gain too much weight, gain weight too quickly, or begin to 

lose weight, your body may be telling you something is wrong. Because your

body’s insulin isn’t working well already, your condition can get out of control

quickly if you gain too much weight, or if you gain weight too quickly.

How do I do it?

You already learned two useful ways to maintain a healthy weight gain: eating

a healthy diet as outlined by your health care provider, and getting regular,

moderate physical activity.
24 maintain        a healthy weight gain

     

       

    

       

  

          

            

   

   

          

  

                           

                         

                    

      

  

what                should I do if I have gestational diabetes?

If you think your weight gain is out of control, but you are following a

recommended diet and physical activity program, tell your health care

provider. He or she will adjust your treatment plan to get your weight gain

back into healthy range.

When do I do it?

It’s a good idea to keep track of how much weight you gain from the time you

learn you are pregnant to the time you have the baby. Knowing your weight

status can help your health care provider detect possible problems before

they become dangerous.

It’s also a good idea to weigh yourself on the same day of the week and at the

same time of day. Your health care provider can make a schedule for you so

you know how often to weigh yourself and at what time of day. You will also

be weighed at your prenatal appointments.

How do I know that I’m doing it right?

One way to determine if your overall weight gain is within the healthy range 

is to follow your weekly rate of weight gain. The table below gives some

general guidelines for weekly rate of weight gain.

Some health care providers feel that your weekly rate of gain is just as important

as your overall weight gain because it shows how well your treatment plan is

working to control your gestational diabetes. If your weekly rate of gain is low,

you might need to adjust your diet to get more calories. If your weekly rate 

of gain is high, you may be developing a condition called preeclampsia, which

can be dangerous. (See the section titled Your health care provider might also

ask you to:  Have your blood pressure checked as indicated for more information

about preeclampsia.) 

W E E K LY R AT E O F W E I G H T G AI N 9

Aim to keep your weekly rate of weight gain within these healthy ranges:

In the first trimester of

pregnancy (the first 3 months):

During the second and third

trimesters (the last 6 months):

If you gained too much weight

early in the pregnancy:

3 to 6 pounds for the 

entire three months

Between 1/2 and 1 pound each week

Limit weight gain to 3/4 of a pound each week

(3 pounds each month) to help get your blood

sugar level under control

A weight gain of two (2) pounds or more each week is considered high.
maintain        a healthy weight gain 25

                              

                              

                   

     

       

   

     

       

         

     

   

   

  

    

   

what                should I do if I have gestational diabetes?

Keep in mind that your weekly rate of weight gain may go up and down
 

throughout the course of your pregnancy. Some weeks you may gain weight,
 

other weeks you won’t; as a result, your weekly rate of gain may not match
 

your overall weight gain goal exactly. Your health care provider will let you
 

know if you’re gaining too much or too little weight for a healthy pregnancy.
 

Weight loss can be dangerous during any part of your pregnancy.
 

Report any weight loss to your health care provider right away.
 

You may also notice that your weight gain slows down or stops for a time.
 

It should start going up again after one to two weeks. If it doesn’t,tell your
 

health care provider immediately. He or she may need to adjust your
 

treatment plan.
 

Are there any other ways I can maintain a healthy weight gain?

Some general guidelines10 that might help you reach your target weekly rate

of gain include:

Try to get more light or moderate physical activity, if your health care
 

provider says it’s safe.
 

Use the Nutrition Facts labels on food packages to make lower­calorie food
 

choices that fit into your meal plan.
 

Eat fewer fried foods and“fast”foods.

Eat healthy foods that fit into your meal plan, such as salads with low­fat
 

dressings and broiled or grilled chicken.
 

Use less butter and margarine on food, or don’t use them at all.

Use spices and herbs (such as curry, garlic, and parsley) and low­fat or
 

lower­calorie sauces to flavor rice and pasta.
 

Eat smaller meals and have low­calorie snacks more often to ensure that
 

your body has a constant glucose supply, and to prevent yourself from
 

getting very hungry.
 

Avoid skipping meals or cutting back too much on breakfast or lunch. Eating
 

less food or skipping meals could make you overly hungry at the next meal,
 

causing you to overeat.
 
26 keep                    daily records of your diet, physical activity, and glucose level

what                should I do if I have gestational diabetes?

       

            

   

      

   

                

        

   

   

            

                      

          

         

        

        

          

         

Keep daily records of your diet, physical activity,

and glucose level

What is it?

Keeping records means writing down your blood sugar numbers, physical

activities, and everything you eat and drink in a daily record book. You

can use a small notebook or ask your health care provider for a testing record

book. There are also sample record book pages at the back of this booklet 

(see Appendix C and Appendix D).

Keep in mind that if you are supposed to keep track of everything you eat 

and drink, that means everything. Bites, nibbles, snacks, second helpings, and

liquids can really add up and may upset your meal plan. It’s also easy to forget

or underestimate how much snacking you really do.

Why do I have to do it?

Keeping daily records helps to track how well your treatment plan is working

and what, if anything, should be changed. The information also reveals

whether or not you need insulin, and if so, how much you need.

You might also find the information helpful when talking to your health care

provider about how you feel. Your record book is a good place to write down

questions or notes on how your body feels, so that you can remember them at

your next prenatal appointment.

How do I do it?

Your health care provider can give you more details about what to write in

your record book. He or she might ask you to keep track of these things:

Blood sugar level—What is your level? Are you in the healthy range?

Food—What did you eat and drink? Was the food on your meal plan?
 

Did you have any snacks? How large/small was your snack? Was it 

more or less than usual?
 

Physical wellness—How do you feel? Are you sick to your stomach? Do you

feel tired, or do you have lots of energy?

Physical activity—What activity did you do? How long did you do it? Was it

within your physical activity program? How did you feel after the activity?

Weight gain—Are you gaining a healthy amount of weight?
   

  

    

   

what                should I do if I have gestational diabetes?

When do I do it?

It’s a good idea to follow a schedule for writing in your record book, so that

you get used to doing it and don’t forget to do it. It might seem like a lot of

work in the beginning, keeping track of so many things, but the more you do

it, the less work it will be.

How do I know that I’m doing it right?

The most important part of keeping daily records is that you do it. Make sure

that you are recording all the items identified by your health care provider.

Take insulin and/or other medications as prescribed

What is it?

Even if you do everything your health care provider tells you to manage your

gestational diabetes, you still might need to take insulin during your pregnancy

to keep it under control. You already know that insulin moves glucose out of

your bloodstream and into your cells to use as energy; you may need extra

insulin to lower your blood glucose level. The only way to get extra insulin

into your body is to inject it under your skin with a needle. Taking insulin is

the same as any other part of this treatment plan. It’s just another way to help

you stay healthy

take        insulin and/or other medications    as prescribed 27
28 take        insulin and/or other medications    as prescribed

     

        

         

     

      

       

                         

                   

    

                          

                 

  

   

        

       

                     

             

  

   

  

            

                     

                     

           

what                should I do if I have gestational diabetes?

Why do I have to do it?

You may have to include small amounts of insulin in your treatment plan if:

Your blood sugar level is too high.

Your blood sugar level is high too many times.

Your blood sugar level remains high, but you are not gaining much weight 

or are not eating poorly.

You cannot safely add physical activity to your treatment plan.

In these cases, the best action for maintaining a healthy pregnancy is to add

insulin. Insulin does not hurt the fetus. The daily records that you keep help

your health care provider decide when and if it’s time to begin insulin. That’s

why it’s important to keep good records.

Here are some other things you should know about insulin:

If you need to take insulin, it does not mean that you didn’t try

hard enough or that you failed at taking care of yourself. It just

means that your body has a high level of insulin resistance and needs some

help getting glucose level back into healthy range. (Refer to the Knowing

your blood sugar level and keeping it under control:  How do I know I’m doing it

right? section of this booklet for more details on the healthy range for glucose.)

Taking insulin does not mean you have type 1 diabetes. People

with type 1 diabetes have to take insulin shots every day of their lives because

their bodies don’t make enough insulin. As a woman with gestational

diabetes, taking insulin does NOT mean that you now have type 1 diabetes.

It only means that your body needs some extra help to balance its insulin

and glucose levels. After your baby is born, your diabetes will likely go away,

and with it, your need to take insulin.

An increase in the amount or dosage of insulin you need does

not mean that your pregnancy is in danger. The amount of insulin

you take will probably increase as your pregnancy goes on. Because your

insulin resistance increases as your pregnancy continues, your body needs

more insulin to overcome this resistance. The goal is to keep your blood

sugar under control, no matter how much insulin it takes. Most women 

take two insulin shots each day, but you may get better glucose control 

with three injections.

You may need more insulin if you are under high amounts of
 

stress or if you are sick because your blood sugar level gets
 

higher on its own in these cases. Some medicines can also cause
 

blood sugars to rise above the healthy range.
 
take        insulin and/or other medications    as prescribed 29

   

    

what                should I do if I have gestational diabetes?

   

   

How do I do it?

Your health care provider will teach you how to give yourself insulin shots, if

you need them. Use the space below to write down what your health care

provider tells you about your insulin treatment.

Question: Answer:

What kind of insulin 

are you taking?

When should you take 

your insulin shot or shots?

How long does it take for

the insulin start working?

How long does the insulin 

last in your body?

How do you store insulin?

How do you measure the 

right amount of insulin?

How do you give yourself

an insulin injection?

Should you eat before or

after your insulin shot?

How will the insulin make 

you feel?

How can you safely throw

away used supplies?
30 take        insulin and/or other medications    as prescribed

what                should I do if I have gestational diabetes?

When do I do it?

How often you need insulin shots will depend on your body. Your health care

provider will tell you how often to take the shots and at what times of day.

Make sure you follow his or her advice about taking insulin to help ensure 

the safety of your pregnancy.

Special instructions for women taking insulin

Follow a regular eating schedule. Your health care provider can tell 

you when to take the insulin and when to eat your meals so that the timing

of both is correct. Do not skip or delay meals and snacks when taking insulin

because this can affect your glucose­insulin balance.

Know the symptoms of low blood sugar. If your blood sugar level

drops below 60 at any time, you have hypoglycemia (hypo means low, and

glycemia means sugar). Low blood sugar can be dangerous. Hypoglycemia is

not common in women with gestational diabetes, but you are at greater risk

for it if you take insulin. The table shown here describes some reasons that

low blood sugar might occur and some of its symptoms.

K N O W T H E S Y M P TO M S O F LO W B LO O D S U G AR

• Too much exercise

• Skipping meals or snacks

• Delaying meals or snacks

• Not eating often enough

• Too much insulin

• Very hungry

• Very tired

• Shaky or trembling

• Sweating or clamminess

• Nervous

• Confused

• Like you’re going to pass out or faint

• Blurred vision

Or...You might feel fine.

Why does low blood sugar occur? How might I feel if I have low

blood sugar?
your                              health care provider might also tell you to: test your urine for ketones if needed 31

what                should I do if I have gestational diabetes?

    

     

               

    

    

     

               

  

   

Know when your insulin is working its hardest. Low blood sugar

is more common at these times, depending on how your body uses insulin

and glucose.

Be careful about doing physical activity, but remain active.

Because both insulin and physical activity lower your blood sugar level,

when combined they can cause your blood sugar level to drop very quickly.

Test your blood sugar before you do any physical activity. If your level is low,

eat something and test again to make sure your level is higher before you

start an activity. Be smart about how much physical activity you do, how

much you eat, and how much insulin you take.

Be prepared. Take your insulin supplies with you when you go out,

especially if you are going to be gone a long time. You should also take

some form of sugar with you, in your purse, in your car’s glove compartment,

or in your pocket, in case your blood sugar drops too low. The best form of

sugar for an emergency is glucose paste or glucose tablets. You can buy

these at the drug store or pharmacy. Ask your health care provider for more

information.

Test your blood sugar if you start to feel dizzy, faint, or tired.

Report any abnormal blood sugar level to your health care
 

provider right away, in case a change in your treatment
 

plan is needed.
 

Your health care provider might also tell you to:

Test your urine for ketones6 if needed

Your body makes ketones (pronounced KEE­tones) when it uses or breaks 

down its own fat. Your body uses fat for fuel when it can’t get glucose.

Ketones might appear in your urine if your meal plan is not providing enough

carbohydrates or calories, if you skip meals or snacks, or if you go for more

than five hours without eating. Your health care provider might test your urine

for ketones at your prenatal appointments to see if you are getting enough

glucose. Or, you may have to do the test at home, every day.

Your health care provider will give you more specific information about testing

your urine for ketones, including how to do the test, where to get testing

supplies, how often you should test your urine, and what to do if your urine

has ketones in it. Ketone test supplies are available at your local drug store,

pharmacy, or medical supply store.
what                should I do if I have gestational diabetes?

     

  

      

    

         

       

Your health care provider might also tell you to:

Have your blood pressure checked2 as indicated

Increased blood pressure may indicate a condition called preeclampsia.

Preeclampsia11 is a sudden increase in blood pressure after the 20th week 

of pregnancy that is associated with swelling in your face and hands. If

untreated, preeclampsia can lead to long­term health problem and can be

fatal. Daily or weekly blood pressure checks may be needed to detect any

changes that might indicate preeclampsia.

If your blood pressure is high, your health care provider might also test your

urine to see if it contains protein. Protein in the urine can also be a sign of

preeclampsia. You may have to perform the test yourself, as directed, if your

blood pressure is elevated. Your health care provider can give you specific

information about testing your urine for protein, including how to do it, when

to do it, and what to do if your urine has protein in it.

32 your                              health care provider might also tell you to: have your blood pressure checked as indicated
       

          

What should I do after my baby is born?

Your health care provider will check your blood sugar level often, starting 

right after your baby is born. For most women, blood sugar levels go back 

to normal quickly after having their babies.

Six weeks2 after your baby is born, you should have a blood test to find out

whether your blood sugar level is back to normal. This test is similar to the 

one you took to find out whether or not you had gestational diabetes. Based

on the results of the test, you will fall into one of three categories.

AF T E R P R E G N A N C Y T E S T C AT E G O R I E S 2 , 1 2

If your category is... You should...

Normal

Impaired Glucose Tolerance

Diabetic

Get checked for diabetes every three years.

Get checked for diabetes every year. Talk to your

health care provider about ways to lower your risk

level for diabetes.

Work with your health care provider to set up a

treatment plan for your diabetes.

The test also checks your risk for getting diabetes in the future. Women who

have had gestational diabetes have a 40­percent higher chance2,3 than women

who haven’t had gestational diabetes of developing type 2 diabetes later in life.

Getting checked for diabetes is important because type 2 diabetes shows few

symptoms. The only way to know for sure that you have type 2 diabetes is to

have a blood test that reveals a higher­than­normal blood sugar level. You should

also tell your health care provider right away if you notice any of these things:

Being very thirsty

Urinating often

Feeling constantly or overly tired

Losing weight quickly and/or without reason

what                should I do after my baby is born? 33
   

     

          

      

34 how                          can I tell if I am likely to develop diabetes in the future

Having one or more of these symptoms does not necessarily mean you have

diabetes, but your health care provider might want to test you to make sure.

Detecting type 2 diabetes early can help you avoid problems, like early heart

disease and damage to your eyes, kidneys, or nerves. If you choose to use

birth control methods in the future, talk with your health care provider about a

method that won’t increase your risk of developing diabetes.

Can I breastfeed2 even though I have gestational diabetes?

Like all mothers, women with gestational diabetes should breastfeed their

babies, if possible. Breastfeeding provides a number of benefits for your baby,

including the right balance of nutrients and protection against certain illnesses.

Breastfeeding is also beneficial for mothers. It allows your body to use up 

some extra calories that were stored during pregnancy. Losing weight after

having the baby enhances overall health and is one way to reduce your chances

of developing diabetes later in life. Many women who have gestational diabetes

also find that breastfeeding improves their fasting blood sugar level and allows

them to maintain a lower average blood sugar level once their babies are born.

How can I tell if I am likely to 

develop diabetes in the future?

Certain traits increase your chances of getting type 2 diabetes within five

years12 of having your baby. If you have one or more of the following, you

should talk to your health care provider about type 2 diabetes:

You developed gestational diabetes before your 24th week of pregnancy.

Your blood sugar level during pregnancy was consistently on the high end

of the healthy range.

Your blood sugar levels after the baby was born were higher­than­average,

according to your health care provider.

You are in the impaired glucose tolerance category (see the After­Pregnancy

Test Categories table on page 33).

You are obese, according to your health care provider.

You have a history of diabetes in your family.
          

     

              

      

                      

                     

      

   

          

    

plan      your next pregnancy. 35

You belong to a high­risk ethnic group (Hispanic, African American, Native

American, South or East Asian, Pacific Islander, Indigenous Australian).

You have had gestational diabetes with other pregnancies.

If you have any of these risk factors, it is even more important that you get

tested yearly for diabetes. Remember that you can take steps to lower your

risk for type 2 diabetes, such as eating a low­fat diet, losing extra weight, and

getting regular, moderate physical activity.

Plan your next pregnancy.

If you know that you want to get pregnant in the future, have a blood sugar

test up to three months before becoming pregnant to make sure you have a

normal blood sugar level. If your blood sugar level is high, you may have

developed type 2 diabetes without knowing it. As mentioned earlier in this

booklet, high blood sugar early in the pregnancy (within the first eight weeks)

can impact the developing body and organ systems of the fetus. It’s important

to get your blood sugar level under control before you get pregnant.

If you do get pregnant again, make sure your health care provider knows that

you had gestational diabetes with your last pregnancy. If you had gestational

diabetes with one pregnancy, your risk13 of getting it with another pregnancy

is about 36 percent.

You can control gestational diabetes!

It may seem like a lot of work, but most women can successfully control their

gestational diabetes and have healthy pregnancies. You can do it, too!

Follow the treatment plan your health care provider designs for you. A healthy

pregnancy and a healthy birth are the greatest rewards.
36 where can I go for more information about gestational diabetes?

Where can I go for more information 

about gestational diabetes?

Eunice Kennedy Shriver National Institute of Child Health and

Human Development (NICHD)

NICHD

National Institute of Child Health 

& Human Development

The mission of the NICHD is to

ensure that every person is born

healthy and wanted, that women

suffer no harmful effects from the

reproductive process, and that all

children have the chance to fulfill

their potential for a healthy and productive life, free of disease or disability, and

to ensure the health, productivity, independence, and well-being of all people

through optimal rehabilitation. The NICHD Information Resource Center is

your one-stop source for NICHD brochures, booklets, and other materials

related to the health of children, adults, families, and populations, including

information about gestational diabetes. 

You can contact the NICHD Information Resource Center at:

Phone: 1-800-370-2943 (TTY: 1-888-320-6942)

Mail: P.O. Box 3006, Rockville, MD 20847

Fax: 1-866-760-5947

E-mail: NICHDInformationResourceCenter@mail.nih.gov

Internet: http://www.nichd.nih.gov 

Other resources

National Diabetes Information Clearinghouse (NDIC) provides

information about diabetes and how to manage diabetes from the National

Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). 

Phone: 301-654-3327

Mail: 1 Information Way, Bethesda, MD 20892 

Fax: 301-907-8906 

E-mail: ndic@info.niddk.nih.gov 

Internet: http://www.niddk.nih.gov/health/diabetes/ndic.htm
where             can I go for more information       about gestational diabetes? 37

 

 


 

 


 

 

 


 

 



 

The National Diabetes Education Program (NDEP) is a partnership

between the NIDDK, the Centers for Disease Control and Prevention, and

more than 200 public and private organizations. To get free single copies 

of NDEP sample materials, please call the automated system or visit the

Program Web site.

Phone: 1­800­438­5383 

E­mail: lisingm@.niddk.nih.gov 

Internet: http://ndep.nih.gov
 

American Dietetic Association (ADA) Consumer Hotline provides

information about how to find a dietitian.
 

Phone: 1­800­366­1655 

Internet: http://www.eatright.org 

American College of Obstetricians and Gynecologists (AGOG) is

the nation’s leading group of professionals providing health care for women.

ACOG provides various patient education resources, assistance in finding a

physician, and additional information services.

Phone: 202­638­5577 

Mail: 409 12th St., SW, PO Box 96920,Washington, D.C. 20090­6920 

E­mail: resources@acog.org 

Internet: http://www.acog.org 

American Diabetes Association is the nation’s leading nonprofit health

organization providing diabetes research, information, and advocacy.
 

Phone: 1­800­diabetes or 1­800­342­2383 

Mail: 1701 North Beauregard Avenue, Alexandria,VA 22311 

E­mail: customerservice@diabetes.org 

Internet: http://www.diabetes.org
 
38 appendix a: high-fiber foods

Appendix A: High-fiber foods

The table below14 lists the dietary fiber content of certain foods and their 

serving sizes.

HIGH-FIBER FOODS

Food

Serving 

Size

Dietary 

Fiber 

(in grams)

Grain and Cereal Products

Bulgur, cooked 1 cup 8.0

Bagel (Plain) 4 inch Diameter 2.0

Bread

Cracked wheat 1 slice 1.0

Wheat 1 slice 1.0

White 1 slice 1.0

Whole wheat 1 slice 2.0

Brown rice (Cooked) 1 cup 4.0

Cereal (Ready-to-Eat)

Bran (with Raisins) 1 cup 7.0

Bran 1/2 cup 10.0

Wheat bran 3/4 cup 5.0

Corn flakes (Plain) 1 cup 1.0

English muffin (Plain) 1 muffin 2.0

Instant oatmeal (Plain) 1 packet 3.0

Muffins

Blueberry muffin 1 muffin 1.0

Corn muffin 1 muffin 2.0

Oat bran muffin 1 muffin 3.0

Wheat bran muffin 

(with raisins) 1 muffin 3.0

Popcorn (Air-popped) 1 cup 1.0

Whole wheat spaghetti 

(Cooked) 1 cup 6.0

Vegetables

Sweet corn (Canned) 1 cup 4.0

Potato (Baked with Skin) 1 medium 4.0

Potato (Baked, No Skin) 1 medium 2.0

Broccoli (Raw) 1 cup 3.0

Carrots (Cooked) 1 cup 5.0

Brussels Sprouts (Cooked)1 cup 4.0

Eggplant (Cooked) 1 cup 2.0

Collard greens (Cooked) 1 cup 5.0

Dietary

Serving Fiber 

Food Size (in grams)

Beans

Baked beans (Plain) 1 cup 13.0

Black beans 1 cup 15.0

Lentils 1 cup 16.0

Lima beans (Canned) 1 cup 12.0

Kidney beans (Red) 1 cup 13.0

Pinto beans 1 cup 15.0

White beans 1 cup 13.0

Chickpeas 1 cup 12.0

Peas (Split) 1 cup 16.0

Refried beans (Canned) 1 cup 13.0

Nuts 

Almonds, Hazelnuts, 1 oz. 3.0

Pecans, Pistachios

Roasted peanuts 1 oz. 2.0

Macadamias, Walnuts 1 oz. 2.0

Chestnuts (Roasted) 1 cup 7.0

Peanut butter 1 TBSP 1.0

Fruits

Avocado (Raw) 1 oz. 1.0-2.0

Raspberries (Raw) 1 cup 8.0

Mango (Raw) 1 cup 3.0

Pear (with Skin) 1 medium 4.0

Strawberries (Raw) 1 cup 4.0

Apple (with Skin) 1 medium 4.0

Peach (with Skin) 1 medium 3.0

Banana 1 medium 3.0

Plantain 1 medium 4.0

Prunes (Dried) 5 prunes 3.0

Raisins (Seedless) 1 cup 6.0
appendix       B: sample menu 39

   

                

                    

   

  

   

              

                  

Appendix B: Sample menu
 

To give you an idea of what a planned day of meals and snacks might look like,

a menu example for one day is shown below. This menu is designed for a

woman who weighed 130­135 pounds before becoming pregnant and

developing gestational diabetes. The menu shown here may not be the right

menu for you; this menu is not meant to take the place of your health care

provider’s advice on menus and meal plans. Talk to your health care

provider for more specific information about the right meal plan

for you.

Breakfast—Hardboiled egg. toast, grapes, and milk

1 egg, hard­boiled

1 slice whole wheat bread

1 tsp canola­based, trans­fat free margarine

1/3 lb grapes (any kind)

12 fluid ounces, non­fat skim milk

Fat: 11 g; Calories: 394; Protein: 22g;
 

Total Carbohydrate 56g;
 

Exchanges: 1.3 fat; 1.3 milk; 1.6 fruit; 0.8 meat; 0.8 bread
 

Mid­Morning Snack—Half a peanut butter and

jelly sandwich with milk

1 slice whole wheat bread

1 TBSP peanut butter (smooth or chunky)

1 TBSP reduced­sugar jelly or reduced­sugar jam

8 fluid ounces non­fat skim milk

Fat:  9.7 g; Calories:  276; Protein: 14.5g

Grams (g) carbohydrate: 36g

Exchanges:  0.5 other carbohydrates; 1.6 fat; 0.9 milk; 0.4 meat;

0.8 bread

Lunch—Cheese, tomato, and black bean pita with milk

1 pita, large, whole wheat

Blend the following for inside the pita: 1/2 cup uncooked black beans, 1/2

fresh tomato (chopped), 1 ounce low­fat sharp cheddar cheese (shredded),

1 TBSP salsa, and 2 tsp olive oil

8 fluid ounces non­fat skim milk

Fat: 17.7 g; Calories: 547.7; Protein: 29.2g

Grams (g) carbohydrate: 71g

Exchanges: 2.8 fat, 0.9 milk, 0.5 vegetable, 1.0 meat, 3.4 bread
40 appendix       B: sample menu

Appendix B: Sample menu (Continued)

       

   

               

             

     

   

            

                  

      

           

    

                  

                     

     

  

            

                      

The menu shown here may not be the right menu for you; this menu is not

meant to take the place of your health care provider’s advice on menus and

meal plans. Talk to your health care provider for more specific

information about the right meal plan for you.

Mid­Afternoon Snack—Apple and peanut butter

1 medium apple with peel, cored and sliced

1 TBSP peanut butter (smooth or chunky)

12 fluid ounces, no­fat skim milk

Fat: 9.2g; Calories: 295; Protein: 15.8

Grams (g) carbohydrate: 41g

Exchanges: 1.6 fat, 1.3 milk, 1.3 fruit, 0.4 meat

Dinner—Grilled chicken with pineapple, rice, and green beans

3 ounce chicken breast, boneless/skinless, raw

4 ounce pineapple rings, canned in juice

1 TBSP sesame seeds, toasted

1 TBSP sesame oil, dark

2 tsp soy sauce, low­sodium

1/2 cup green beans, cooked

1/4 cup instant rice, uncooked

1 tsp cornstarch

1/4 lb fresh strawberries

8 ounces water

To prepare: place chicken breast in shallow container; combine 1/2 pineapple

juice, toasted sesame seeds, sesame oil, cornstarch, and soy sauce in bowl; pour

over chicken breast. Place half the rings from the pineapple over the chicken;

refrigerate 1 hour or overnight. Remove chicken and pineapple from marinade

and discard marinade; grill or broil chicken breast and pineapple until cooked

through (turning as needed). Cook rice as indicated on package. Prepare

green beans as indicated on package. Serve with strawberries for dessert.

Fat: 16.2g; Calories: 523.7; Protein: 23.0g

Grams (g) carbohydrate: 60g

Exchanges: 2.4 lean meat, 2.8 fat, 1.8 vegetable, 1.8 fruit, 1.1 bread

Daily Totals

Total fat: 63.8g; Total Calories: 2036.4; Total Protein: 104.5g

Grams (g) carbohydrate: 264g

Exchanges: 10.1 fat, 4.4 milk, 4.7 fruit, 6.1 bread, 2.6 meat, 2.4 lean meat,

2.3 vegetable, 0.5 other carbohydrates
appendix       B: sample menu 41

Appendix B: Sample menu (Continued)

       

            

     

   

        

                

   

                

   

   

   

               

                        

                       

                     

                             

        

“Free” Food and Snack Options

Raw vegetables—You can have up to 2 cups of these “free”raw
 

vegetables, without having to count the calories or carbohydrates into 

your meal plan.: cabbage (all varieties), celery, cucumber, endive, lettuces 

(all varieties), mushrooms, peppers, radishes, spinach.
 

Drinks—You can count 8 fluid ounces of these sugar­free or unsweetened

drinks as 1 snack: broth, bouillon, or consommes (also the low­salt varieties),

carbonated or mineral water, club soda. You should also drink a lot of water

while you are pregnant with gestational diabetes.

Condiments—You can use the following in your meal plan, in the amounts

listed: catsup (1 tablespoon), fat­free cream cheese (1 tablespoon), horseradish,

fat­free mayonnaise (1 tablespoon), fat­free margarine (1 tablespoon),

reduced­fat margarine (1 teaspoon), mustard, non­stick cooking spray,

fat­free salad dressing (1 tablespoon), salsa (1/4 cup), fat­free or reduced­fat

sour cream (1 tablespoon), soy sauce (light), taco sauce (1 tablespoon),

vinegar,Worcestershire sauce

Seasonings—Use these items to season your foods without adding

condiments. Please note that“salt” seasonings are high in sodium; use only in

small amounts. Serving size for these seasonings is 2­3 dashes: garlic, herbs

(dried or fresh), flavoring agents, pimento, spices, Tabasco or hot pepper sauce.

Source: Kraft TM Foods Diabetic Choices Daily Recipes, 2002; also Treating Diabetes with Good Nutrition, Diabetic

Meal Plans, MediConsult.com, Inc. 2000.
Appendix C: Sample glucose 

monitoring record sheet

42 appendix             C: sample glucose monitoring record sheet Name: __________________________________ Target Blood Sugar Levels Fasting No higher than 95 1 hour after eating No higher than 140 2hours after eating No higher than 120 Remember, if your blood sugar is out­of­range: • Write down what you ate and how much you ate in the Notes column. • Write down what exercises you did and how long you did it in the Notes column. • Write down any skipped meals or snacks in the Notes column. Date 

Blood Glucose Level Insulin

Amount 

Urinary 

Ketone 

Levels 

Notes 

Fasting 1 2 Hours

after Breakfast

1 2 Hours

afterLunch

1 2 Hours

after Dinner
appendix                 D: sample food and physical activity record sheet 43

Appendix D: Sample food and 

physical activity record sheet

Name:

____________________________________________________

n:wdoe itr

w w,elobe pacsthe In 

• Everything you eat or drink and at what time you eat or drink it.• How your food was prepared, such as broiled,baked,fried,or uncooked.• Things you add to food, such as butter, salad dressing, or artificial

sweetener.

• The amount of each food you ate.• The amount of carbohydrates you ate, in grams, as indicated in the

Nutritional Facts label on the food package

• All of your physical activity, such as brisk walking, swimming, or prenatal 

exercise class.

• How much time you spent doing physical activity.

Date Time ,ed

tIo 

epar

t

rP

dded 

as

A

W

ou

t  I

Y

wo

H,

hingsT

dooF

and 

Amount Carbohydrates Physical Activity

al

t

ic

en

s

y

y

p

h

S

P

e 

tivit

im

oing 

cA

T

D
44 references and acknowledgements

References and acknowledgements

1 American College of Obstetricians and Gynecologists Practice Bulletin: Clinical

management guidelines for obstetricians-gynecologists. Number 30, September

2001. Obstetrics and Gynecology 98(3):525-38, 2001.

2 American Diabetes Association: Gestational Diabetes Mellitus (Position Statement).

Diabetes Care 26(Suppl 1): S103-S105, 2003. 

3 Metzger BE, Coustan DR (Eds.): Proceedings of the Fourth International WorkshopConference on Gestational Diabetes Mellitus. Diabetes Care 21(Suppl. 2): B1-B167, 1998.

4 Adapted from Nutrition and Your Health: Dietary Guidelines for Americans (Fifth Edition).

U.S. Department of Agriculture/U.S. Department of Health and Human Services.

Government Printing Office; Washington, DC: 2000.

5 American Diabetes Association: Evidence-Based Nutrition Principles and

Recommendations for the Treatment and Prevention of Diabetes and Related

Complications (Position Statement). Diabetes Care 26(Suppl. 1): S51-S61, 2003.

6 Jovanovic-Peterson L, and Peterson C: Is Exercise Safe or Useful for Gestational

Diabetes Women? Diabetes 40 (Suppl. 2): 179-181, 1991.

7 Exercise During Pregnancy and the Postpartum Period. ACOG Technical Bulletin No.

189:1-4, 1994

8 Brown JE: Nutrition and Pregnancy: A Complete Guide from Preconception to Postdelivery. 

Los Angeles, CA: NTC/Contemporary Publishing Group, 1998.

9 Gabbe SG, Neibyl JR, and Simpson JL (Eds.): Obstetrics: Normal and Problem Pregnancies

(Third Edition). New York, NY: Churchill Livingstone, 1996.

10 Nutrition During Pregnancy. ACOG Patient Education Publication AP001. Washington,

DC: ACOG, 1995.

11 Joint National Committee on Prevention, Detection, Evaluation and Treatment of High

Blood Pressure: The Sixth Report of the Joint National Committee on Prevention,

Detection, Evaluation and Treatment of High Blood Pressure. The Archives of Internal

Medicine 157: 2413-2446, 1997.

12 Expert Committee on the Diagnosis and Classification of Diabetes Mellitus: Report of

the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus.

Diabetes Care 26 (Suppl. 1): S5-S20, 2003.

13 MacNeill S, Dodds L, Hamilton DC, Armson BA, VandenHof M: Rates and Risk Factors

for Recurrence of Gestational Diabetes. Diabetes Care 24:659-662, 2001.

14 U.S. Department of Agriculture, Agricultural Research Service. 2002. USDA National

Nutrient Database for Standard Reference, Release 15. Nutrient Data Laboratory

Home Page, http://www.nal.usda.gov/fnic/foodcomp.

The NICHD would like to acknowledge Steve Gabbe, M.D., for his

contributions to this booklet. The image on page 6 was provided 

by Tina Williams Photography.

Portions of this booklet are based on a manuscript by Deborah ThomasDobersen, R.D., M.S.
NICHD
 National Institute of Child Health 

& Human Development 

1­800­370­2943
 

http://www.nichd.nih.gov
 

NIH Pub. No. 04­2788
 

July 2004