Author: Abigail Rasminsky

Twenty-six weeks into my pregnancy, my OB informed me that I might have gestational diabetes. I was shocked. Other than my age—I was 35—I had zero risk factors. I exercised regularly. In fact, I had once been a dancer and yoga teacher. I was fit and healthy. I figured it was all a big mistake. I’d do the glucose tolerance test and all would be fine.
Sometime between 24 and 28 weeks, most healthcare providers recommend pregnant women be screened for gestational diabetes. The glucose challenge test is relatively painless: You drink a syrupy sweet drink and wait an hour. Your blood and urine levels are tested, and if they fall within a certain range, you’re fine.
If they spike outside that range, however, you go for a follow-up glucose tolerance test. This test, which is slightly more involved, necessitates fasting overnight (no fun). The following morning, having forgone breakfast, I went in to have my blood and urine tested. Then I consumed an even sweeter drink, and my levels were tested every hour for the next three hours—all while I continued to fast. (Bring a good book and a few podcasts. You’ll be starving.)
When the test came back positive for gestational diabetes, I panicked. Was my baby okay? Had I done something wrong? Was it all those croissants I’d eaten in the first trimester? What should I do now?
There was no need to panic. My baby was fine. I was fine. I had a mild case, which meant I didn’t have to take insulin. But even if I had, it’s an entirely manageable and relatively common condition, as anywhere from 2 to 10 percent of pregnant women experience gestational diabetes. The trick is learning to test your blood sugar at regular intervals, sticking to a balanced diet, and prioritizing exercise.
Beyond that, we’ve got all the details you need to know to manage gestational diabetes or put your mind at ease if you think you might be at risk.

What is gestational diabetes?

Gestational diabetes is not the same as type 1 or type 2 diabetes. It is a condition that develops during pregnancy, almost always ends with the birth of the baby, and has nothing to do with whether you have type 1 or type 2. Typically diagnosed between weeks 24 and 28, gestational diabetes causes high blood sugar levels that affect how your cells break down sugar or glucose. If managed well, gestational diabetes isn’t a problem, but it can be dangerous for mother and baby if the condition is not addressed.
Although gestational diabetes has little to do with types 1 or 2, “[Doctors] sometimes diagnose type 2 diabetes or type 1 diabetes during pregnancy that had previously been missed,” according Rebecca Weiss, MD, an endocrinologist at Kaiser Permanente in Woodland Hills, California. “This can be apparent based on a woman’s blood sugar control during pregnancy.”

Am I at risk?

“Gestational diabetes is caused by hormones produced by the placenta that increase insulin resistance in the mother,” explains Weiss. “The main causative hormones are growth hormone, placental lactogen, corticotropin releasing hormone, and progesterone. These hormones increase the body’s insulin resistance, leading to higher sugars, and in some cases, gestational diabetes.” Weiss explains that this is why all women are screened because even thin, healthy, fit women can develop the condition.
No one really knows how what causes gestational diabetes, but there are some risk factors:

• Age—if you are over 25
• Overweight or obese pre-pregnancy 
• Excessive weight gain during pregnancy
• A history of diabetes in your family
• Hypertension or preeclampsia in this pregnancy

There is also an increased risk for expecting women in certain ethnic groups, including African American women, Latinas, South and East Asian women, and Native American women.
A woman can lessen her risk of developing gestational diabetes by adopting healthy eating and exercise habits before and during pregnancy, explains Julie Peacock, RDN, a registered dietician nutritionist and integrative whole-health wellness counselor in New York City.
“Before getting pregnant, talk to your doctor to establish if you have any risk factors—family history, overweight, history of polycystic ovarian syndrome, and history of irregular blood sugars.” You can then target your food and exercise plan to specifically watch carbohydrate intake and get the recommended amount of exercise daily.
Peacock emphasizes, however, that this holds true for all women, pregnant or not. “The goal is always to move your body frequently and load up on whole foods while decreasing or eliminating processed foods and foods high in sugar, salt, and [linkbuilder id=”5310″ text=”artificial ingredients”].”
“The saying ‘eating for two’ is not accurate at all,” adds Weiss. “Pregnant women actually only require about 250 extra calories a day during pregnancy. I always recommend to pregnant patients to maintain a healthy diet and to continue to exercise as they did prior to pregnancy.”

How do I know whether I have gestational diabetes?

There are no symptoms of gestational diabetes, so unlike other conditions during pregnancy, it is virtually impossible to tell without a test. After testing, your OB will be the one to deliver the news.

Will gestational diabetes affect my baby?

If your gestational diabetes is well managed, you baby will be totally fine. It’s when gestational diabetes is mismanaged—or not treated at all—that the baby might face one or more of the following risks.

Increased Birth Weight

According to the Mayo Clinic, an excess of glucose in mom’s bloodstream may prompt baby’s pancreas to make too much insulin. This can make the baby grow too big to be birthed vaginally, and will necessitate a C-section.

Pre-Term Birth

If a baby seems to be growing too big, your doctor might induce before the your due date to ensure a safe delivery.

Low Blood Sugar (Hypoglycemia)

Occasionally, babies of moms with gestational diabetes develop low blood sugar shortly after birth because their insulin production is too elevated. In extreme cases, this can cause seizures in the baby, which may necessitate intravenous glucose solution treatment to help the baby’s blood sugar level return to normal.

Type 2 Diabetes

The baby could be at a slightly greater risk of developing diabetes later in life.

Will this affect me after my baby is born?

The short answer is no. The longer answer is that there is a very, very small chance that it could.  “Ninety percent of the time, gestational diabetes goes away after birth,” explains Peacock. “But if a woman had gestational diabetes, she is at a higher risk for developing type 2 diabetes.”
It’s very important to continue eating and exercising healthfully throughout the pregnancy and after delivery. Stick to the same dietary guidelines you followed during pregnancy (eat whole foods and limit processed and refined foods), maintain a healthy weight, and be sure to get at least 30 minutes of exercise daily.

Tips for Managing Gestational Diabetes: You are what you eat.

“What a woman eats is just as important as how much and when she eats,” explains Peacock. “Keeping her blood sugar levels stable is the goal.”

Key Foods to Incorporate Into Your Diet:

• An abundance of vegetables—leafy greens, cabbage, broccoli, cauliflower
• Protein-rich foods—hormone-free meats, beans, and legumes (black beans, split peas, lentils, etc.), eggs, and pregnancy-safe fish
• Fiber-rich complex carbohydrates—oats, quinoa, barley, buckwheat, and brown rice
• Dairy—milk, cheese, and plain yogurt are good sources of protein and can be a healthy part of any diet

What to Avoid:

• Soda, juices, and candy
• Most coffee drinks and purchased smoothies
• Donuts and baked goods
• Deep-fried foods
• Flavored water, milk shakes, certain nut milks

“These foods are high in refined sugar and/or flour,” Peacock explains. “When you order these foods at a restaurant or buy them at the store, they contain more sugar, fat, and sodium than what you would make at home.” That said, this isn’t advice that only goes for diabetics—this is Peacock’s advice for anyone trying to eat in a healthful way.

Two Tips to Keep in Mind:

1. Protein with each meal can help keep blood sugar levels stable.
2. When you have a carbohydrate source, make sure it’s a whole food. This will ensure that it’s fiber rich, and therefore healthier. Eat the apple instead of drinking an apple juice.

A Typical Menu

For a lot of women, the most challenging aspect of gestational diabetes is developing different eating habits and sticking to them. If you’re used to inhaling a bowl of sugary cereal before running out the door, you’ll have to make some major amendments to your diet.
Here are some basic guidelines:

• Someone with diabetes can have two to four carbohydrate servings with each meal and one to two per snack.
• One serving is equal to one piece of bread, one small apple, half a banana, ¾ cup berries, one cup of milk or yogurt, ⅓ cup beans, or ⅓ to ½ cup rice, pasta, or cooked grain.

Looking for inspiration? Try the following sample menu on for size.

For Breakfast

Prepare and enjoy a small portion of a cooked grain like oats along with an egg or high protein yogurt to help the body absorb the carbohydrates more efficiently. Opt for natural, no-sugar-added peanut or almond butter on whole grain toast.

For Lunch and Dinner

The bulk of these meals should be leafy greens. Add 4 ounces of chicken (or another protein) and 1 cup of a cooked grain, a piece of fruit, or a roasted root vegetable like sweet potatoes, beets, or squash.

Snacks

Enjoy two to four snacks a day, keeping in mind the goal of spacing them out evenly, every two to three hours, to keep your blood sugar levels from spiking or falling. Having a snack before bed also helps keep levels from plummeting overnight. Examples of good snacks include:

• A hardboiled egg, a few whole grain crackers, and a handful of carrots
• ¾ cup blueberries and 6 ounces of Greek yogurt
• One rice cake with ½ avocado, mashed
• Two slices of cheese, a few crackers, and 1 cup of raw vegetables
• A pear and a handful of almonds

Move your body.

“Regular exercise helps the body use insulin better and can lower blood sugar,” Peacock explains. She suggests that women get at least 30 minutes of moderate exercise daily. “Think of moderate exercise as the kind that leaves you slightly out of breath, with a faster heart rate, and makes you sweat.”
If you’re unsure about what kind of exercise to pursue, Peacock advises continuing to do what you did before you were pregnant. A few good options include brisk walking, stationary cycling, swimming, and yoga. Consult with your doctor about what forms of exercise are appropriate for you.
Since it does affect blood sugar levels, eating a snack or meal one to two hours before exercise is important. A snack could be half a banana and a scoop of almond butter, or a plain rice cake and spoonful of hummus or smashed avocado.
Remember to always have a form of quickly accessible sugar with you when you exercise, such as glucose tablets or hard candy just in case you experience a blood sugar low.

Don’t give up carbs—really.

Carbohydrates are the sugars, starches, and fibers found in fruits, grains, vegetables, and dairy products. Though trendy diets often treat carbohydrates as something to avoid, Peacock says they are one of the basic food groups and are important to a healthy life. Carbohydrates are macronutrients, meaning they are one of the three main sources of energy for the body. In fact, they are the body’s main source of energy and provide imperative fuel for the central nervous system and energy for working muscles.
When thinking about carbs, remember that they’re classified as either simple or complex. The difference between the two types is their chemical structure and how quickly the sugar they break down into is absorbed and digested. “Generally speaking, simple carbs are digested and absorbed more quickly and easily than complex carbs,” Peacock explains. “Simple carbs are found in candy, soda, and syrups. These foods are made with processed and refined sugars and do not have vitamins, minerals, or fiber. They are considered ‘empty calories’ and can lead to weight gain and uncontrolled blood sugars. Complex carbohydrates include beans, peas, lentils, nuts, potatoes, root vegetables, corn, whole-grain breads, grains, and cereals.”
Carbs affect blood sugar levels, and when blood sugar levels are too high, they’re harmful to both the woman and the growing fetus. To help manage blood sugar levels, it is important to monitor carbohydrates in terms of how many, what type, and how often you’re consuming them.
When too many carbs are eaten at once, the blood sugar levels in a woman with gestational diabetes will get too high. To keep blood sugar levels in check:

• Avoid eating too many carbohydrates at one time.
• Choose complex carbohydrates that are high in fiber and low on the glycemic index .
• Avoid skipping meals.
• Combine carbohydrates with protein or healthy fats to help slow down digestion.
• Eat a protein-rich breakfast that includes fibrous carbohydrates.

“Although it’s easy to look at carbs as the villain here,” Peacock says, “they’re important for energy and foods with carbs have nutrients that are necessary for a healthy pregnancy, so it’s important to learn how to incorporate them smartly as opposed to avoiding them altogether.”

The earliest weeks of pregnancy can be a tremendously exciting—and confusing—time. Your body is undergoing an enormous number of changes at a rapid clip. You probably don’t feel like yourself. You are nervous about the viability of the pregnancy and overcome with exhaustion. And chances are you’re trying to keep the whole thing a secret!
First, the basics. Pregnancy is divided into three trimesters. The first ranges from week 1 through week 13. The second trimester reaches through week 27, and the third goes through week 40. So really, pregnancy lasts 10 months, not nine, as most of us have been taught.

If you take a pregnancy test a week after missing a period and the results are positive, you are already considered around 4 to 5 weeks pregnant. This is because pregnancy is calculated from the date of your last menstrual period, not from the date of conception, which occurs two weeks later. (A pregnant woman will be asked over and over again in doctors’ appointments when the date of her last period was, so it’s vital to keep track, especially as cycles vary.)
The first trimester is often filled with the most anxiety, because up to 20 percent of pregnancies end in miscarriage. A miscarriage is a pregnancy loss that occurs before week 20; anything after that is a stillbirth. The most important thing to know, however, is that there is nothing you can do to make a pregnancy viable—and little you can do to lose a pregnancy that is viable, explains Kerry Price, an OB-GYN in Laguna Hills, California. “Whatever is going to happen first trimester-wise has nothing to do with what you’re doing.”

8 Earliest Signs of Pregnancy

Pregnancy symptoms are wildly variant from one woman to another. Even the same mother-to-be can experience two or three pregnancies completely differently—one leaving her incapacitated with nausea and another with just the slightest bit of fatigue. So don’t panic: Just because your best friend threw up every day of her first trimester doesn’t mean you will.
That said, there are some common early signs:

1. Fatigue

Growing a baby is physically akin to climbing Mount Everest. Your body is working extraordinarily hard and there are very high levels of hormones coursing through the body—specifically progesterone, which tends to make you very sleepy and nauseated.
Don’t be surprised if you find yourself falling asleep at 8 p.m. on the couch, dropping into a deep slumber for 12 full hours, and waking up feeling exhausted. Many women start experiencing the extreme fatigue really early—around 6 weeks, says Jocelyn Brown, a licensed midwife at GraceFull Birthing in Los Angeles.

If You’re Experiencing This Symptom

“If you can completely surrender to the exhaustion, build your work schedule around it,” says Brown. “If you have the luxury to take a nap, take a nap. Many women in my practice say, ‘But I have all these things to do!’ You have the rest of your life to do them. Just go to bed—you’re building a skeleton right now!”

2. Nausea

Although this is frequently referred to as “morning sickness,” many women experience it all day every day for weeks (or months) on end. This can begin as early as week 2 and last all through the pregnancy, although it begins for most women in the 4 to 6 week range and abates at the end of the first trimester. Many women feel it most acutely between weeks 9 and 11, when hormones are peaking.
The reasons for nausea are multifactorial, explains Price: Rising levels of a hormone called human chorionic gonadotropin (hCG) and progesterone (women who are on progesterone often feel even more nauseated). Progesterone slows the bowel, which can cause constipation; it also slows the esophageal sphincter, which causes acid reflux.

If You’re Experiencing This Symptom

If your nausea is run-of-the-mill morning sickness (you’re not utterly incapacitated, you can keep food down, etc.)…
Do not let yourself get too hungry. Eat small, frequent meals, and keep them bland. Think crackers, bananas, and popcorn. Keep saltines (or any snack you can stomach) with you at all times—especially by the bed. Eat a few when you get up in the morning or in the middle of the night to pee.
Brown suggests setting an alarm for every hour or two and eating even if you’re not terribly hungry. An empty stomach should be avoided at all costs, and steer clear of spicy foods. Try adding 25 mg of ginger four times a day (or ginger candy or lozenges) to your diet and taking a vitamin B6 complex. Some women find that wearing pressure bands around their wrists (airplane-style) helps. Make sure to stay hydrated.
If your nausea is incapacitating and you can’t keep anything down…
Consult your doctor or midwife right away. In the age of Kate Middleton’s well-documented hyperemesis gravidarum—a condition in which a pregnant woman is debilitated by nausea and vomiting—it is vital to seek out treatment if you cannot function.
Brown asks her patients: How much is this disrupting your life? Do you need medication or to go on disability? Do you need to be hospitalized?
Fortunately, this condition only affects 0.5 to 2 percent of pregnant women. Unfortunately, if you have it for one pregnancy, you are likely to have it for another. “We encourage people to try to go medication free,” Price says, but adds that if a woman really cannot function normally in her day-to-day life, she will prescribe it.

3. Implantation Cramping and/or Bleeding

Implantation bleeding usually occurs a few days—or up to two weeks—after implantation. In other words, before you actually know you’re pregnant.

If You’re Experiencing This Symptom

“There are a ton of pregnancies that have early trimester bleeding and turn out to be fine,” explains Price. This has to do with changes in the level of progesterone in the body, or it can be related to the cervix. If the blood is brown and painless, assume all is fine and wear a liner.

4. Heavier Bleeding and/or Cramping

This could (or could not) be a sign of something more serious, like a miscarriage.

If You’re Experiencing This Symptom

“There are 99 reasons why someone would be bleeding in early pregnancy,” Brown explains, “and only one is miscarriage.” If the blood is dark brown or pink, Brown says she doesn’t usually worry. “Bright red gets my attention.” If a woman is having cramping but no bleeding, it’s not usually a problem; and bleeding but no cramping may not be cause for alarm either. “It’s when a woman is cramping and bleeding that I worry.” If you are experiencing those symptoms, call your doctor or midwife immediately.
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5. Frequent Urination

Have to pee all the time? This is because the rise in hormonal levels brings more blood to your kidneys, which fills your bladder up more quickly. It is also caused by an increase in blood flow (50 percent more!), which means that way more fluid is being circulated through your kidneys.

If You’re Experiencing This Symptom

Stay hydrated with water, but avoid diuretics such as coffee, tea, and other caffeinated drinks. You also want to make sure to empty your bladder completely each time you pee; you can help this along by bending forward slightly when you’re on the toilet.

6. Mood Swings

Wanting to cry for absolutely no reason? Or feeling totally blissed out? Suddenly wracked with anxiety? It may be the hormones.

If You’re Experiencing This Symptom

Mild mood swings are totally normal, but if you suddenly feel markedly different from how you usually do—or if you’re feeling anxious and/or suicidal—consult your doctor or midwife immediately. They will probably refer you to a psychiatrist who specializes in pre- and postpartum depression and anxiety.

7. Breast Tenderness

This tenderness can resemble a sign of PMS, but it’s generally more acute and unrelenting. (In fact, it’s not unlike the feeling of first growing breasts.) This often begins in the 4 to 6 week range (so just when you’re taking a test) and abates at the end of the first trimester as your hormones level out.

If You’re Experiencing This Symptom

Avoid underwire bras when possible, and wear a sports bra to bed.

8. Heart Palpitations

When you’re growing a baby, your heart has to work considerably harder, and blood supply is increased, which can cause the heart rate to increase by 10 to 20 beats a minute. In some cases, this can result in heart palpitations or abnormalities.

If You’re Experiencing This Symptom

Most heart palpitations are benign, but it is wise to ask your doctor about them.

And Three More Early Pregnancy Symptoms

• Breast Changes: The areola often darkens considerably and can grow larger.
• Increase in Body Temperature: This is something that you may only notice if you’ve been charting your basal body temperature while trying to conceive. If the basal body temperature stays high, it can indicate that you are pregnant.
• Smell Sensitivity and Food Aversions: Some women report being able to smell scents from many rooms away and not being able to stand the look or smell of certain foods.

How early can I know for sure?

For most women, the earliest sign of pregnancy is a missed period, but some women can sense it even earlier. She may have incredibly tender breasts (much more so than with PMS), a little cramping, or feel uncharacteristically emotional, nauseated, or exhausted. She may already have sudden aversion to, say, coffee, which she has always loved. But the best way to know is to take a test.
An at-home pregnancy test will measure the level of hCG in your urine; this hormone is only present if you’re pregnant. According to the Mayo Clinic, the best time to take a test is one week after your missed period.
If you take it before then, the pregnancy may not be detectable, because it takes seven to 10 days for hCG to be present in the urine after successful implantation of the egg. In fact, the hCG concentration doubles every two to three days during early pregnancy, so even taking it a day after a missed period can result in a false negative.
That said, if you take it too early, you could also get a false positive. A chemical pregnancy is when you have a fertilized egg that doesn’t implant. Pregnancy tests are so sensitive these days, however, that you are given a positive result before the egg implants. A week later, your period comes, which indicates that you are not pregnant.
Although tests vary by sensitivity, if you wait a week, chances are the pregnancy results are accurate. There’s a catch, though: Positive results are almost always accurate. But you can get a false negative if you take the test too early or don’t follow the instructions on the box properly. If you get a negative result and your period still doesn’t come for a few days, take the test again.

I’m pregnant! What do I do now?

So you saw the double line or the “pregnant” sign on the test. Now what? It’s time to find yourself an obstetrician or a midwife, who will perform a blood test to confirm the pregnancy.

Self-Care During First Trimester

Eat well.

If you are feeling very sick, this can be tough. Look for protein-rich foods and eat whichever of those you can stomach. Brown suggests peanut or almond butter, salted nuts (the salt will bring up your electrolytes), hard-boiled eggs, protein smoothies (don’t worry if you can only get half of it down), or a piece of jerky.
“Pregnant women tend to go for the carbs, but this is putting the wrong kind of bacteria in your gut,” Brown explains. “Bad morning sickness can be exacerbated by poor balances of flora—a gut bacteria that’s not helping you.” She advises reducing carbs if possible because that will also decrease your sugar intake, which is good. If this doesn’t seem possible, take a probiotic; this can reduce nausea in the long run.

Continue exercising.

What were you doing before? This is usually a good gauge of what kind of strain you can put your body through while pregnant. If you were a ballet dancer, there’s no reason to stop dancing. But if you were a fan of hot spinning, hot tubs, saunas, or hot yoga, you’ll want to steer clear. If you hadn’t found time to exercise in your pre-pregnancy life, it’s a good time to start.
“I advise 150 minutes of moderate intensity exercise a week,” Brown says, “and start small.” This means 30 minutes, five times a week. It can be anything from going for walk in your neighborhood to taking a prenatal yoga class to swimming.

Take prenatal vitamins.

Folic acid supplements are the most important prenatal vitamin, since they help prevent neural tube defects like spina bifida and cleft lip. The time to take them, however, is in the first 4 to 7 weeks.
“We tell people to start taking them three months before conceiving so you have good levels of folic acid in your body already,” says Price. The usual suggestion is 400 micrograms of folate a day, says Brown. In addition to folic acid, you can also get folate from food, such as dark leafy greens, broccoli, avocado, beans, peas, and lentils. If you can’t stomach those right now, “make the ‘better than’ choice,” advises Brown.

Manage any chronic health problems, including weight.

A healthy weight can influence pregnancy outcomes, Price explains—everything from risk for C-section to postpartum depression and success with breastfeeding. This does not mean to diet or restrict your intake; it simply means to maintain an active, healthy lifestyle and address any chronic health problems, including your mental health.

Some foods should be avoided.

Many women stick to certain foods during the first trimester, and they are by and large safe.
But some to stay clear of are any raw, undercooked, or unpasteurized fish, meat, or dairy; raw sprouts (especially alfalfa, which can contain Salmonella); and alcohol. Make sure to wash raw vegetables very well and avoid eating fish with high levels of mercury (e.g., tuna, shark, and swordfish). Caffeine should be drunk minimally (no more than one cup of coffee a day).
That said, as with everything pregnancy related, these will vary from culture to culture. Women in Japan eat sushi during pregnancy, but it’s fresh. Some French women drink a minimal amount of wine.
In all things, talk to your doctor and trust your own body.