Managing Gestational Diabetes: Why Is My Baby Growing Larger?

Q: Managing Gestational Diabetes: Why Is My Baby Growing Larger?

Hello~ Based on your current diet： half a bowl of carbohydrates, unlimited vegetables, and a palm-sized portion of meat primarily consisting of cabbage, spinach, and mushrooms, with occasional additions of white or red radish for variety. <br>The cooking methods are mostly stir-f

Despite controlling blood sugar levels, the baby continues to grow larger?

Hello, I have been diagnosed with gestational diabetes after failing two out of four screening tests.
I have been following a nutrition education plan from a dietitian for three weeks, which has successfully lowered my blood sugar levels during two subsequent screenings.
However, my baby is now larger than when I initially failed the tests.
I would like to know if there is an issue with my dietary approach.
The dietitian recommended that I consume half a bowl of carbohydrates, unlimited vegetables, and a portion of protein the size of my palm.
I primarily eat cabbage, spinach, and mushrooms, occasionally adding some white or red radishes for variety.
I usually prepare my vegetables by steaming or boiling them without oil, and if I do use oil, it is a small amount of olive oil (about a teaspoon).
I have switched from white rice to whole grains and reduced my portion from half a bowl to one-third of a bowl.
For breakfast, I have one slice of whole grain toast with a fried egg and a small amount of tuna.
I eat five meals a day, with snacks between breakfast and lunch, and between lunch and dinner, primarily consisting of 200cc of unsweetened soy milk, two small pieces of soda crackers, 4-5 cherry tomatoes, half an apple, or half an orange.
After three weeks, my blood sugar levels have decreased from 167 mg/dL two hours after meals to 113 mg/dL.
However, I am confused as to why my baby is larger despite having controlled blood sugar levels.
I consulted my obstetrician, who advised me to further reduce my sugar intake.
I have considered eliminating all starches, such as rice, noodles, and toast, but I am concerned that this may lead to an unbalanced diet.

Could you please advise if there is anything inappropriate in my dietary approach or if any adjustments are needed? Thank you.

Tang Tang, 30~39 year old female. Ask Date: 2017/03/07

Dr. Cai Xiuwen reply Nutrition

Hello~ Based on your current diet: half a bowl of carbohydrates, unlimited vegetables, and a palm-sized portion of meat primarily consisting of cabbage, spinach, and mushrooms, with occasional additions of white or red radish for variety.
The cooking methods are mostly stir-fried with water (without oil) or boiled in soup, and if oil is used, it is a small amount of olive oil (about a teaspoon).
The rice has been changed from white rice to multigrain, and I have also reduced my portion from half a bowl to one-third of a bowl.
For breakfast, I have one slice of whole wheat toast with a fried egg and a small amount of tuna.
I have five meals a day, with snacks between breakfast and lunch, and between lunch and dinner, consisting mainly of 200cc of unsweetened soy milk, two small pieces of crackers, 4.5 cherry tomatoes, half an apple, or half an orange.
I am unsure of your current gestational week, pregnancy weight, and current weight.
If you are in the third trimester, the baby's growth rate is naturally rapid.
In addition to controlling your diet, increasing physical activity can also help manage weight.
Therefore, if your diet is already controlled, the next step is to increase exercise.
Aim for an additional 30 minutes of walking in the morning and evening while monitoring your weight and the baby's weight.
Wishing you safety and health.
This response is from Dietitian Tsai Hsiu-Wen at Nantou Hospital, Ministry of Health and Welfare.

Reply Date: 2017/03/07

More Info

Managing gestational diabetes can be a complex process, especially when it comes to understanding how dietary choices impact both maternal health and fetal growth. Based on your description, it seems that you have made significant efforts to control your blood sugar levels through dietary modifications, which is commendable. However, the concern about your baby growing larger despite controlled blood sugar levels is a common issue faced by many expectant mothers with gestational diabetes.

Firstly, it is important to recognize that gestational diabetes can lead to increased fetal growth, known as macrosomia, which is defined as a birth weight greater than 8 pounds, 13 ounces (approximately 4,000 grams). This condition can occur even when blood sugar levels are managed effectively. The reasons for this can be multifaceted:
1. Insulin Resistance: During pregnancy, the body naturally becomes more insulin resistant, which can lead to higher levels of glucose in the bloodstream. Even with dietary control, some women may still experience elevated insulin levels, which can stimulate fetal growth.

2. Nutritional Intake: While you have made adjustments to your diet, it’s crucial to ensure that your carbohydrate intake is balanced with protein and healthy fats. The recommendation of half a bowl of starch may still be too high for some women, depending on their individual insulin sensitivity. It might be beneficial to work closely with a registered dietitian who specializes in gestational diabetes to tailor your meal plan further.

3. Fetal Factors: The growth of the fetus is influenced by genetic factors and the overall health of the pregnancy. If there are no other complications, it is possible that your baby is simply larger due to genetic predisposition or other non-dietary factors.

4. Caloric Surplus: Consuming five meals a day, while generally a good strategy for managing blood sugar, can sometimes lead to an unintentional caloric surplus if portion sizes are not carefully monitored. It’s essential to ensure that the total caloric intake aligns with your energy needs without exceeding them.

5. Physical Activity: Incorporating regular physical activity can help manage blood sugar levels and promote a healthy weight gain during pregnancy. If you haven’t already, consider adding moderate exercise, such as walking, into your daily routine, as this can help improve insulin sensitivity.

Regarding your specific dietary concerns, it’s understandable to worry about the balance of nutrients. Completely eliminating starches like rice, bread, and pasta may not be necessary or advisable, as they provide essential energy and nutrients. Instead, consider focusing on the type and quantity of carbohydrates you consume. Opt for whole grains and monitor portion sizes to ensure they fit within your dietary goals.

Lastly, it’s crucial to maintain open communication with your healthcare provider. If your obstetrician has suggested reducing sugar intake further, it may be worth discussing specific carbohydrate targets or exploring other dietary adjustments that could help manage fetal growth while ensuring you and your baby receive adequate nutrition.

In summary, while you are doing well to manage your blood sugar levels, it may be beneficial to reassess your overall dietary strategy with a healthcare professional. This can help ensure that both you and your baby remain healthy throughout your pregnancy. Remember, every pregnancy is unique, and personalized care is key to achieving the best outcomes.

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