From Pre-Conception to Delivery: Mastering Diabetes for a Healthy Pregnancy.

 Weather you are diabetic before pregnancy or develop Gestational Diabetes during pregnancy, this article will help you. 

If you are pregnant, or planning to get pregnant, your doctor must have guided you about gestational diabetes. When a pregnant, non-diabetic female develops diabetes after the 20th week of gestation, we call it gestational diabetes. This often goes away after childbirth, but the risk remains in the subsequent pregnancies.

You might be concluding that if it develops only after the 20th week and goes away by itself, there is nothing to worry about.

But Gestational Diabetes can put the baby and yourself at risk. 

Gestational diabetes can harm the health of the mother and the baby at various fronts:

1. Preeclampsia: This is a pregnancy complication characterized by high blood pressure and potential organ damage. Risk of preeclampsia increases significantly in a mother with GDM.
2. High blood sugar can increase the risk of UTIs. This puts you at the risk of taking antibiotics that can harm the featus. 
3. Women with GDM have a higher chance of developing type 2 diabetes later in life.
4. Continuous hyperglycemia causes the baby to gain above average weight. This also causes complications during delivery.
5. Some studies suggest a potential link between GDM and birth defects. 

Planning a pregnancy is an exciting time, but for women with diabetes, it can also be a time of uncertainty.

The most empowering way of managing blood sugar levels during pregnancy is through lifestyle change. A whole- foods's diet supplemented with sustainable lifestyle changes is the only fool-proof weapon against gestational diabetes.

Here is more about the importance of lifestyle changes:

Managing Diabetes alone VS managing Diabetes when pregnant is different. Your nutritional needs during pregnancy are different and so is your ability to workout impacted. 

You need to learn the various needs of the many stages of pregnancy, and also the specific foods to avoid eating. This way, you will be able to create a comprehensive meal plan that benefits yourself and your babies needs.

Preconception Planning.

Obesity decreases fertility during the preconception period. 

Pre-pregnancy weight plays a significant role in a woman's risk of developing gestational diabetes mellitus (GDM). 

Here's how pre-pregnancy weight is linked to GDM risk:

1. Insulin Resistance: Excess body fat, particularly around the abdomen, can impair the body's ability to use insulin effectively. Insulin is a hormone that helps regulate blood sugar levels. When insulin resistance occurs, blood sugar levels can rise, increasing the risk of GDM.
   
   Don't exactly know what Insulin Resistance is? Watch the below video to understand the mechanism of diabetes better.
   
   
   
   
2. Chronic Inflammation: Every body cell is also a hormone making factory. Fat cells are not just excess cells in the body, but a cause of inflammation. Obesity can contribute to chronic low-grade inflammation in the body. This inflammation can further disrupt insulin sensitivity and increase the risk of GDM.

Studies have shown a clear correlation:

• Women who are overweight or obese before pregnancy are at significantly higher risk of developing GDM compared to women with a normal weight.
  
  
• Even a modest weight loss (5-10% of body weight) before pregnancy can significantly reduce the risk of GDM.

Supplement's to consider preconception:

I strongly suggest my clients to work on building their nutritional stores naturally preconception. No supplements can replace a healthy, wholesome nutrition plan. Additionally, my team also works with clients to identify and get rid of obesogens in the environment.

Obesogens are chemicals found in various everyday products that can interfere with the body's metabolism and promote weight gain. These substances can disrupt endocrine function, leading to increased fat storage and changes in appetite regulation. Common sources of obesogens include:

• Plastic products: Bisphenol A (BPA) and phthalates
• Pesticides: Certain chemicals used in agriculture
• Industrial chemicals: Such as perfluorooctanoic acid (PFOA)
• Personal care products: Parabens and other synthetic additives
  
  

Impact on Pregnant Women:

For pregnant women, exposure to obesogens is particularly concerning. These chemicals can cross the placenta, affecting the developing fetus. Here are some of the potential impacts:

1. Developmental Changes: Obesogens can interfere with the normal development of the fetus, potentially leading to changes in metabolism and an increased risk of obesity later in life.

2. Hormonal Disruption: Obesogens can mimic or block hormones, disrupting the endocrine system of both the mother and the developing baby. This disruption can lead to weight gain and metabolic issues.

3. Increased Risk of Gestational Diabetes: Exposure to obesogens has been linked to a higher risk of gestational diabetes, which can have long-term health implications for both mother and child.

4. Epigenetic Changes: These chemicals can cause changes in gene expression without altering the DNA sequence. Such epigenetic modifications can affect the child's susceptibility to obesity and other metabolic disorders.

The few supplements we do suggest client's to consider though are Vitamin B12, D3, Folic acid, Iron (for anemic mom's) and low- dose calcium.  

These supplements pre-manage the most common and the most dangerous risks of pregnancy: 

• Iron deficiency anemia in the mother,
• Neural tube defects (NTDs) in the baby.

Besides this, when you start wokring on your nutritional goals, all your body's needs will be met naturally. And your body will be prepared and ready to conceive and nurture your baby.

Here is also a list of all food that are great sources of iron and folate:

1. Leafy green vegetables
2. Lentils and legumes.
3. Asparagus
4. Brussels sprouts
5. Broccoli
6. Pumpkin seeds, chia seeds, and hemp seeds.

In the pre-pregnancy stage, overall wellness and health of the body should be your top priority. 

My program with its health experts and wellness professionals can help you achieve your optimized health. We will help you prepare your body for conceiving and nurturing a healthy life inside your body.

Here is one of our client's journey:

Plant-Based Tips for Healthy Weight Management

Focusing on a balanced, plant-based diet can be a great way to achieve and maintain a healthy weight before pregnancy. 

Here are some tips:

• Load Up on Vegetables: Aim for a variety of colorful vegetables at every meal. They're low in calories, high in fiber, and packed with essential nutrients.
• Choose Whole Grains: Opt for whole grains like brown rice, quinoa, and whole-wheat bread over refined grains. They provide sustained energy and keep you feeling fuller for longer.
• Embrace Legumes: Beans, lentils, and chickpeas are excellent sources of plant-based protein and fiber, promoting satiety and blood sugar control.
• Healthy Fats: Include healthy fats from sources like avocados, nuts, and seeds. These fats contribute to feeling full and support hormone balance.
• Limit Processed Foods: Processed foods tend to be high in unhealthy fats, added sugars, and refined carbohydrates, all of which can contribute to weight gain.
• Hydration is Key: Drinking plenty of water helps curb cravings and reduces bloating. Aim for eight glasses daily.
• Mindful Eating: Pay attention to hunger and fullness cues. Eat slowly and savor your food to avoid overeating.
• Regular Exercise: Aim for at least 30 minutes of moderate-intensity exercise most days of the week.

Guidelines To Follow During the Three Trimester's.

While there are some principles that apply to all trimesters, such as avoiding refined sugars and taking more fiber and whole grains. Each trimester has some specific needs.

Here are some specific nutritional tips and tricks for each trimester:

First Trimester:

First trimester of pregnancy is extremely crucial. This is the time when a baby can develop congenital malformations if requirements like folic acid are not met. That is why your doctor must have put you on iron and folic acid supplements even before you are pregnant.

During your first trimester, you will be gaining weight as per your body mass index (BMI). Most women might not gain any weight at all and this is healthy too. Excess caloric intake (unless you are underweight) is not suggested.  

You might not need to tweek your insulin or medication needs just yet. You can continue to exercise like you were before getting pregnant, but closely watch for signs of hypoglycemia. Make sure to work with a fitness trainer who is trained to act quick incase your blood glucose level drops too fast. 

Your doctor will monitor your HbA1c's, but I strongly insist my clients also check their fasting glucose at home a few times per week. Include whole- grains and pulses 3- 4 times a day and avoid hyper palatable foods. Processed foods must be kept to a minimum. 

Should you be struggling with nausea,

• try sipping on homemade ginger and lemon tea a few times per day.
• Smelling camphor also helps some of my clients.
• Eat smaller meals through the day VS one big meal at night. 

Instead of focusing on "weight management' solely, focus on overall health. It is such an all-rounder strategy that will:

• Keep the inflammation in the body under check
• Improve insulin sensitivity
• Control blood sugar levels
• Improve gut motility
• Increased energy levels.

The more important factor to manage during the first trimester is the morning sickness and nausea. 

Here are some plant-based methods that will curb your nausea and morning sickness and keep you feeling good and fresh throughout. 

Ginger Tea: This classic remedy deserves its reputation. Ginger has properties that can soothe the digestive system and reduce nausea. Steep fresh ginger root in hot water or enjoy a cup of ginger tea readily available at most grocery stores.

Bland, Easily Digestible Foods: Opt for small, frequent meals throughout the day to keep your stomach from getting too empty, which can worsen nausea. 

Choose bland, easily digestible foods like:

• Crackers: Plain crackers are a go-to for many. Opt for whole-wheat crackers for added fiber.
• Toast: Dry toast is another classic choice. Consider adding a mashed banana for a touch of sweetness and potassium.
• Applesauce: This naturally sweet and smooth food is gentle on the stomach and provides some hydration.
• Bananas: Rich in potassium and easily digestible, bananas can help combat nausea and replenish electrolytes.

Additional Tips:

• Peppermint: Sip on peppermint tea or suck on peppermint candies. Peppermint has a calming effect on the stomach and can help alleviate nausea.
• Citrus Aromas: The fresh scent of lemons or oranges can be invigorating and potentially reduce nausea. Sniff a cut lemon or orange peel or use a diffuser with a few drops of essential oil (avoid direct skin contact with essential oils).

Second Trimester:

The second trimester of pregnancy brings a wave of exciting developments for both the mother and the growing baby.

During the second trimester, your baby is rapidly developing organs and tissues. To support this growth, your body needs additional energy. This translates to a slight increase in calorie needs, typically around 350 calories per day compared to pre-pregnancy. Note, this might not be necessary if the mother was obese to begin with. 

While increasing your calorie intake is important, it's crucial to focus on nutrient-dense, whole plant-based foods to ensure you and your baby are getting the best possible nourishment. Whole- foods also keep blood sugar's in control. 

Avoid high GI foods such as processed white bread, white rice, sugar and certain fruits. 

Low GI fruits MUST be included for a healthy pregnancy. I also insist my clients to stay away from dairy, particularly ghee and butter. Both of these increase intra- myocellular fats and makes your diabetes worse. 

At this stage, excessive weight gain, unhealthy sugars, and meat consumption can worsen your GDM. Moreover, severe complications may develop, such as:

1. Preeclampsia 
2. Urinary tract infections
3. Macrosomia
4. Increased risk of birth defects

Here is what you need to do:

1. Prioritize fruits, vegetables, whole grains, and legumes in your food.
   
   
   
   
2. Be mindful of portion sizes, especially with fat -rich foods.
3. Fiber helps slow down the absorption of sugar into your bloodstream. Include plenty of it.
4. Avoid sugary sodas, juices, and processed drinks.

Tips for Smart Snacking:

• Snack frequently: Only if you are unable to sit for large meals. Otherwise 2- 3 nutrient dense meals will also suffice your caloric needs. This part has to be personalized based on your lifestyle, work timings, cooking help etc. 
  
  
• Plan your snacks: Having healthy options readily available can help you avoid unhealthy choices when hunger strikes.
  
  
• Listen to your body: Pay attention to your hunger cues and don't be afraid to eat when you're feeling hungry.

During the second trimester, a pregnant female at risk of developing GDM should get her blood sugar levels checked at every visit to the doctor's office. 

Pregnant females who have been diagnosed with GDM should observe their blood sugar checks routinely during:

1. Before and after meals
2. Before bedtime
3. When not feeling well.

This need not be done daily, but 2- 3 times per week is helpful. The growing featus demands the release of excess insulin. If the insulin is not used up by the body, it will lead to insulin resistance. Thus, gestational diabetes develops. 

Third Trimester:

Now you've entered the third trimester! 

You're in the home stretch, and your body's working wonders to prepare for your little one's arrival. Nutrition remains a key player, not just for your baby's development but also for supporting a smooth delivery.

You are going to gain weight and activity might become tougher. With GDM, stick to the plant-based nutrition routine you have been following from the preconception period. 

Avoid refined and unhealthy sugars, and do not leave the side of green vegetables, whole grains, seeds, and legumes.

Three most important requirements in the third trimester are:

• Calcium: Fetal bones are developing at this stage. In the absence of adequate mineral availability, the fetus draws on the mother's bones. The mother can end up with osteoporosis and the fetus could be born premature.
  
  
• Docosahexaenoic acid: The third trimester is very crucial for the fetal brain development as well. That is why it is very important to include healthy fats such as the omega-3 fats. Beans, avocado, flaxseeds, chia seeds, and dry fruits are superb sources for the same.
  
  
• Iron: : Iron is essential for the proper development of the baby’s brain and nervous system. During the third trimester, the fetus undergoes rapid growth and development, requiring more iron for these critical processes.

Plant-Based Powerhouse Foods:

I highly suggest my clients stick as close to a plant- based diet during pregnancy's as possible. Not only is it an assured way to get your micronutrients in, but also prevent's you from consuming obesogens that can impact the babies health. Watch this:

Here is a breakdown of the specific nutrients that you should ensure in your diet during pregnancy. 

Protein: The Building Blocks of Life.

Protein is essential for building and repairing tissues, including your baby's growing organs and muscles. 

Here are some excellent plant-based sources of protein:

• Legumes: Beans, lentils, and chickpeas are nutritional powerhouses. Enjoy them in soups, stews, salads, or even dips like hummus.
• Tofu and Tempeh: These soy-based products are complete proteins, meaning they contain all nine essential amino acids. You can be creative with them in stir-fries, scrambles, or baked dishes.
• Quinoa and Buckwheat: These pseudo-cereals offer a complete protein package along with complex carbohydrates for sustained energy. Add them to salads, dishes, or use them as a base for grain bowls.
• Seeds and Nuts: Almonds, walnuts, chia seeds, and hemp seeds are packed with protein, healthy fats, and fiber. Sprinkle them on salads or oatmeal, or use nut butters as a spread.

Fiber: Keeping Your System Running Smoothly.

Fiber is crucial for maintaining a healthy digestive system, which is particularly important during pregnancy. It also helps regulate blood sugar levels and keeps you feeling fuller for longer. 

Here are some fiber-rich plant-based options:

• Whole Grains: Whole-wheat bread, brown rice, quinoa, and oats are excellent sources of fiber. They provide sustained energy and essential nutrients for both you and your baby.
• Fruits and Vegetables: Aim for a rainbow of fruits and vegetables at every meal. They're naturally high in fiber and packed with vitamins and minerals.
• Legumes: As mentioned earlier, beans, lentils, and chickpeas are not only great protein sources but also excellent sources of fiber, promoting healthy digestion.

Essential Vitamins: Fueling Growth and Development

Vitamins play a critical role in fetal development. Here are some key vitamins and their plant-based sources:

• Folate (Folic Acid): Essential for neural tube development in the baby. Folic acid is found in leafy green vegetables (spinach, kale), lentils, chickpeas, and fortified plant-based milks.
• Iron: Crucial for oxygen transport throughout the body. Sources of iron include lentils, beans, tofu, fortified cereals, and dark leafy greens. 
• Vitamin B12: Plays a significant role in red blood cell formation and nervous system function. Look for fortified plant-based milks (soy milk, almond milk) and cereals, or consider having a B12 supplement after consulting your doctor.
• Vitamin D: Supports bone development in the baby. Sunlight exposure is important, but fortified plant-based milks, mushrooms exposed to UV light, and some leafy greens can contribute to this essential nutrient.

Foods to Limit or Avoid.

Building healthy habits is a marathon, not a sprint.

While occasional indulgences can happen, sticking to a balanced diet throughout the day will have a greater impact on your overall well-being.

To make your efforts more effective and fruitful in every stage of pregnancy, it is important that you spot the black sheep and remove them.

Here are the foods that you need to be wary of. They can quickly disturb your blood sugar and triglyceride levels. Remember, we are aiming for an optimized health for a perfect pregnancy and childbirth. 

• Refined carbohydrates:

Replacing refined grains with whole grains is the first step an Indian diabetic should take to reduce weight and manage Diabetes more effectively. What does this mean? Eat grains in their whole form. Avoid white rice, breads and bakery goods. Eat brown rice, millets and whole- wheat phulka instead. 

Our body quickly absorbs processed grains such as white flour bread, which results in blood sugar spikes. It puts higher demand for insulin and raises blood sugar levels.

Sugary drinks do the same. So, instead of indulging in carbonated sodas with loads of white sugar in them, you can always keep a bottle of fresh water with lemon, mint and cucumber. Avoid juices too and eat the whole fruits. 

• Hyper- Palatable foods

Packaged snacks contain trans fats, cholesterol, refined sugars, and high salt content. All these factors contribute to blood sugar spikes, weight gain, high triglyceride levels, hypertension. 

These foods worsen the entire health profile of your body and put you at a greater risk for GDM. 

During all trimesters, unhealthy fats in packaged snacks can worsen your diabetes and blood pressure levels.

• Red Meat and Processed Meats 

A study conducted on a group of around three thousand females in their fertile years revealed the following result:

Higher pre-pregnancy consumption of total meat, especially red and processed meat, and heme iron intake, are associated with an increased GDM risk.

Heme iron causes generalized inflammation throughout the body. It also increases body weight. Both factors are independently associated with diabetes, especially during pregnancy. 

• Eggs and Dairy

Dairy products like ghee, yogurt, and paneer are commonly used in Indian cuisine. Dairy products bring along the ever-disastrous saturated fats! There is another problem with dairy products, watch this:

In the same way, eggs can be a devastating food choice for pregnant females. Eggs contain fifty percent fat, most of which is saturated fats, triglycerides, and cholesterol.

Higher prepregnancy intake of cholesterol and saturated fats has been associated with an increased risk of developing gestational Diabetes.

Additional Tips & Resources.

While this article provides a foundation for navigating pregnancy, every woman's journey is unique. 

Our team of registered dieticians and healthcare professionals are here to support you. Schedule a consultation to discuss your needs, preferences, and any concerns you may have.

Remember, well-planned nutritional habits can be a powerful tool for managing diabetes and promoting a healthy pregnancy. 

You've got this, mama!