Gestational diabetes is one of the most common pregnancy complications today. So it stands to reason that one of the questions we are most often asked about prenatal nutrition is whether or not it can have an impact on gestational diabetes. Women want to know if they can avoid gestational diabetes by proper prenatal nutrition. The short answer is “yes”…the long answer is interesting, complicated, and controversial.

The root of the problem is in the definition of gestational diabetes, and whether or not it truly exists as a disease entity.

A blood glucose level of 140-150 milligrams per milliliters of plasma after fasting for twelve hours is considered normal in the non-pregnant woman, and was once considered normal for pregnant women too. But in the 1970s, research was conducted on thousands of pregnant women, and it was determined that a much lower 105 milligrams per milliliter was average — and therefore “safe” — for pregnant women. Unfortunately, these women who were studied were never evaluated for their nutritional status, neither before testing, nor for complications as pregnancy progressed, so nutrition was not even a factor in coming up with this number.

According to The Brewer Pregnancy Hotline, “Well-nourished women who consume adequate protein, calories, vitamins, and minerals keep their blood glucose levels at the same levels as normal non-pregnant women and even maintain an energy supply reserve (glycogen) stored in their livers.” If you are well nourished in pregnancy, you have a reserve that will keep you going for about 12 hours if you are unable to eat! This is not true of the poorly nourished woman: her blood sugar levels will spike and drop based on her eating routine, without any reserves to help her along.

“It seems certain that 105 milligrams per milliliter is an artificially low level for pregnancy blood glucose, a determination that was heavily weighted with results from women whose pregnancy diets simply were not adequate for the nutritional demands pregnancy imposes.” (The Brewer Pregnancy Hotline) Now perhaps you can understand why “gestational” diabetes is a questionable diagnosis, at best.

Management of this “condition” is also questionable and can lead to further complications. Calls to the Brewer Hotline over the years show that most doctors do not correctly manage so-called “gestational” diabetes correctly: they simply hand out a low- or no-carb diet, and disregard the nutritional needs of a pregnant woman.

So now you have a potentially false diagnosis, the management of which is likely to lead to further complications… so that the diagnosis becomes a self-fulfilling prophecy.

The Brewer Pregnancy Hotline cites several reasons why this might happen to you:

• you have a family history of diabetes that alerts your physician to the possibility that you, too, may be developing the disease even though there is no glucose spilling in your urine;
• you have given birth previously to a baby who weighed more than 9 pounds (as happens commonly when your diet is excellent);
• you are gaining more weight on a good diet than your doctor or midwife has been trained to think is acceptable (you may have twins, you may have been thin and underweight, you may be just perfect, but their weight limit is still back at 20 pounds, which was taught thirty years ago as the maximum acceptable weight gain limit);
• you have a sonogram for some other reason and it’s determined that your baby is bigger than the charts say it should be for the length of your pregnancy (no account is taken of the fact that those charts are also heavily weighted with babies whose mothers were not optimally nourished!);
• you have a normal (by the old standard) blood glucose level (140-150 mg. per ml.) when you take a test for it at some point in pregnancy (to satisfy your doctor’s insistence);
• you spill some glucose in your urine, but upon further evaluation show no other sign of diabetes (pregnancy makes some women’s kidneys ultra-sensitive to glucose, so they allow some to escape — a condition called low renal threshold that is in no way related to diabetes and which is harmless).

As you can see, so-called “gestational” diabetes is a conundrum which, if you get caught in it, can make your pregnancy a frustrating experience, with perhaps no true risk. If you are a true insulin-dependent diabetic, you need special nutritional management during pregnancy. But if you just happen to “fail” a GTT and get labeled “gestational” diabetic, you might find that your care is being unnecessarily managed.

Why is this all such a concern? Why do doctors fear “gestational” diabetes? Truly diabetic women can have serious pregnancy complications. But most “gestational” diabetics can have completely normal pregnancies if they are well-nourished — hence, the short, affirmative answer to the question, “Can the Brewer Diet help me if I’ve been diagnosed with gestational diabetes?” YES!