Gestational diabetes: should I do the load curve? What can I eat?

Gestational diabetes is defined as glucose intolerance of varying severity that appears during pregnancy and resolves after delivery.

It is very important to be able to diagnose it, but even more important to prevent it , because it can lead to problems for the fetus, such as high or low birth weight, premature birth, jaundice, metabolic problems, preeclampsia , heart problems and predisposition to a caesarean section .

Furthermore, women with gestational diabetes appear to have an increased risk of developing type 2 diabetes after pregnancy.

Gestational diabetes screening: who should do it?

In 2010, the International Association of Diabetes and Pregnancy Study Groups (IADPSG) recommended universal screening for Gestational Diabetes Mellitus (GDM), specifying, through guidelines, how to carry out screening

All pregnant women, between the 24th and 28th weeks of gestation, must carry out a loading curve with 75 g of glucose (OGTT 75 g), with blood glucose sampling at 60 and 120 minutes (in addition to the initial blood glucose sampling prior to glucose load).

Universal screening has, of course, increased the prevalence of gestational diabetes diagnoses and insulin prescriptions.

Since this leads to a significant increase in health costs, in Italy the Ministry of Health has opted for a modification of these guidelines, creating its own, included in the broader guidelines for physiological pregnancy.

Specifically, in Italy, screening is carried out in two ways, based on the level of risk factors present in pregnant women :

• Women with gestational diabetes in a previous pregnancy or with a prepregnancy body mass index >30 or with baseline blood glucose values ​​between 100 and 125 mg/dl should have a 75 g OGTT between 16 and 18 weeks of pregnancy. In case of normal values, the OGTT 75 g will have to be repeated between 24 and 28 weeks.
• Women > 35 years or with body mass index >25 or with fetal macrosomia in a previous pregnancy (infant born > 4.5 kg) or with gestational diabetes in a previous pregnancy (even with a normal first OGTT at 16 to 18 weeks) or with a family history of close relatives with type 2 diabetes or from a family originating from areas with a high prevalence of diabetes must have a 75 g OGTT between 24 – 28 weeks of gestation.

However, several studies have shown that screening for risk factors is not highly efficient , since there is a percentage of women without risk factors who, however, still have gestational diabetes.

This means that the savings on health costs obtained by not carrying out universal screening are fictitious, as health costs increase for women who are diagnosed late and whose children need interventions and treatment for neglected gestational diabetes.

What can I eat if I have gestational diabetes?

In general, however, most cases of gestational diabetes are controlled through nutrition and physical activity. In 10-20% of cases, these precautions are not sufficient and we intervene with a pharmacological therapy with metformin or insulin-based.

The diet must essentially have a low glycemic load , therefore with mainly wholemeal carbohydrates , with a preference for cereal grains over pasta, bread with naturally wholemeal and unrefined flours, not excessive portions and the presence of vegetables , greens and protein foods in main meals.

The intake of legumes is recommended , in case of gastric disorders (frequent in pregnancy) the decorticated and pureed versions are preferable.

Consume whole fruits and not juices / juices / centrifuged / extracts because they have too little fiber intake in favor of an excessive concentration of sugars. Of course, avoid sweets or limit them to a few “special” occasions, always without exaggerating.

As a physical activity, a pregnant woman is certainly not asked to do races and marathons, but even walking for at least 40 minutes a day can be a good activity , especially for those who are not very familiar with the gym.

This type of diet and activity must be followed from the beginning of pregnancy, because they can also help prevent gestational diabetes in predisposed subjects. As has been known for decades, prevention is better than cure!