Gestational Diabetes: When Standard Nutrition May Miss the Mark
By Elizabeth Link, BCHN, NTP
When most people hear the term “gestational diabetes,” they assume it’s a temporary condition, something that just happens during pregnancy and then disappears. But the story is a lot more nuanced.
Gestational diabetes mellitus (GDM) is either a condition that develops during pregnancy or, in some cases, an undiagnosed case of type 2 diabetes that’s discovered during routine prenatal labs. While it may seem mild, the potential risks are significant for both mom and baby. These include:
Macrosomia: Excess fetal growth that increases the risk of birth complications
Preterm birth: High blood sugar can lead to early labor
Preeclampsia: High blood pressure and organ stress in the mother
Long-term metabolic risk: Both mother and baby are at higher risk for type 2 diabetes due to epigenetic programming (Moon & Jang, 2022)
Why Blood Sugar Should Be Lower in Pregnancy
Here’s something surprising: Pregnancy is actually a time when a woman’s blood sugar should run lower than normal, often by around 20% (Nichols, 2018). The body naturally becomes more insulin resistant to prioritize glucose delivery to the developing baby. But instead of causing high blood sugar, the body compensates by dramatically increasing insulin production, up to 300% more than baseline (Nichols, 2018).
If that compensation falters, blood sugar rises, and that’s where gestational diabetes comes in.
This is why testing A1C early in pregnancy is so important. A1C gives us a 3–4 month average of blood sugar by measuring how much glucose is attached to hemoglobin. A first-trimester A1C can flag hidden blood sugar issues early, offering a chance to intervene before complications escalate.
Carbs: Not the Villain, But Not Always a Friend
Let’s talk macros.
Of the three macronutrients, carbohydrates are the only one that reliably and significantly raises blood sugar. Protein can raise it slightly through gluconeogenesis, a slow, stable process, while fat actually helps blunt blood sugar spikes by slowing gastric emptying. It also protects against the crashes, reactive hypoglycemia, that often follow high-carb meals, especially in women with blood sugar issues.
So why is the standard recommendation for pregnant women to eat at least 175 grams of carbs per day?
This figure is based on the estimated minimum glucose requirement of the adult brain, around 130 grams per day. But in a state of mild carbohydrate restriction, the body efficiently produces ketones, a clean-burning, brain-friendly fuel that reduces glucose needs dramatically (Moses et al., 2009).
To be clear, I’m referring to physiological ketone production on a nutrient-dense, moderate-carb diet, not ketoacidosis, which is a dangerous condition in uncontrolled diabetes.
A Smarter Approach: Moderate Carb, High-Nutrient, Ancestral-Inspired
In my practice, I help moms use a strategy I call the Nutritional Order of Operations, a framework I created to help identify the right interventions in the right order, based on physiology and testing. And when it comes to gestational diabetes, nutrition is a powerful lever.
Studies show that a low glycemic diet during pregnancy can reduce the need for insulin by over 30% (Moses et al., 2009). Yet conventional guidelines still push high carbohydrate intakes, regardless of the mother’s individual tolerance.
I believe a more reasonable target is closer to 130 grams of carbohydrates per day, enough to support fetal brain development while keeping mom’s blood sugar stable. The focus should be on:
Prioritizing protein and healthy fats at every meal
Choosing low glycemic, fiber-rich carbs as a side, not the main feature
Supporting insulin sensitivity through gentle movement like walking, prenatal yoga, or swimming
Incorporating medium-chain fats and glycine-rich proteins to nourish both mom and baby
For example, a woman weighing 175 pounds, around 80 kg, might do well with 110 grams of protein daily (1.4 g/kg), around 90 grams of fat (40% of a 2000-calorie intake), and 130 grams of carbohydrates (about 35% of total calories). This blend stabilizes blood sugar while still providing abundant nutrients and fuel for fetal development.
Nutrients of Concern
While all nutrients matter in pregnancy, a few deserve extra attention in the context of gestational diabetes:
Magnesium: With an RDA of 350 mg during pregnancy, magnesium is often low, especially in women with GDM. It plays a key role in blood sugar regulation and vascular health (Nichols, 2018).
Vitamin D: While the RDA is 600 IU, many experts believe this is too low. Low vitamin D is linked to complications like preeclampsia, poor bone mineralization, and increased GDM risk (Viljakainen et al., 2010).
Final Thoughts
Pregnancy isn’t the time for extremes. It’s a time for strategic nourishment. And while the risks of elevated blood sugar during pregnancy are real and under-discussed, it’s equally important to ensure adequate fuel, especially for fetal brain development.
By taking a moderate-carb, nutrient-dense, individualized approach, we can support both mom and baby with tools grounded in ancestral wisdom, clinical evidence, and modern physiology.
If you’ve been told to eat more carbs than feel right for your body, or if you’re unsure how to manage gestational diabetes without feeling restricted, there are better options. And I’m here to help you find them.
References
Astrup, A., Magkos, F., Bier, D. M., Brenna, J. T., de Oliveira Otto, M. C., Hill, J. O., King, J. C., Mente, A., & Ordovas, J. M. (2020). Saturated fats and health: A reassessment and proposal for food-based recommendations: JACC state-of-the-art review. Journal of the American College of Cardiology, 76(7), 844–857. https://doi.org/10.1016/j.jacc.2020.05.077
Moon, J. H., & Jang, H. C. (2022). Gestational diabetes mellitus: Diagnostic approaches and maternal-offspring complications. Diabetes & Metabolism Journal, 46(1), 3–14. https://doi.org/10.4093/dmj.2021.0335
Moses, R. G., Barker, M., Winter, M., Petocz, P., & Brand-Miller, J. C. (2009). Can a low-glycemic index diet reduce the need for insulin in gestational diabetes mellitus? A randomized trial. Diabetes Care, 32(6), 996–1000. https://doi.org/10.2337/dc09-0007
Nichols, L. (2018). Real food for pregnancy: The science and wisdom of optimal prenatal nutrition. Pilates Nutrition Press.
Viljakainen, H. T., Saarnio, E., Hytinantti, T., Miettinen, M., Surcel, H., Mäkitie, O., Andersson, S., Laitinen, K., Lamberg-Allardt, C. (2010). Maternal vitamin D status determines bone variables in the newborn. Journal of Clinical Endocrinology & Metabolism, 95(4), 1749–1757. https://doi.org/10.1210/jc.2009-1391