“You have an entirely different body now,” my midwife said at a routine prenatal visit during my second trimester. While that’s not completely true – I would jump at the chance to trade in the bulging disc in my lumbar spine for a new, healthy one – it is partially accurate. The pregnancy hormones that drive the growth and development of a baby can alter the environment inside the mother’s body in unpredictable and unwanted ways. Among these, the body may change how it makes and utilizes insulin, which creates problems controlling blood sugar levels. Approximately one in ten pregnant women develop gestational diabetes and it’s becoming increasingly common.

On this particular day at my midwife’s office I was trying to get out of taking a glucose tolerance test. I wasn’t happy about swallowing a sugar solution and sitting around a lab waiting to give blood samples when I had more important things to do, but my biggest objection was that it was unnecessary. I believed that it was impossible for me to have high blood sugar. After all, I wrote the book – literally – on preventing and reversing prediabetes with dietary and lifestyle changes in The Prediabetes Detox and I follow my own advice. 

I eat an anti-inflammatory diet that includes good quality protein, plenty of fiber, and healthy fat. I eat little or no refined carbohydrates like pasta, bread, potatoes, rice, and sweets, aside from seasonal whole fruit and an occasional square of 85% dark chocolate. I drink mostly water and lots of it. I get plenty of sleep, practice relaxation, and exercise more than I ever did before I was pregnant. Because exercise has been the only effective method of controlling my back pain, most days I walk 10,000 steps or more and spend 45 to 60 minutes exercising in the pool or on the elliptical machine. Never in my life have I had blood sugar problems and routine test results have always been well within the normal range. My weight gain during pregnancy has been on the low end of normal and the baby is healthy. Surely I was immune to gestational diabetes. 

None of these arguments got me out of taking the test. As a physician myself, I understand why it’s important to test pregnant women for gestational diabetes and why we can’t just take a patient’s word for it that their blood sugar levels are normal. Some women show signs like excess weight gain or have risk factors like a family history of diabetes, but many women don’t have any symptoms at all. We can’t feel how much sugar is in our blood so the only way to know is to test it. 

Identifying gestational diabetes is important because it puts the baby at risk for preterm birth, excessive birth weight, shoulder dystocia during delivery, low blood sugar shortly after birth, and newborn respiratory distress syndrome. Gestational diabetes also increases the risk of preeclampsia, a condition characterized by high blood pressure, organ damage, and potentially life-threatening complications for both mother and baby. And blood sugar problems during pregnancy makes it more likely that mother and baby will develop type two diabetes and/or obesity in the future. (On the bright side, moms with gestational diabetes who breastfeed for at least three months reduce their risk of type two diabetes and some studies show that for every year a woman breastfeeds, her risk goes down by fifteen percent regardless of body mass index, diet, exercise, and smoking.)

When my test results came in, I was shocked to learn that some of the measurements were abnormal. They were only slightly elevated, but I was still concerned. So I started tracking my blood sugar levels daily, upon waking and two hours after meals. I soon realized that within the context of my regular diet and lifestyle, my glucose levels are always normal. It was only when I was given a large dose of sugar for testing purposes that my body was unable to metabolize it efficiently. So the solution was to continue what I was already doing: avoiding sweets and starches, exercising regularly, and making time for rest and relaxation.

These are the same strategies I recommend to my patients, whether the goal is to prevent gestational diabetes, control high blood sugar, or simply have a healthy pregnancy. The five guidelines below will help you optimize your diet, exercise routine, and lifestyle. If you’ve been diagnosed with gestational diabetes, talk to your midwife or doctor about how often you need to monitor your blood sugar and whether additional interventions are necessary. 

One simplest ways to lower levels of sugar in the blood is to eat less sugar. This includes sweet foods and beverages as well as starches, which includes grains like rice, root vegetables like potatoes, and foods made from flour like bread, pasta, crackers, processed breakfast cereal, muffins, cakes, cookies, and other baked goods. It also includes processed fruit like jelly, jam, canned fruit with syrup, fruit concentrates, and extracted fruit juices.

Exercise helps prevent and reverse gestational diabetes by lowering blood sugar, making cells more sensitive to insulin, reducing inflammation, and boosting levels of serotonin, which helps prevent food cravings. It also reduces the risk of excessive weight in newborn babies, helps prevent preeclampsia, and improves cardiovascular function, blood pressure, fitness, and self image. And it helps treat lower back pain, constipation, bloating, fatigue, and insomnia. The best forms of exercise for pregnant women are moderately-intense, low-impact activities like swimming, water aerobics, brisk walking, and cycling. Before you exercise, get permission from your midwife or obstetrician. If you aren’t already physically active, consider meeting with a personal trainer who has experience working with pregnant women and can put together a routine for you, familiarize you with exercise equipment, and make sure that you’re doing the exercises correctly.

Short sleep cycles can increase the risk for diabetes by raising blood sugar levels and causing cells to lose sensitivity to insulin. Lack of sleep can also trigger sugar cravings and prompt you to eat more sweets and starches. Pregnant women should get at least eight hours of sleep each night in the summer and at least nine hours in the winter, and take naps as needed. If you struggle with insomnia, talk to your naturopathic doctor about natural remedies and sleep hygiene strategies like avoiding electronics before bed, sleeping in complete darkness, and eliminating sugar, caffeine, and alcohol from your diet.

When we’re exposed to stress, whether physical or mental, real or imagined, levels of stress hormones like cortisol go up. As a natural survival mechanism, high levels of stress hormones trigger high levels of blood sugar. Over time, this can increase the risk of developing diabetes. High cortisol levels also deplete serotonin, causing us to crave sweet and starchy foods. One of the best ways to keep cortisol levels low is to find activities that help us manage stress effectively. Exercise is a good one, but other options exist: yoga, meditation, guided imagery, breathing exercises, progressive muscle relaxation, qigong, and massage. Like any skill, relaxation requires practice, focus, and concentration, and the more you do it, the easier it will be. Pick activities that feel right to you and practice them daily or whenever the need arises.

For lots of reasons, pregnant women shouldn’t smoke and shouldn’t be exposed to secondhand smoke. Smoking cigarettes raises blood sugar levels and increases the risk of developing diabetes (as well as other illnesses like cardiovascular disease and cancer). Even if you don’t smoke, being around people who do can have a similar effect. Studies show that people exposed to secondhand smoke have higher levels of fasting blood sugar and hemoglobin A1C, more insulin resistance, and a higher incidence of diabetes. When it comes to quitting, close to 90 percent of successful long-term quitters stopped smoking abruptly, and this cold turkey method has been shown to be twice as effective as nicotine replacement therapy and medications that are taken to reduce cravings.