Kelsey Marksteiner: Really what I try to do with pregnancy is simply to track the blood sugar, so have the woman use an at-home glucometer to track her blood sugar when she wakes up, so the fasting blood sugar, and then before and after meals. Based on those results, that’s what I would use to make my recommendation for carbohydrates, and that involves a bit of experimentation as well. If we are seeing that the blood sugar is tending to be high after meals, we’re going to lower the carbohydrates a little bit in those meals and then see how that changes the blood sugar. If it’s still a little bit too high but it’s lower than it was before, we know we’re on the right track and we just keep decreasing.
I wish there was an answer of, like, what is the lowest you can go carb-wise that is safe for a pregnant woman, and I don’t think we have that answer just because there are a lot of ethics issues, of course, when you are dealing with pregnant women, so there hasn’t been too much research on, you know, whether a ketogenic diet is safe for a pregnant woman, for example, but there’s certainly some fear that it’s not. So I wouldn’t recommend going super-low carb. For example, if you have someone with gestational diabetes while they’re pregnant, then you would aim for the lower end of carbohydrate intake, but you should be able to get their blood sugar pretty stabilized on a fairly low-carb diet without dipping into a ketogenic diet.
One of my favorite resources for anything gestational diabetes is a fellow RD. Her name is Lily Nichols. Jill, if we can pull up this link, this is a podcast that Laura and I did with her, and it’s a really, really interesting podcast about gestational diabetes. If you have pregnant women who have either just slight blood sugar issues or if they have full-blown gestational diabetes, this is a really great listen. Lily also has a book that she has written now, and that’s a really great read. You can give that to your clients to sort of make them understand what is involved when they have gestational diabetes and how they should be eating. You can listen to this episode, you can read her book, and Lily also has a bunch of other interviews on other podcasts, so I would just type her name into Google and see what you can find. Her website is a really great resource as well, which is PilatesNutritionist.com. She’s a fantastic resource for anything blood sugar related in pregnancy, so I would definitely seek out all of her information.
In general, I really, really just try to focus the carbohydrate intake on the blood sugar readings. I wouldn’t say there’s any go-to carbohydrate level that’s perfect because everybody is different and every pregnancy is different, so you really need to use the data to drive what you’re doing.
A little helpful hint there, just because the glucometers are not perfect, would be to have your client get their glucometer, take it to a doctor’s appointment when they’re getting their blood level tested of glucose by doing a needlestick in the office, and then do a glucometer prick at the same time that they’re getting their blood sugar tested, and then when they get their results back from their doctor, compare it to what the glucometer said the level was. Really glucometers are better for testing trends rather than the actual number, but if you can get a sense of how off it is, so let’s say the level at the doctor’s office was 85 and the glucometer read 95, you can make a guess that it’s generally going to be about 10 points higher than what it actually is, and you can just keep that in mind when you’re seeing the readings from your client and maybe not freak out if the level after a meal is 145 because we know that it’s probably actually around 135. That can just save you a little bit of headache in terms of a woman getting upset about a number that is a little bit too high when you can kind of know that it may just be a little bit high because the glucometer is a little bit off. That’s just a really good tip in terms of knowing a little bit more accurately what your glucometer is reading because they do tend to be off somewhat.
OK, if anybody else has any questions about that, feel free to ask them, and we have another question that’s slightly related down here as well. In general, there’s no perfect level of carbohydrates for a pregnant woman, and there’s also no perfect amount of carbohydrates for a pregnant woman with blood sugar issues. I would really just use those levels of glucose to determine how much that person should be eating at each meal.