What are examples of suitable carbohydrates for a pregnant individual with gestational diabetes?

Suitable Carbohydrates for Gestational Diabetes

For pregnant individuals with gestational diabetes, carbohydrates should come from nutrient-dense, complex sources including fruits, vegetables, legumes, whole grains, and dairy products, with emphasis on high-fiber, low-glycemic index foods, while avoiding simple carbohydrates that cause higher postmeal glucose excursions. 1

Recommended Carbohydrate Amount

• Minimum of 175 grams of carbohydrate daily (approximately 35% of a 2,000-calorie diet) is the established dietary reference intake for all pregnant individuals, including those with GDM 1
• This minimum threshold is critical—going below 175 g/day may increase risk of micronutrient deficiencies and trigger maternal ketosis 2
• Carbohydrate intake should be distributed throughout the day into three small-to-moderate sized meals and 2-4 snacks 1

Specific Carbohydrate Sources to Choose

Higher-quality, nutrient-dense carbohydrates include: 1

• Whole grains (brown rice, quinoa, oats, whole wheat bread)
• Legumes (beans, lentils, chickpeas)
• Non-starchy vegetables (leafy greens, broccoli, peppers, tomatoes)
• Fruits (berries, apples, citrus—consumed whole rather than juiced)
• Dairy products (milk, yogurt—preferably unsweetened)

These complex carbohydrates result in controlled fasting and postprandial glucose, lower free fatty acids, improved insulin action, and may reduce excess infant adiposity 1

Carbohydrates to Avoid or Limit

Simple carbohydrates will result in higher postmeal glucose excursions and should be avoided: 1

• Added sugars and sweetened beverages
• Refined grains (white bread, white rice, pastries)
• Processed foods with high sugar content
• Fruit juices (even 100% juice causes rapid glucose spikes)

Glycemic Index Considerations

Low-glycemic index foods are preferred as they produce smaller, more gradual increases in blood glucose 3, 4, 5

• Low-GI carbohydrates have consistently shown advantages for glycemic control in GDM without demonstrated disadvantages 5
• Examples include: steel-cut oats, sweet potatoes, most legumes, non-starchy vegetables, and whole fruits with skin 3

Practical Distribution Strategy

Carbohydrate tolerance varies by meal timing: 1

• Carbohydrate is generally less well tolerated at breakfast than at other meals—consider limiting breakfast carbohydrates to 30-45 grams 1
• An evening snack is usually necessary to prevent accelerated overnight ketosis 1
• Distribute remaining carbohydrates across lunch, dinner, and 2-3 additional snacks

Critical Pitfalls to Avoid

Do not severely restrict carbohydrates below 175 g/day despite temptation to control blood glucose through carbohydrate restriction 1

• Substituting fat for carbohydrate may unintentionally enhance lipolysis, promote elevated free fatty acids, and worsen maternal insulin resistance 1
• Fasting urine ketone testing should be performed to identify those severely restricting carbohydrates 1
• Evidence suggests carbohydrate intake below 165 g/day increases risk for micronutrient deficiency 2

Fiber Requirements

Aim for 28 grams of fiber daily from whole food sources 1

• High-fiber carbohydrates slow glucose absorption and improve glycemic control
• Fiber-rich foods include vegetables, fruits with skin, legumes, and whole grains

Fat Quality Matters

While focusing on carbohydrate quality, the nutrition plan should emphasize monounsaturated and polyunsaturated fats while limiting saturated fats and avoiding trans fats 1

• Include nuts, seeds, fish, and healthy oils (olive, avocado)
• This supports vascular health and may reduce excess infant adiposity 1