Ask Lily #1: It is normal and safe to lose weight during pregnancy?

Ask Lily #2: How do I check my blood sugar (use a glucometer)?

Ask Lily #3: Will I automatically need a C-section or induction?

In short, no. However, C-sections and inductions are often (unnecessarily) pushed on women with a gestational diabetes diagnosis, as described in this research study.

"Whether cesarean deliveries should be routinely performed in women with elevated fetal weights is controversial, because no randomized trials exist to address this question. In the Toronto Tri-Hospital Study, women with treated GDM had a lower rate of macrosomia than women for whom glucose levels were blinded, but women with identified GDM had a two-fold increased risk of cesarean delivery. These findings suggest that the GDM diagnosis itself, apart from fetal weight, was an (unnecessary) risk factor for surgery. Along similar lines, whether induction should be offered in anticipation of reducing comorbidities in glucose intolerant mothers is also controversial, because no randomized trials exist. A Cochrane database review concluded that inducing glucose intolerant mothers at 38 weeks’ gestation was associated with reductions in birth-weight and did not increase risk of cesarean delivery, but delay of delivery in women with well-controlled GDM has also not been shown to be harmful."

Ask Lily #4: Are there any supplements that can help lower my fasting blood sugar?

Yes, although keep in mind that there are many, many potential factors that can influence your fasting blood sugar. First, be sure to watch the bonus training on fasting blood sugar (see bonus tab above) for a detailed overview. As you know, I'm a fan of getting your nutrients from food first and only resorting to extra supplements if necessary. The nutrients mentioned in that training—vitamin D, magnesium, glycine (as found in collagen or gelatin)—are all helpful in overall blood sugar management.

One additional nutrient that recently gained attention is inositol. Inositol is a relative to B-vitamins (but technically not a true B vitamin), that I've had some success in lowering insulin resistance and fasting blood sugar in clients.

Although there’s not a ton of data (yet), some studies have found it effective at lowering blood sugar. There are many studies using it outside of pregnancy, particularly for lowering insulin resistance in PCOS (polycystic ovarian syndrome) and type 2 diabetes, but for our purposes, I want to focus on the research in pregnancy.

In one study of ~70 women with GD, fasting blood sugar went from an average of 99 mg/dl (5.5 mmol/l) to 83 mg/dl (4.6 mmol/l) following supplementation with inositol at 4 grams per day for 8 weeks. Markers of insulin resistance went down and total insulin levels also dropped (both of which show us that inositol improved insulin sensitivity, meaning their bodies were more responsive to their own insulin). [<--By the way, I can say that in my work with clients, we observed improvement in blood sugar in as a little as a week of supplementation, so don’t fret if you don’t have 8 weeks to wait.]

There’s also some research showing that supplementing early in pregnancy can help prevent gestational diabetes in some women who are at risk, such as those with a higher prepregnancy BMI (this is good to keep in mind if you plan on more children!).

It also is associated with lower rates of preterm birth and macrosomia (big babies) in women who were supplemented from early pregnancy who were at risk for GDM (this study also showed lower rates of GDM in the inositol-supplemented group).

Not all studies have been positive. Here’s one that showed no significant reduction in GDM in women with a family history of diabetes. That said, most of the studies done outside of pregnancy show a significant benefit to those with type 2 diabetes, so I still think inositol is worth a try with a family history of diabetes. From a physiological standpoint, it makes sense to increase your intake of nutrients that help with insulin resistance during a time when your body is highly insulin resistant (hello, gestational diabetes!) Here are a few research articles to check out on type 2 diabetes (1 and 2)

Overall, I think this is a viable supplement to consider if your fasting blood sugar is running high. Inositol is overwhelmingly supported as a beneficial nutrient for pregnancy/fertility/blood sugar control and there are no concerns over toxicity. In short, it seems to me to be another tool in your toolbox with no downsides (see this for more on inositol’s general role in reproductive health.

The form to purchase is myoinostol or, my preference, a supplement called Ovasitol, which has the two most common forms of inositol and in the specific ratios they exist in your body (myoinositol and D-chiro inositol). I have no connection with the company, it's just a good product with a lot of research behind it. You can check your local health food store or purchase on Amazon. If Ovasitol is out of your budget, opt for myoinositol.

The dosage used in research is 4 grams per day in split doses (so 2 grams twice per day). Inositol has a very pleasant, mildly sweet flavor, so it’s an easy addition to food/drinks.

If you have questions about supplementing with inositol, please post in our course Facebook group!

***Have a question and want to get input from your course mates? Join us in our private Facebook group and get the conversation started!

Tag Lily in your post if you'd like her input during weekly office hours (Wednesday mornings Pacific Time).***

The most frequently asked questions are added to the Ask Lily page.