Ketosis can help with gestational diabetes by improving glucose tolerance during pregnancy. It has also been shown to reduce mean fasting plasma glucose levels, improve glycemic control, and improve other health markers. Several studies have demonstrated that low carbohydrate diets have similar effects on blood glucose control in gestational diabetes as other dietary approaches.

Gaining weight is often cited as a reason for gestational diabetes, and the assumption is that losing it will prevent the condition. However, the latest research shows it may be a little more complicated than that.

Gestational diabetes is a type of diabetes that only develops in pregnant women. Up until recently, it was believed that gestational diabetes was one of the inevitable consequences of pregnancy—no one was to blame. All types of diets would make it worse, and the only effective solution was to give the mother a lot of sugar to prevent it. Things have changed, though, thanks to better understanding of the condition. People who suffer from gestational diabetes can control their condition with a low carb diet, or a keto diet.

Updated on June 17, 2021 by, with medical review by


Natalie Thompson Cooper was extremely worried when she was diagnosed with gestational diabetes in her first pregnancy at the age of 28. Hyperglycemia is a disease that affects one in every seven to one in every five pregnancies. It causes blood sugar levels to become excessively high.

Natalie was well aware that hyperglycemia exposed her body tissues and her unborn daughter to high glucose levels, putting both her and her fetus at risk for a variety of complications, including miscarriage, birth defects, macrosomia (extremely large size), high blood pressure, pre-eclampsia, seizures, birth trauma, and higher rates of C-section and even stillbirth.

Furthermore, gestational diabetes (GD), also known as ‘carbohydrate intolerance of pregnancy,’ significantly raises the risk of future health issues for both the mother and her children, including considerably greater risks of type 2 diabetes, metabolic disorders, and cardiovascular disease.

Gestational diabetes is one of the most common and significant complications of pregnancy. Prenatal guidelines the world over recommend the routine screening of all pregnant women and then, if positive, strict management, starting with dietary therapy, then if that does not work, insulin injections.

However, the optimal “dietary therapy” is still up for dispute, with some studies advocating a diet rich in complex carbohydrates (60 percent carbs) and others advocating a reduced carbohydrate diet (40 percent carbs).

However, the suggested “reduced carb” GD diet is still much greater than the rigorous low-carb high-fat or ketogenic diet’s under 20 g per day. In fact, many GD recommendations suggest that women consume a minimum of 175 g of carbohydrate per day on a purportedly “lower-carb” diet, a number at which many women’s blood sugar levels increase to potentially dangerous levels.

175 grams of carbs is ridiculous! .. ‘Do I have to consume carbohydrates?’ women ask. ‘No, you don’t,’ I reply.

— Lois Jovanovic, Ph.D.

“Honestly, 175 g of carbs is ridiculous! Dr. Lois Jovanovic, one of the world’s top specialists on diabetes in pregnancy, advises that women should go as low as it takes to maintain their blood sugar under 90 mg/dl (5 mmol/L) on a daily basis. Jovanovic recently left the Sansum Diabetes Research Center in Santa Barbara, California, as director and chief scientific officer. “Women ask me, ‘Do I have to consume carbohydrates?’ I tell them, ‘No, you don’t!’ It’s that straightforward.”

Natalie Cooper Thompson is a good example of this.

After being diagnosed with GD during her first pregnancy, Natalie, an elementary school teacher in Buford, Georgia, was told to eat carbohydrates at every meal and three snacks a day, getting a daily carbohydrate requirement of at least 175 g — enough to ensure that no ketones were found in her urine.

She ate the foods they recommended — bananas, whole grain bread, fruit, rice, steel cut oats — and checked her blood sugar seven times a day using a home monitor. The numbers were constantly out of whack. She was soon on four insulin injections per day, but her GD remained uncontrolled. She was diagnosed with preeclampsia (high blood pressure and protein in her urine). Her kid was delivered by C-section at 37 weeks and weighed 8 pounds (4 kg). “The diet had no effect on me!”

The ketogenic diet may be found here.

Natalie found ketogenic diet six years later, following failing reproductive treatments for her PCOS, a miscarriage, and a successful adoption. She dropped 40 pounds (18 kilograms) in three months, bringing her weight down to 210 pounds (95 kilograms), which helped her infertility and PCOS problems. She was surprised to find herself pregnant after six years of infertility.


During three separate pregnancies, Thompson Cooper

At 18 weeks into her second pregnancy, she got GD once again. Her physicians and nutritionist both advised her to eat carbohydrates at every meal and three snacks a day, with a daily need of 175 grams. Natalie simply smiled and agreed this time, but she maintained her carbohydrates under 50 grams and used a home meter to check her blood sugar on a regular basis. She did need insulin in the end, but just one shot at night. “It wasn’t perfect, but I was a lot better at controlling my blood sugars. I couldn’t possibly consume the quantity of carbohydrates they suggested. My blood sugars would be much too high if I did.”

Now, age 36, she is happily pregnant again — 24 weeks — with her third pregnancy. She has continued keto eating these past two years, which may have helped resolve her infertility, resulted in a total weight loss of 95 lbs (43 kg) and a healthy pre-pregnancy weight of 155 lbs (70 kg). In June, at 18 weeks, she had a glucose tolerance test again to screen for GD. She drank a sickly sweet drink with 50 g of sugar, and had her blood glucose checked one hour later. This time she passed with flying colours: her blood sugar was 85 mg/dl (4.7 mmol/l). “That is about as perfect as you can get!”

Is it possible that she may get GD later in the pregnancy? She has no idea, but she will do all she can to avoid increasing her carb intake and will check her blood sugar levels on a regular basis. She wants to stay under 50 grams of carbohydrates each day, and ideally under 25 grams. “It amazes me that 175 grams of carbohydrates is still advised for GD! It’s completely insane.”

Is the present guidance scientifically sound?

Dr. Jovanovic and Lily Nichols, a dietician in the United States, both agree. Jovanovic has been consulting in the United States for the last several years, advising endocrinologists and ob/gyn physicians that women may safely reduce carbohydrates to the amount that maintains blood glucose under tight control (see below), even if that means no carbs at all. “Repeat after me: pregnant ladies do not need to consume carbohydrates!” she tells physicians caring for women with GD.


The same suggestion is given by Nichols. She is the author of the 2015 book Real Food for Gestational Diabetes, and she writes at She also provides an online gestational diabetes course.

For the most of her career, Nichols has focused in gestational diabetes, especially with a California GD program called “Sweet Success,” which also advised a daily carb intake of at least 175 grams. “It was always disheartening to see how many of my pregnant clients would end up failing diet treatment and having to go on insulin, as we call it. “I couldn’t understand why someone with gestational diabetes, which translates to carbohydrate intolerance, would need such a high carbohydrate intake,” Nichols said.

After that encounter, Nichols began looking through the historical research literature to figure out why 175 g of carbs per day had become the arbitrary cutoff point for lower-carb GD dietary therapy. “It turns out that this figure is based on a best estimate rather than solid research. There’s no proof that consuming less than 175 grams of carbs is detrimental. The only reason doctors continue to promote a higher-carb diet is because of false ketosis fears.”

As stated in a previous post: Is it healthy to eat a low-carb diet when pregnant? There aren’t many solid scientific research on low-carb ketogenic diet during pregnancy. Ketones in the urine of pregnant women with GD, on the other hand, “freak physicians out,” according to Nichols, since they are concerned about the life-threatening illnesses of diabetic ketoacidosis during pregnancy or starving ketosis. “These are not at all the same as nutritional ketosis,” adds Nichols, whose book includes an entire chapter dedicated to the myths about ketosis in pregnancy. “Put the ketone stix away,” says Dr. Jovanovic. Ketones in the urine have little significance.”


Nutritional ketosis in pregnancy is a natural condition that is acceptable and healthy, according to both women and reproductive specialist Dr. Michael Fox.

Dr. Fox points out that physicians are trained in obstetrics school that ketones in the urine indicate starving ketosis. This is common in individuals with hyperemesis (extreme nausea and vomiting) and in pregnant women who don’t consume enough calories.

Ketones in the urine or blood, according to Dr. Fox, are not an abnormal condition and are anticipated with a ketogenic strategy if pregnant women eat regularly (at least every 3 hours) and consume enough of calories (approximately 2500 calories or more per day).

Ketones in the urine or blood, according to Dr. Fox, are not an abnormal condition and are anticipated with a ketogenic strategy if pregnant women eat regularly (at least every 3 hours) and consume enough of calories (approximately 2500 calories or more per day).

In summary, according to all three specialists, pregnant women with GD may cut carbs and not worry about ketones in their urine as long as their blood sugars stay within normal limits and they consume enough calories from nutrient-dense meals for themselves and their infants. (Note: A combination of high blood sugar and extremely high blood ketones indicates ketoacidosis, which is a medical emergency.) Urine ketones cannot be used to diagnose diabetic ketoacidosis; only blood ketones and blood acidity may be used.)

These experts provided four practical recommendations for reducing the risk of GD for all pregnant women, particularly those at greater risk of GD, such as those with polycystic ovarian syndrome (PCOS), pre-diabetes, obesity, and prior GD in pregnancy, in lengthy interviews for this article.

Tip #1: Test your blood sugar levels early to determine your risk.

Women who have pre-existing insulin resistance or undetected pre-diabetes are significantly more likely to acquire GD during pregnancy. “Many women, even before pregnancy, have undiagnosed blood sugar problems. In addition, the physiology of pregnancy causes all women to become more insulin resistant. Insulin levels are up to three times greater during the tenth week of pregnancy than they were before the pregnancy.”

Prior to pregnancy or early in the first trimester, a HbA1c test — which analyzes the average blood sugar levels over the preceding three months — may assist identify women at risk. Prediabetes is defined as a blood sugar level that is more than 5.7 percent, and many physicians treat it the same way they treat gestational diabetes. The greater the number, the higher your blood sugar is on average. In 98.4 percent of cases, a level of 5.9% or above correctly predicts gestational diabetes.

If readings are greater than 5.6 mmol/l (100 mg/dl), which is indicative of prediabetes, a fasting blood glucose test before to pregnancy or early in the first trimester may also help identify possible issues. Both ladies point out that, depending on your results, you may need to prioritize blood sugar management. “Taking care of it early in the pregnancy may avoid blood sugar problems and subsequent complications,” Nichols added. “Waiting until 24 to 28 weeks to diagnose GD implies the baby may have been exposed to elevated blood glucose for several weeks earlier in the pregnancy,” Jovanovic adds. You want to get on top of things as soon as possible.” Because of fast blood cell turnover and limited iron reserves, HbA1C tests taken later in pregnancy are less accurate.

Tip #2: Use a home glucose monitor to keep track of your blood sugar levels.

Women at greater risk of GD, those who have been diagnosed with GD, and those who want to know how their pregnancy and food are affecting their blood sugar may consider obtaining a home glucose monitor. Fasting blood glucose first thing in the morning and one to two hours after every meal or snack are the times to test. Better yet, get a prescription for a continuous glucose monitor from your doctor (CGM).

The meter is not deceitful. If your blood sugar level is too high, you must take action.

— Lois Jovanovic, Ph.D.

After only two weeks of testing, you’ll be able to see how the things you’re eating are affecting your results and change your diet appropriately. Home monitoring, often known as “feeding to the meter,” is the “proactive way to proceed,” according to Nichols and Jovanovic. “It’s inconvenient, but the meter doesn’t lie. “If your blood sugar is too high, you must take action,” Nichols advises.

Both say that if your blood sugar is normal for a few of weeks, you can maintain eating the way you are. Just keep in mind that if your readings were normal in the first trimester, you should check again in the 24-28 week timeframe since insulin resistance increases as pregnancy progresses. Natalie Thompson Cooper, for example, has opted to self-monitor her blood sugar levels during her pregnancy.

Your local pharmacist can provide you with a variety of glucose monitors. Follow the instructions that came with your specific meter. Before testing, wash your hands with soap and water and thoroughly dry them. Alcohol wipes should not be used since they may affect the outcome. It’s also a good idea not to touch any food before testing, since this may cause the results to rise.

While optimum outcomes are unknown due to the fact that blood sugar levels are on a scale, the common opinion is that you should strive for the following:

  • Fasting blood glucose should be between 90 and 99 mg/dl (5.0 and 5.5 mmol/l); less than 90 mg/dl is ideal.
  • Blood glucose less than 140 mg/dl (7.8 mmol/l) 1 hour after a meal (postprandial); less than 120 mg/dl is ideal.
  • Blood glucose levels should be less than 120 mg/dl (6.7 mmol/l) two hours after eating; returning to baseline is ideal.

Using a notepad or one of the online trackers, keep track of your daily blood glucose levels, the food you ate, and the activity you performed. The SugarStats tracker is very simple to use.

Tip #3 Know your screening and diagnostic choices.

Screening for GD is usually done in the first trimester for individuals who are at high risk (those with a history of GD or PCOS) and at 24-28 weeks for everyone else. The glucose challenge test involves drinking a syrupy sweet drink containing 50 mg of sugar and having blood glucose levels checked an hour later.

Nichols wrote a blog post on how she failed the test by one point during her pregnancy in 2015, reading 141 mg/dl (7.9 mmol/l) instead of the cutoff of 140 mg/dl (7.8 mmol/l). She believes her failure was caused by a low-carbohydrate diet she followed before to the test. Her blood sugar levels were completely normal at home, ruling out the possibility of gestational diabetes.

Because their systems aren’t used to managing so much sugar at once, false positives in the glucose challenge test are frequent, especially among women who follow a low-glycemic, low-carb, or ketogenic diet. Many women find it difficult to consume the sweet beverage, which causes nausea, vomiting, dizziness, and headaches. According to studies, consuming 50 g of sugar in 28 jelly beans or 10 sticks of “Twizzlers,” a popular strawberry-flavored licorice candy in North America, is easier to stomach, has less side effects, and has the same outcomes.



Women who fail the glucose challenge must next undergo a three-hour Oral Glucose Tolerance Test (OGTT) to confirm the diagnosis of GD. This involves consuming twice as much sugar (100 g) and having blood drawn every three hours for the following three hours.

The two-step screening approach for gestational diabetes is obsolete, according to Nichols, since a large proportion of healthy women “fail” the first test, while other women with increased insulin production “pass” it and are never officially diagnosed.

“That is why the International Association of Diabetes and Pregnancy Study Group (IADPSG), the World Health Organization (WHO), and nearly all countries, with the exception of the United States, recommend the more reliable and specific 2-hour, 75 g glucose tolerance test, which is done fasting and has more rigid cut-offs for diagnosis,” she says. However, in other countries, the 75 g fasting test is not yet the norm, and it may lead to more women being diagnosed with GD (possibly because it detects women with “mild” gestational diabetes).

Nichols and Jovanovic note that women can forego the tests if they instead choose to track their blood sugar at home. If you show your doctor the results of your readings, you can usually convince them to forego other tests. “You can always decline the tests. You have that right. But you should be tracking your own sugars,” says Nichols. Jovanovic advises: “Just show them your home blood sugars. That is all that matters.”

Tip #4: Consume a nutrient-dense “whole-food” diet.

Two fried eggs with sliced avocado and cherry tomatoes grace the cover of Nichols’ book, indicating a low-carb, high-fat lunch. She adds, “It’s the ideal breakfast, or any meal, for gestational diabetes.” Her recommendation is to prioritize nutrient-dense meals over empty calories.

“Some low-carb dieters rely only on fat bombs and bulletproof coffee to survive. You should eat a variety of foods and use common sense.” She suggests eating protein-rich foods such as meat, fish, and eggs, as well as snacks such as nuts and seeds, as well as a variety of vegetables cooked in natural fats such as olive oil or butter. To guarantee a healthy natural intake of vitamins, minerals, and antioxidants in your diet, Nichols recommends eating liver once or twice a week.

She also advises avoiding any highly processed meals, added sugar, refined carbohydrates, and high-glycemic fruits and liquids. If your blood sugar levels are still high, avoid any fruit except berries. “To have a good pregnancy, you don’t need to bring in bread and cereals,” Nichols adds. Pay attention to how you’re feeling and keep an eye on your blood sugar levels. “Some pregnant women may feel better eating somewhat more carbohydrates, but I believe the majority of women with GD, and all pregnant women, do better with at least half to one-quarter of the carbohydrates suggested in traditional dietary recommendations (which is upwards of 65 percent of calories from carbohydrates).

Is that message now being picked up by gestational diabetes programs all around the world, and they’re recommending a reduced carb diet? Unfortunately, not yet.

A nutritionist from the NHS advised me to eat bread with every meal and snack on cookies and low-fat ice cream!

Sarah H. –

Sarah H., 37, of Southern England, was diagnosed with GD a month ago, in the 38th week of her third trimester. A nutritional regimen for women with GD was recommended to her. “I was advised by an NHS dietician to eat bread with every meal and nibble on cookies and low-fat ice cream!” She was also told to avoid all saturated fats and to enjoy fruit juice, dried fruit, bananas, crisps, and sponge cake in her diet.

Sarah sent the advise she got to Dr. Andreas Eenfeldt and the Team, asking, “What do you think would happen if I followed their advice?” She thinks she’s been insulin resistant and prediabetic for a long time.

Five years ago, she discovered the low-carb, high-fat diet. She has been eating a more liberal low-carb diet and eating more fruit than usual throughout this, her third pregnancy.

But now that she’s been diagnosed with GD, she’s adhering to a low-carb diet and using a home meter to check her blood glucose on a regular basis, and she’s doing well. “Home surveillance is a fantastic idea. It’s something I like doing. “I can see the effects of the things I consume right away,” the math instructor adds. “I know that if I followed NHS dietary recommendations, my blood sugar would skyrocket.”

Anne Mullens is a writer who lives in the United States.

Dr. Michael D. Fox’s medical opinion

Ketones are pathologic (abnormal) in pregnancy, according to obstetrics training. Ketones in the urine are most frequently associated with starving ketosis. This is common in individuals with hyperemesis (severe nausea and vomiting) and in women who do not consume enough calories during pregnancy.

Most training for OB/GYN’s happens in inner city hospitals, where there is a high prevalence of drug users in pregnancy. This group is notorious for starvation and subsequent complications in the child including early delivery, growth retardation and low birth weight. Doctors fear these complications and are going to react to this positive test.

People with diabetes have been taught to have an excessive fear of diabetic ketoacidosis, which would result in a positive urine dipstick test at the majority of ob visits.

The misunderstanding between nutritional ketosis (ketogenic diet) and diabetic ketoacidosis, a totally distinct and life-threatening pathologic disease, is one of the most significant barriers to teaching physicians and healthcare workers about the ketogenic approach.

Doctors aren’t taught about nutrition in medical school, and they’re certainly not taught about nutritional ketosis. I would never have been able to describe or comprehend nutritional ketosis until I got interested in metabolic medicine. As a result, there is no knowledge gap among obstetricians since they have never been educated in this procedure.

Ketosis is not an unhealthy condition and is anticipated with a ketogenic strategy, I have reassured patients (without type 1 diabetes) as long as they eat regularly (at least every 3 hours) and consume enough of calories (around 2,500 calories or more per day).

“I am following a ketogenic dietary strategy, and ketones are anticipated in the urine,” is one method to educate the medical staff. Unless you think I’m sick, I’m going to stick to my diet.” Then suggest that the doctor pay you a visit.

Dr. Michael D. Fox is a medical doctor.

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Is it healthy to eat a low-carb diet when pregnant?

Trying to conceive? Try the Better Baby Diet of beef, butter & bacon

Beginners should stick to a low carb diet.

A beginner’s keto diet

Gestational diabetes is a special type of diabetes known to affect pregnant women, and is usually diagnosed during the pregnancy itself. While it is a mild form of diabetes, it can still cause a great deal of complications and risks for both the mother and her unborn child. So what should you do to lower the chances of gestational diabetes in your future child? Low carb or keto is the answer to helping your baby and yourself.. Read more about low-carb gestational diabetes meal plan and let us know what you think.

Frequently Asked Questions

Is keto diet good for gestational diabetes?

Ketogenic diets are not recommended for gestational diabetes.

How many carbs should I eat a day with gestational diabetes?

You should eat a diet that is low in carbs, and high in protein.

What kind of carbs are good for gestational diabetes?

Carbs are good for gestational diabetes.

This article broadly covered the following related topics:

  • how many grams of carbs should you eat with gestational diabetes?
  • gestational diabetes not eating enough carbs
  • low carb diet before glucose tolerance test
  • low carb diet for gestational diabetes
  • is keto a good diet for gestational diabetes
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