Posted on May 20th, 2021by RMANY

Ep 62: Gestational Diabetes Mellitus or GDM with Casey Seiden

Fertility Forward Episode 62:

The importance of balanced blood sugar levels on both fertility and pregnancy is often overlooked. For this reason, today on Fertility Forward, we discuss blood sugar regulation, gestational diabetes mellitus (or GDM), and polycystic ovarian syndrome (or PCOS) with regard to pregnancy and fertility. We are joined by an expert in this field, Casey Seiden, who is a Registered Dietitian and Certified Diabetes Educator at the Maternal-Fetal Medicine Associates in Manhattan. She helps women optimize nutrition during preconception, pregnancy, and postpartum, and also manages the Gestational Diabetes Program that receives referrals from doctors across New York City. She is also the owner of Casey Seiden Nutrition, a private practice that specializes in women's health and diabetes, as well as the author of the cookbook Meal Prep for Two. Casey discusses the impact of unbalanced blood sugar on our hormones and efforts to get pregnant. She explains what gestational diabetes is, what risk factors may make you more prone to it, what you should be aware of before getting pregnant, and the long-term risks of this for both mom and baby. Whether you are pregnant or not, learn some tips to help you balance your own blood sugar, find out why avoiding carbohydrates is not the answer, and hear why it’s okay to indulge in a nice dessert from time to time. For all this and more, tune in today!

Transcript of Episode 62

Rena: Hi everyone. We are Rena and Dara, and welcome to Fertility Forward. We are part of the wellness team at RMA of New York, a fertility clinic affiliated with Mount Sinai Hospital in New York City. Our fertility forward podcast brings together advice for medical professionals, mental health specialists, wellness experts, and patients, because knowledge is power and you are your own best advocate.
Dara: I am thrilled today to have a wonderful discussion on blood sugar regulation, which is so important during pregnancy and also for fertility. And today we have Casey Seiden who is the dietician and diabetes educator at Maternal Fetal Medicine associates in Manhattan. She helps women optimize their nutrition during preconception, pregnancy, and postpartum, and also manages the gestational diabetes program that receives referrals from doctors across New York City. She's also the owner of Casey Seiden Nutrition, a private practice that specializes in women's health and diabetes, and authored a cookbook, Meal Prep for Two. Casey received her Master's degree and completed her dietetic internship at Teacher's College Columbia University. She currently lives in Manhattan with her husband and our younger daughter, Maddie. Casey, I'm thrilled to have you on today.
Casey Seiden: Same here. Thanks so much for this opportunity.
Dara: Oh, of course. We were just discussing beforehand that we had meant to meet a couple of years back at a nutrition conference. We have a mutual friend, Amanda, who's also in the nutrition world, but it's so crazy that we ended up meeting today!
Casey Seiden: Well, it's finally nice that we could look forward to meeting in person again one day soon, which is really, really exciting.
Dara: I know. I mean, I've been following your Instagram, it's eat.well.together, correct?
Casey Seiden: Yep.
Dara: I've been following it for quite some time now and I'm super impressed with what you're putting out there and how you're educating the masses. It's fabulous.
Casey Seiden: Thank you. Yeah. And I feel like gestational diabetes is one of those things that is a scary place on the internet so I really aim with my account to provide that safe and comforting space for women.
Dara: Oh, you definitely do. You, you make it approachable and realistic, not too restrictive, which is really nice. But what instigated you to go into this specific field? Is it something that you've grown up with in your family or something personal?
Casey Seiden: It's not actually, yeah. Going into nutrition, period, wasn't really related to any kind of personal health issue that I had. I’ve always just been interested in food. I loved cooking, that maybe, was more of my family background. We were always cooking together, grandmas, aunts, my mom. So came at it from a culinary love. And then my first job out of undergraduate degree was working at farmer's markets here in the City. And I loved it so much, but realized even in the food world of nutrition, becoming a dietician and getting jobs in the future would be helpful. So that's what prompted me to go back to school for my masters and do the dietetic internship. And that's really where I fell in love, kind of with the diabetes side of clinical nutrition. So, worked in that in lower income communities after my internship and then the opportunity presented itself back in the fall of 2019 to transition over to maternal fetal medicine. They had a dietician at the time and I jumped at the opportunity to work a little bit closer to home and just really dig into this new population that, well, I am, I'm lying actually. It was a little personal because at that time that I accepted the job, my husband and I had been thinking about getting pregnant and had been going through a journey of our own. So it did kind of align in that sense, not the diabetes, but certainly more the women's health issue and prenatal nutrition. So yeah, I really do love it. These women are amazing that I get to help every day.
Dara: How nice is that? We're women, but I think it's, it's definitely an area that is always in need, but specifically for diabetes, I feel like that's a topic that we haven't really discussed much on our podcast yet, but it's interesting because it's something that I personally discuss with all of my patients, the importance of blood sugar control. But let's kind of delve a little bit deeper. Why is it so important to focus on blood sugar control for overall health, but specifically if you want to get pregnant?
Casey Seiden: Yeah, that's a really good question. I like how you're framing it more as like blood sugar regulation, because you know, diabetes is maybe a condition that you get diagnosed with, but we all, as a general population, could benefit from balanced blood sugars because really when our blood sugars are kind of doing these big dramatic dips throughout the day, right? Going from super high to then super low, it's impacting our stress response, it's impacting appetite and hunger hormones, inflammation, all sorts of things. And from the fertility side, you know, this is where I kind of think of the link between blood sugars and polycystic ovarian syndrome with PCOS, right, which at the end of the day, that is driven by insulin resistance. And so when we have crazy blood sugars and this insulin resistance, we're not ovulating and so it makes it tougher to get pregnant. So that's really the crux of the issue and it's coming to wanting to get pregnant.
Dara: It's amazing. I love how you said that also. I really do feel like no matter where people are on their journey to motherhood or even just for overall health, blood sugar control is important, but even more important, specifically, if you have diabetes, if you have polycystic ovarian syndrome, it's that much more important. So benefit, you know, could benefit anyone, but specifically if you have PCOS or diabetes. Aand I, like, I often use the analogy of like that sugar mountain of we want to prevent that really steep blood sugar mountain because as fast as it rises, it can fall and that can perpetuate that cycle of the cravings.
Casey Seiden: Exactly. 100%. Yeah. We want to try to keep it more in that like gentle wave in the middle.
Dara: But I think, yeah, the biggest misconception when people think about blood sugar control is that they have to avoid carbohydrates.
Casey Seiden: Yes.
Dara: And I know we we’re very much aligned on how that's crazy, that's preposterous and that's, you know, it goes to something that's very restrictive, but it's more focused on the quality that we're going for.
Casey Seiden: Exactly. Yeah. I'll meet with someone for the first time. They had just gotten a diagnosis of diabetes or gestational diabetes and all of a sudden they've just adopted the most restricted keto style diet. And there's not a carb in sight and they're pretty miserable. So you're right. It does come down to, okay, what’s the quality of the carbs? We want to be choosing these really complex high fiber carbohydrates that are slow to digest and then watching maybe, you know, depending on the person, the portion sizes of things cause that can really influence how quickly or how dramatically we're going to see that, that mountain effect.
Dara: Exactly the quality and the quantity for sure is important. I kind of wish that everyone who was considering having a baby, having that background knowledge because I feel like that's something that's not widely known and especially, I'm happy that we're kind of coming out of the anti carb craze into a much more intuitive eating, hopefully philosophy or approach to eating that people kind of have that background knowledge of it's important to have carbs, but it's important to have the to more often go for great quality, complex carbs and to go for the right quantity.
Casey Seiden: And the other important thing I think is not forgetting about carbs plus those other nutrients. Everyone thinks and it's true, how great is fruit? Fruit has so many benefits, so many vitamins and minerals it's really high fiber. So why would you think that having, you know, an apple on its own could be a bad thing? And it's not, it's not good or bad, right? But we could really optimize your blood sugar response if we had that apple with some almonds or with some peanut butter. Adding that fat and protein, boom! We just balanced your blood sugars so much better than had we had that Apple alone.
Dara: That was my snack today, by the way, I was like, I've haven’t fruit in a while, but I actually have PCOS so it's something that is definitely on my mind. But even really with PCOS or with diabetes, I think it's so it's so important across the board for people. People wonder why they're hungry an hour after eating a piece of fruit, which they think is healthy and there's fiber in it.But just that little tweak of adding in a protein, adding in a healthy fat can really sustain someone that much longer and not elevate their blood sugar levels too quickly.
Casey Seiden: Yeah, no, I, 100% agree. It's so important to find that right balance and that pairing.
Dara: We do see gestational diabetes much more frequently in women who have PCOS. Are there any other risk factors that you're aware of that could be somewhat linked to gestational diabetes?
Casey Seiden: Yeah. There are other risk factors cause a lot of women, when I meet with them, they do want to point the finger at the diet. That it was something that they ate that caused this. They had nausea in the first trimester and all the carbs just led them to this. Truthfully it is more of these other risk factors. So PCOS is a big one. Family history of diabetes or PCOS or if your mom had gestational diabetes or you were a larger baby potentially might mean you're more at risk. Age also. I mean the guidelines say anyone over age 25 and most of the women I'm dealing with are over 25 years old. But I typically see, yeah, that 30 to 35 year old range being at a higher risk or older. Race and ethnicity also, you know, people from a more Hispanic, African-American or a South Asian background might develop it over other groups. And again, those are things out of our hands, right? They’re non-modifiable risk factors, but it's just good to know that if you fall into one of those groups, this might be something that should be on your radar as you go into pregnancy.
Dara: I think that's the key thing is being aware of it going into a pregnancy because a lot of times once they already have gestational diabetes, Oh my goodness, what do I do? And I think, I think it should be a conversation if you potentially have any of those risk factors, whether it's the OBGYN or an endocrinologist, reproductive endocrinologist to have that discussion and say, it may be a good idea to meet with a dietician or someone who can give you some more information.
Casey Seiden: and to get some baseline knowledge of where you stand. Get some labs done. Let's check a hemoglobin A1C as you're going through your fertility journey or even early in that first trimester if we didn't do it before conception.yYou know, just that information alone is going to help us guide us, like, okay, do I need to start making some changes now? Or can I kind of continue and see what happens later on?
Dara: It's good throughout the process to kind of get the lab work, see where your levels are and depending where they are to have a customized plan for that person, for sure. The risk factors can be, you know, the age, if you're going into a pregnancy overweight or obese, genetic components for sure. But there's a lot of also risks for the woman and the baby long-term when it comes to gestational diabetes, right?
Casey Seiden: We always talk about those immediate concerns of, you know, related to birth, having a larger baby, but we are in utero kind of doing a little bit of fetal programming and mom's body is adapting during the pregnancy, too. So if blood sugars are not really well maintained during the pregnancy and the data is so, it's a humongous amount of research out there, and there's not a clear cut answer, but you know, we're seeing in the research that anywhere from maybe five to upwards of even 20 to 30 years down the road, children and moms are developing diabetes. And that's one big reason why it's a good idea. Let's, let's get this blood sugar under control in pregnancy so that we could decrease both of your risks of having, you know, lifetime blood sugar issues.
Dara: Exactly. I think, yeah. The idea of figuring it out now, as opposed to waiting for the possibility of getting diabetes, whether it's yourself or your little one. Figuring it out when you're diagnosed with that, or even if you are known to be at high risk for that. It's really interesting. I actually, it's really upsetting, but I'm not sure if you saw this last week, there was a, a research article that came out. I want to read a little bit about it. It was presented at the American College of Obstetricians and Gynecologists annual meeting and they found that among women who qualified for early screening for gestational diabetes, that only 12% actually received the screening, which is wild. And this is interesting. I had my eldest 11 years ago. I don't remember. I'm sure they had early screening, but the early screening I believe is what, 24 to 28 weeks?
Casey Seiden: Early is usually closer to like 12 to 14 weeks.
Dara: Even earlier?
Casey Seiden: Yeah. For certain like high risk populations. Yeah.
Dara: But that's wild that a lot of these people weren't getting screened earlier that were at higher risk. And then the interesting thing is almost one fifth of the women who were qualified, but didn't undergo early gestational diabetes screening were eventually diagnosed with gestational diabetes later on in their pregnancy. So I mean, I think that should be a discussion early on if someone is at high risk, perhaps if they have PCOS, it would be a good idea for that early screening, which I think that's important.
Casey Seiden: Yeah. I agree. And I, again, I didn't, I'm not in those people's head. Like, why didn't you go for the early screening? I kind of get it. That glucose drink is like not a fun thing to go through. And if you are told like, yeah, we're going to do this twice in your pregnancy. Like, maybe you might skip it the first time if you had a previous bad experience you vomited while you took it or something, you don't want to do it again. So potentially that earlier screening, maybe there's options we can talk about with your OB whether it's the glucose test or it's an A1C or it's at home monitoring or something, but definitely getting some kind of look in the first trimester or early second trimester would be so beneficial.
Dara: I'm with you with the drink test. I wish I was business savvy enough to create an alternative to the drink that they do give you.
Casey Seiden: There's one out there a company had reached out to me. I have no idea. I can't remember what the name of it was, but it was like a very more clean label type of a drink. Yeah. I know.
Dara: Without the red dye. Without the red dye 40 in it.
Casey Seiden: Yeah. I got the clear one. I did like the lemon lime clear one. I honestly don't think it was that bad, but...
Dara: My first one, I got the orange and with my second daughter, they had a clear one and did have the lemon lime one, but there's definitely aways to go to make it a little bit more enjoyable than what's on the market now. So we kind of briefly spoke about the importance of blood sugar regulation in terms of not only looking at the quality and the quantity of the carbohydrates, which maybe we can delve a little bit deeper into that, but also the importance of, I think we should even discuss maybe a little bit of the importance of what the timing of the day, because a lot of people come to me and they say, I'm just hungry. I'm craving carbs throughout the whole day. And usually I ask what's the first thing they eat in the morning and people aren't aware of that, you know, what you eat in the morning can really play a role with your, your regulation later on.
Casey Seiden: Absolutely. So, I mean, let's talk about the timing first because the hormone insulin that helps to lower blood glucose levels, it is working in line with our circadian rhythms. So, you know, it's that light and dark cycle outside. So insulin kind of starts off really quiet in the morning. We have higher levels of cortisol, kind of this wake up hormone, which cortisol increases blood sugars in the morning. And so it's kind of a mismatch, right? Our blood sugars are going up, but we don't have a lot of circulating insulin. And then in pregnancy, you put on top of it, the placental hormones, it's just a mess in the morning. It's a lot going on. So, you know, if we were to start the day with a breakfast of just like oatmeal or some kind of big plate of toast and fruit, which is all objectively healthy foods, right? Then it's really going to be tough on our blood sugars for the entire day. I think eating breakfast is important, right? There's studies that show that people that skip breakfast actually have a tougher time controlling their blood sugars all day long. So we want to eat it, but focusing on more like a protein fat focused breakfast, maybe with a side of carbs, it's just not the main player in the meal.
**Dara:* Yeah. An accessory to your meal, as opposed to the main focus.
Casey Seiden: Exactly. Yeah. Rather than those two slices of toast, maybe let's do one slice of like a nice sprouted toast or a whole grain bread with, you know, two eggs or getting that good choline. We're getting those nice healthy fats and protein and some avocado, right? Like that would be a great blood sugar balanced breakfast.
Dara: Exactly. And I think it's interesting cause most people focus on, okay, I know late night eating may not be great for my blood sugar control and it makes, I mean, even one makes sense for a lot of people because you're slowing down, you're less active throughout the day. You're trying to wind down before you go to bed. But the morning, most people are less aware of they, you know, I think a lot of people think I need to get my carbs in the morning, so I'll burn it off the rest of the day. But I love how you said it's important to have that protein and healthy fats to help sustain you because you're already often going in with a higher blood sugar into your first meal of the day.
Casey Seiden: Right. Yeah. And it could still be a dense meal. It could still be a very calorie dense meal, but just coming from more protein and fat. And I think that's optimal too. Kind of starting the day with a nice, more dense protein fat focused meal. You move through the day with lunch, you know, let's bring in a bit more carbs at lunch or for that afternoon snack. Again, we have more circulating insulin in the middle of the day, you know, when the sun is out so we could capitalize on that middle of the day to have our quinoa with our salad or have a chickpea pasta for lunch or fruit for your afternoon snack. And then potentially like you were just saying for dinner, when we're winding down for the day, the sun's going down, our insulin's going down dinner might be something, just a nice piece of grilled salmon with a really big side of some roasted veggies or something.
Dara: And I think it also depends on when people are having dinner. I mean, we both live in New York. The trend is kind of going back now. People are starting to, to eat outside a little bit more and not necessarily in their home, but a lot of people who eat late at night and then they go right to bed. The idea of minimizing your carbohydrates if you do eat late. And you know, if you are someone who eats a little bit earlier and there's a buffer time, or maybe you typically work out after your dinner, there's maybe a little bit more wiggle room if you wanted to add in some sort of complex carbohydrate.
Casey Seiden: Yeah. And there's somewhat of a fine balance there too, because sometimes if we're having dinner too early, right?? For habit, we do want to avoid like a large dump of carbohydrates too late in the evening especially if we're just going to go to sleep. But on the flip side, if we have an early dinner, like six, with carbs, but then we're not eating anything for the rest of the day and we're waking up in the morning at seven, eight getting our breakfast...that is a long time for the body to be going without any fuel coming in. So, you know, it's super common. You'll Google online and all the GDM forums, everyone talks about a bedtime snack. So that can be a helpful strategy for stabilizing those blood sugars and those hormones over night is a tiny bit of carb potentially with some protein or fat, you know, before you hit head to bed, just something super light can help overnight stabilize those glucose levels.
Dara: So what would be an ideal snack to go for at night?
Casey Seiden: Yeah. So some people will do like a little half a cup of Greek yogurt with some blueberries or blackberries on top. Or they'll do maybe like a rice cake with cheese or rice cake with like some mashed avocado on it or something like that. So, and everyone is different. Some people really can't tolerate the carbs then, and they'll stick with cheese and almonds and that's just enough to prevent them from waking up in the middle of the night hungry and keeps their fasting blood sugars nice and low and controlled.
Dara: And that's great. I think I like what you said, the idea that if customizing it. Everyone has different likes and dislikes. Everyone's sugars are different. And if you are someone who does check, it can actually give you a great idea of what your typical routine looks like and where you may be more sensitive and sometimes it can be quite surprising. Certain foods that you would think may raise your blood sugars may not raise your specific blood sugars.
Casey Seiden: Yes. Not a one size fits all. So it's a lot of, you know, back and forth trial and error with the women that I work with to see really what their body can tolerate.
Dara: I just, I love your approach that it's, it is customizable and it does have a healthy way of looking at things that's not restrictive. You posted something for Easter of like, you know, an egg and a Cadbury egg and how you've crossed off bad on the Cadbury egg and they're both good. And I think that's just a great message for our listeners because I hate the term bad food. What does that mean? Everything can have a purpose in your day-to-day routine and it's not a matter of you pass something to be restrictive the next day to counterbalance that. It's realizing that we're humans and sometimes we're going to go for the horrible deaths and those are going to go for the chocolate and that's OK.
Casey Seiden: Yeah. It's really, when we start to place that moral value on the food that doesn't do us any good. Women are already feeling guilty and shameful enough about getting this diagnosis so we don't need to talk about food in that way. And you know, if your blood sugars are really well controlled, I am not super concerned about a slightly elevated reading from having a dessert one night or a pizza night with your husband or your kids or something. If it goes a little bit over and everything else looks beautiful, I promise you that your baby is probably doing okay.
Dara: Listen guys. It's okay if here and there you have something that you know, is not something that you probably would have. It's for me, it's more of the long-term habits that we need to look at. Supplements. So supplements is not something that I typically recommend. It's not necessarily within my wheelhouse, but you're definitely much more knowledgeable in terms of gestational diabetes. Are there any supplements that you see on the market that you like that you recommend? I'm assuming it's customized depending on who you meet with?
Casey Seiden: Yeah. And I think supplement is such an interesting word. When you, when you Google diabetes and supplements, like the crazy things that come up and they're not to knock anyone in more of like an integrative or holistic approach to medicine or nutrition, but some of the things that the gummies for apple cider vinegar and things like that, like, we don't have a ton of data on that yet. We're getting some, but those I'm a little bit more wary of, but other nutrients such as vitamin D or chromium, like these are actual, like, vitamins and minerals that we know and are seeing more studies can be helpful for insulin sense, you know, sensitizing effect. They're helping to lower glucose. So most of my patients are already taking a prenatal vitamin. So I'm kind of working with each of them individually, seeing what prenatal vitamin they're on. Okay. What level of vitamin D or chromium does it have in it? Can we boost it? Maybe you might benefit from a bit more. Someone with a history of PCOS, you know, a supplement that can be helpful for blood sugars for them is something called inositol. So that can be really helpful. This Myo-Inositol, if you're taking it prior to your pregnancy, or even in your first trimester, I believe check with your doctor, but I believe it is safe to continue taking through your pregnancy. That can really help it almost acts like a natural Metformin, which is that very common diabetes drug to manage blood sugars.
Dara: Yeah, you can have it. I mean, I've taken it before in a powdered form that you just pour into your into some water or, you know, if you're having coconut water here and there, and it doesn't have such a funky taste.But I feel like there is some promising research out there on Myo-Inositol.
Casey Seiden: It's really up and coming. So it's something to keep an eye on. Again, talk with your doctor, get connected with the dietician. Who knows what doses people are putting out there on the market. But yeah, those are, those are the big ones. And the other things I think you read are like things like cinnamon pills for blood sugar. Add some cinnamon to your food. I feel like I'm like you I'm like a very food focused person first before you run out and buy all the crazy pills like let's, let's at least make sure your diet quality is full of those blood sugar, supporting nutrients, too.
Dara: And it's so easy to get cinnamon, to put cinnamon on, on anything, your yogurt, your cottage cheese, your oatmeal. You know, if you're drinking coffee, that could be another avenue. I'm happy to see that we're, we're aligned on that, that I feel vitamin D we're seeing the benefits of vitamin D for so many different health conditions and especially because we live on the East coast, I think all of us are vitamin D deficient in the winter time. And especially this past year where we've had less time outdoors and vitamin D you know, the, the easiest way to get vitamin D is through sunlight and it is much more challenging to get in food. So that is why supplementing if it's not already in your prenatal vitamin or perhaps if you've tested your vitamin D levels and are low, perhaps supplementing depending on what your doctor recommends, but, you know, typically anywhere from 1000 to 4,000 IUs or higher, potentially if a doctor recommends that.
Casey Seiden: Yeah, that's super consistent with what I've seen too.
Dara: But it's great. Yeah. Prenatal vitamin is, is wonderful, but food, what you eat really, I think plays the most important role. And also we didn't really discuss exercise because exercise can also be helpful for blood sugar stabilization and PCOS, diabetes, gestational diabetes,
Casey Seiden: Right Whatever type of movement we can incorporate into our daily routine, increasing that muscle mass and when we have more muscle mass, your muscles can just, they act like big sugar sponges. They can just very easily soak up that extra glucose without the help of insulin. So I think anytime of day that we can get walking and do an at home pilates or prenatal yoga class type thing, or hopping on the spin bike is really helpful. A lot of patients will look to do it after a meal, which makes sense, right? If we're eating food and we want that, you know, blood sugar spike or rise to dramatically come down. So if you kind of go for a walk after your lunch or after dinner, those are excellent strategies too,
Dara: For sure. And I mean, especially now that we're coming into the summer months, soon, it's much easier, but like even in the winter time, if you are on the East Coast or somewhere where it's cold, bundle up. Put on a good podcast for a book on tape and if you're in an apartment building, take the stairs, there's always something. That's what I do with my kids after dinner is we'll go check our mail after dinner and we'll walk down the stairs. So it's something, my kids don't even realize that it's, it's a great after a meal, but...
Casey Seiden: We grew up with family walks after dinner. That was just like our thing. And my husband and I would do that prior to baby. I mean, baby goes to sleep so early now we can't go do our walk, but it feels weird to not have that habit anymore.
Dara: Oh, for sure. Yeah. And walking is great. I'm, I'm happy that you're saying lighter work cuts. I think a big misconception is that to manage blood sugars, that you often have to do something very high intensity, high impact. And, you know, I think it should be different for everyone. Some people prefer more of the high intensity workouts, but you don't necessarily have to be doing that to help stabilize your sugars.
Casey Seiden: Yeah. And I think that brings up a good link again, to the PCOS issue, right? Like sometimes people are doing those HIIT workouts, they're killing themselves. And what is that doing? It's just driving their cortisol, their stress response up, which we said increases your blood sugar. So we don't need that happening! Find that gentle, joyful movement that works for you and doesn't increase more stress and inflammation in your body.
Dara: It's interesting. I see a lot of that with my patients that are, that have PCOS. And I think that the hard part is they look towards the exercise more so than the food to help balance things out. And they figure if I do something more intense, I'll burn more calories that will help me lose the weight. But it's interesting when I, when I work with my patients to make it more like a Pilates, yoga walking type of workout or a lower intensity lighter weights, that's often the sweet spot along with blood sugar control through what you're eating. I really feel like that can be the pivotal change that people can see the, the success and some of those symptoms, those PCOS symptoms from at least not being as present.
Casey Seiden: 100% agree.
Dara: I know you had mentioned, so I did look it up, but you're so ahead, Casey. She saw this very interesting research paper that I think he meant in 2013, that patients that do undergo assisted reproductive technology have an increased chance of gestational diabetes. And I think you mentioned it, which is great. The reason could be possibly because of age. So people who are, are undergoing these treatments are often above the 25 year old that you mentioned is the typical age that can lower your chances of gestational. But also if women are having multiples that can also put them at a higher risk.
Casey Seiden: Yeah.Very true. And this was something, yeah. I was interested to hear from your perspective too. And I, yeah, age was something I was thinking, you know, again, women with PCOS, if they maybe weren't working with a dietician to address their symptoms and decrease that insulin resistance to hopefully potentially ovulate and get pregnant naturally, they just said, Oh, it's not working. I'm going to go the IVF, the IUI route. They had underlying PCOS the whole time and so that's why they were at risk of the GDM. So it's not necessarily that the technology of IUI or IVF cause you to get GDM. It's one of those other risk factors, which I just find so interesting.
Dara: That's exactly it. So it's not the actual fertility treatment. It's the women who are getting the treatment may have PCOS that's not being controlled through what they're eating or their day-to-day routine. Also people who are overweight or obese, which sometimes we do see, you know, a high propensity for people who are obese, who are getting fertility treatment. So another reason why talking with a dietician, meeting with a dietician, having that discussion when you are planning to start a family, to make sure that you are doing everything that you can to help maximize your chances of being healthy and having a healthy pregnancy and a healthy baby.
Casey Seiden: Yeah. There's really a lot to be said for, you know, being proactive in all of this.
Dara: Yeah. And being your best advocate. You're, you know, I think even with that other study that show that a lot of these women who were at high risk, weren't getting screened earlier. You need to speak up. If you feel, you know, you are at higher risk, it doesn't hurt to ask to be screened earlier.
Casey Seiden: Yeah. And that's why I'm so glad to have this opportunity to speak with you. I'm glad that positions like ours at an OBs office, at a reproductive fertility office exist because nutrition, so many people would think, well, what does nutrition have to do with, with getting pregnant or, you know, aside from taking a prenatal, what else do I need to focus on in my pregnancy? So much! So, you know, having these conversations with, with doctors, with patients getting the news out about this, I think, you know, maybe we'll start to see an evolution in this and decrease the prevalence of some of these things.
Dara: I really hope so. And I I'm all for banding together. I wish there was more dieticians in our field that really do specialize in this because I feel like there really is a need for this discussion early on. It's great to be proactive and to really help set women up right at every stage before pregnancy, during pregnancy postpartum, even later on when it comes to menopause. I think it's great to just check in. And I think I wish there was more education out there that was more widely available for women.
Casey Seiden: Yeah. Well, and for us dieticians too, I mean, let's be real, you didn't learn half this stuff in school. So, you know, we need to create some more education for us practitioners.
Dara: Oh, definitely. A great place to start for people who are looking to get more information. I love your Instagram so remind everyone your handle?
Casey Seiden: Yeah. I’m @eat.well.together.
Dara: And what's the best place to reach you? Would it be via email? Would it be on your, on a website?
Casey Seiden: On my Instagram there's a, there's a link there in the bio that you can check out some of the offerings that I have. It'll lead you to my website, but we can throw it in the show notes. My website is So you can always reach out there if you want to chat about anything else and learn more about how, how we can help support you.
Dara: I love that. So how we usually end our podcast is discussing gratitude. So Casey, what are you grateful for today?
Casey Seiden: Such a good one. I am grateful for flexibility in my life right now. Lots of different things have given me the opportunity to just be a bit more mobile, whether that's at work or in my personal life, my living situation. And I think that's just going to be, set us up for a good few months. I am grateful for just flexibility overall.
Dara: That's a good one. That's a really great one. I am grateful that we have been able to connect and you know, unfortunately not in person, but still virtually and really to meet someone who has a similar viewpoint. Someone, I can tell you're very passionate at what you do. You've dove deep into all the research and, and really making it approachable for everyone, not just other dieticians or other people in this field, but for the lay person. And really, I look forward to going to your Instagram all the time and, and seeing all your pictures and I'm constantly learning. So just not just flexibility, but also just learning about all different topics and sharing that knowledge with our listeners.
Casey Seiden: I've been listening to your guys' podcast all week when I go to pick up my daughter from daycare. So I've learned so much and a lot of your recent episodes, so I appreciate you as well.
Dara: Thank you so much, Casey. Thanks for being here. And we would love to have you back on, especially when there's more research down the road, which I know there'll be more research on this topic. We would love to, to get your insight then.
Casey Seiden: Yeah. Just say the word on there.
Dara:** Thank you so much for listening today and always remember: practice gratitude, give a little love to someone else and yourself. And remember, you are not alone. Find us on Instagram at fertility_forward. And if you're looking for more support, visit us at and tune in next week for more Fertility Forward.

The First Step Towards Your Future

Every journey begins with a first step. Attend a free seminar, speak with
a patient concierge, or schedule a consultation.

Get Started

Stay Connected

Jun 22nd - Virtual Egg Freezing 101 Seminar. Jun 22nd - Virtual Egg Freezing 101 Semin…. Learn More