T falls to dietician Sara McKittrick to set a healthy eating plan for women diagnosed with gestational diabetes.

She regulates their foods for healthy eating, dividing a pre-determined amount of carbohydrates and calories between several small meals each day.

"Most of them can be controlled by monitoring the amount of food that they eat at any one time," Mrs. McKittrick said. "Most of the women are already having snacks but if they're not, you're trying to split the carbohydrate load of one meal between four to six smaller meals.

"What you don't want is to have a particularly high rise in their blood sugars after one particular meal. Instead of having them eat a bowl of cereal and two slices of toast in the morning, I'd rather they just had their cereal and then had a slice of toast as their snack.

"You try and get them to consume a healthy diet for pregnancy and sufficient calories for pregnancy, but you spread it out over small meals."

The dietician said she also emphasises healthy choices ? whole grains and fibres instead of foods which will send their blood sugars rocketing.

"Refined carbohydrates, white bread and white flour, tend to send their blood sugars really high. So where they can, they should make carbohydrate choices such as bran flakes or oatmeal. They should have whole grains or multi-grain bread as all of their starches."

Of the women she is assisting at the moment, less than half have conditions so serious that they require doses of insulin.

"I'm following eight to ten women at the moment ? it's a high number for us ? and maybe only two or three of them are on insulin," she explained. "Generally, we experience rises and falls. We might see two to three women one month and eight to ten the next."

Her task remains the same in spite of the fluctuation in numbers. According to Mrs. McKittrick, her charge is to regulate portion sizes so that both the baby and its mother achieve a healthy, balanced diet.

"I make dietary adjustments with them based on their blood sugars several times each week. Usually, I'll consider their blood sugars after supper and if they're a little high, I'll take down the portion size.

"But because we want to make sure they're having sufficient calories and not producing ketones overnight, we increase the snack somewhere along the line. If we have to take down the amount they're eating at a meal, we have to manipulate one of their snacks during the day."

Determined that their babies are born healthy, most mothers are anxious to co-operate, she added.

"I think the nice thing for them is knowing that whatever they do is for a healthy outcome of pregnancy and most of them are quite motivated to do it. It helps that they know there's a short term to it too. They're thinking, 'I'll have that treat after I've delivered the baby'.

"They're all very hesitant at the start about learning to prick themselves to test their blood sugars but they soon become motivated. As I tell them, it's the only way they have of knowing if what they discussed with me is working."

Where a client log comes back with unusually high blood sugars, the dietician will examine their food intake for that week in order to determine the cause of the spike.

"If they have an explanation for a high ? say it was their baby shower that day and they had a piece of cake ? then we can say, 'Okay, next week we can do better than that'.

"But it's when I can't explain it that I become concerned. That's when we discuss it with Debbie (Jones of the Bermuda Diabetes Centre) and their doctor and probably start them on insulin.

"For the most part they're motivated. With gestational diabetes I encourage them not to have sweet drinks of any kind. Juice tends to cause an immediate rise in their blood sugars.

"Another person with diabetes not in pregnancy might be able to work four ounces of juice into their diet somewhere. Some pregnant women have a hard time with that. Prior to that test at 28 weeks they've been drinking cranberry juice or fruit juices and they can't understand why it's not healthy."

She added that everyone diagnosed with gestational diabetes isn't unhealthy, that some simply need their diets to be adjusted for pregnancy.

"I've got a young fit mum at the moment. She was drinking an awful lot of fruit juice and eating a lot of fruit prior to the test. Her husband used to prepare her a lovely fruit platter every morning and thought he was doing the best thing for her.

"I had to let him know that she was better off with a slice of whole wheat toast and peanut butter, and a portion of fruit later ? so it's just about manipulating the diet. Her blood sugars have been perfect ever since we did that."

Far worse is an attitude taken by some pregnant women, that they have to double their food intake to satisfy the baby growing inside them.

"If you go into a pregnancy deciding you're going to eat healthy, and not eat for two as some people jokingly say, if from the outcome of pregnancy you decide to make healthy choices, you put yourself at lower risk for gestational diabetes.

"I saw a mum who gained between 40 and 50 pounds in her pregnancy and that's obviously going to be a tremendous strain.

"On the other hand, there are a lot of mums who have eaten healthy but they may have a family history of diabetes and so gestational diabetes is probably something they could not have avoided."