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So You Have Gestational Diabetes—Now What?

By Carol Caffin
Reviewed by Alyssa Quimby, M.D.
November 18, 2022

Receiving a diagnosis of gestational diabetes can be stressful and disappointing. As if you didn’t have enough to worry about! But while it’s true that the condition can have serious complications if left untreated, there’s plenty you can do to keep you and your baby healthy.

Gestational diabetes (GD) is diabetes that develops for the first time in pregnancy. It affects an estimated 2% to 5% of pregnant people (or up to 9% of those with risk factors) in the United States. With GD, a person’s body doesn’t make enough insulin (a hormone that regulates metabolism of carbohydrates), and the result is high blood sugar (glucose).

Properly managed GD usually resolves on its own once the baby is born, but as many as 60% of people with GD may, at some point in their lives, progress to Type 2 diabetes, which is a lifelong condition. Here’s what you need to know about GD—and how to have the healthiest possible pregnancy even with this diagnosis.

Who Is at Risk for Gestational Diabetes?

The exact cause of gestational diabetes is unknown, but it causes insulin resistance similar to that of Type 2 diabetes, says Janice Henderson, M.D., a board-certified ob-gyn and assistant professor of gynecology and obstetrics at the Johns Hopkins University School of Medicine.

“The placenta produces many hormones that can lead to increased insulin resistance—that is, they interfere with insulin’s ability to carry glucose into the cells,” Henderson explains. “When the pancreas can’t produce enough insulin to overcome this resistance, blood glucose becomes elevated.”

Gestational Diabetes Risk Factors

Anyone can develop diabetes during pregnancy, but there are some known risk factors for GD, including:

  • Obesity or being overweight prior to pregnancy
  • Age—being age 35 or older (with a particular increase at age 40 or older)
  • Sedentary lifestyle
  • Smoking (quitting either before or during pregnancy will decrease your risk)
  • Personal history of gestational diabetes or prediabetes
  • Family history of diabetes (most significantly if it’s in a first-degree relative, like a parent or sibling)
  • Polycystic ovary syndrome (PCOS)
  • Previously delivering a baby weighing more than 9 pounds
  • Race or ethnicity (Black, Hispanic, Asian American, and Native American people are at greater risk of GD)

When Do You Test for Gestational Diabetes If You’re at Higher Risk?

When you test for gestational diabetes will likely depend on your doctor’s evaluation of your level of risk. Early testing is generally done at the end of the first trimester if a pregnant person has a BMI greater than 25 and at least one of the other known risk factors, according to Stacey Ehrenberg, M.D., a board-certified ob-gyn, maternal-fetal medicine specialist, and director of Diabetes in Pregnancy at the Cleveland Clinic.

“Unfortunately, due primarily to the obesity epidemic, many women enter pregnancy with undiagnosed Type 2 diabetes,” Henderson adds. “For this reason, early screening strategies have been developed to detect preexisting diabetes.”

Standard Testing for Gestational Diabetes

For a pregnant person of average risk, screening for gestational diabetes takes place in the second trimester, between weeks 24 and 28. This is the time frame when the placenta has usually grown enough to make signs of GD observable, and is still early enough to treat effectively, says Ehrenberg.

The standard screening is called a glucose challenge test, and involves drinking a sugary solution, waiting an hour, and then having blood drawn and tested.

If the blood glucose level exceeds a certain threshold, then a second glucose screening will be performed. The glucose tolerance test involves an eight-hour fast, a drink with 100 grams of glucose, and blood tests at one-, two-, and three-hour intervals. If two or more of the blood draws during the three-hour test show abnormally high results, then the patient is diagnosed with gestational diabetes.

GD Symptoms to Look Out For

“Occasionally, if the blood glucose is especially high, people notice increased thirst and increased urination,” Henderson says. However, symptoms of GD are generally nonexistent or vague, she adds. This is why screening is so important.

What Happens When GD Is Left Untreated?

Although getting diagnosed with diabetes during pregnancy isn’t something people hope for, a diagnosis means you can manage and treat your condition to help ensure you have a healthy pregnancy. It’s when GD isn’t diagnosed or isn’t properly managed that problems—sometimes very serious ones—can occur, including high birth weight, polyhydramnios (excessive amniotic fluid, which can increase the risk of preterm birth), or stillbirth.

“Large babies increase the risk that the mother will need to deliver via C-section,” explains Henderson. She adds that, “in a vaginal delivery, a large baby may cause lacerations or vaginal tears” as well as other delivery complications, ​​such as getting stuck (a condition called shoulder dystocia) or causing excessive bleeding.

High birth weight can put a baby at higher risk of obesity later in childhood and of developing diabetes and metabolic syndrome. It can also put the baby at risk for having significant hypoglycemia (low blood glucose), jaundice, or neonatal respiratory distress at birth.

Managing and Treating Gestational Diabetes

“The first step in treatment [of gestational diabetes] is educating the patient about the condition and why treatment is important,” Henderson says. Your doctor will talk to you about how to manage your condition through diet, exercise, and blood sugar monitoring. They may also prescribe medication.

Keep Tabs on Your Blood Sugar

All complications are related to a mother’s blood sugar, Ehrenberg says, so it’s important to keep blood sugar in the goal range. You’ll likely be instructed to test your blood sugar regularly—first thing each morning and before and/or after meals—to be sure it stays within that ideal range.

Control Your Blood Sugar by Adjusting Your Diet

To control blood sugar, your doctor may recommend that you do any of the following:

  • Cut simple carbs, like white bread and white rice
  • Eliminate sweetened beverages
  • Eat smaller and more frequent meals
  • Consume more lean protein and fresh fruits and vegetables

Sometimes a doctor will recommend a consultation with a registered dietitian who can help you figure out the best eating plan for your condition.

Stick to an Exercise Routine

Regular physical activity is important for a healthy pregnancy, and that goes double when you’re diagnosed with gestational diabetes. Along with healthy eating, exercise helps in the management of diabetes, and research suggests it’s beneficial in improving pregnancy outcomes for people with GD.

If you already have a workout routine, talk to your doctor about how to continue it comfortably and safely. And if you aren’t much of a mover and groover, then now is the time to start.

Henderson stresses the importance of getting at least 30 minutes a day of moderate activity—even a walk after dinner can be beneficial and is highly encouraged.

Take Any Prescribed Medication As Directed

If diet and exercise alone can’t keep your glucose under control, you may need medication. Insulin injections tend to be the most commonly prescribed. “Insulin is always our first choice because it doesn’t cross the placenta and can’t harm the baby in the long or short term,” Ehrenberg says. “It is far safer to take the insulin and keep your blood sugar within the goal range than to not take it and have high blood sugar.”

The antidiabetic drugs Metformin or Glyburide, while not approved by the Food and Drug Administration for GD, are being prescribed increasingly by doctors for the treatment of gestational diabetes. People often like the fact that these can be taken orally, in pill form, rather than shots, Henderson says.

Keep an Eye on Baby

For some people with gestational diabetes, doctors will order extra ultrasounds and tests called antenatal fetal surveillance to be sure the baby appears to be growing and moving healthily. This may give you extra peace of mind as you near your due date.

“My best advice is not to worry,” Ehrenberg says. “Your care team will help you manage this and take it one step at a time.”

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