Understanding gestational diabetes: what puts you at risk and how to manage it

Pregnancy brings a lot of changes — some thrilling, some confusing, and a few that demand close attention. One of the medical issues that can appear during pregnancy is gestational diabetes, a form of high blood sugar that begins or is first recognized while pregnant. This article walks through why it happens, who’s more likely to get it, and clear, practical ways to manage blood sugar so both parent and baby stay as healthy as possible.

What gestational diabetes is and how it develops

Gestational diabetes is glucose intolerance that first appears in pregnancy, usually in the second or third trimester. It happens because pregnancy hormones create a degree of insulin resistance, and if the pancreas can’t compensate by making enough insulin, blood glucose rises.

The condition differs from type 1 and type 2 diabetes in its timing and often its severity; many people return to normal glucose metabolism after delivery, though the metabolic stress of pregnancy can reveal an underlying predisposition. Prevalence varies by population and testing method, but in the United States it affects roughly 6–9 percent of pregnancies and is rising alongside obesity and advanced maternal age.

Knowing how it arises helps explain why management focuses on diet, activity, and targeted medication when needed — the goal is to reduce excess glucose flowing to the fetus and to protect maternal health. Early detection, careful monitoring, and a team approach make a measurable difference in outcomes for both mother and child.

Key risk factors: who’s more likely to develop gestational diabetes

Risk factors fall into two broad categories: those you can’t change and those you can. Nonmodifiable risks include older maternal age, certain ethnic backgrounds, and a previous pregnancy with gestational diabetes.

Modifiable risks center on body weight, lifestyle, and health conditions present before pregnancy. Obesity is one of the strongest predictors: higher pre-pregnancy BMI raises insulin resistance and the chance of gestational diabetes. A family history of type 2 diabetes and a personal history of polycystic ovary syndrome (PCOS) also increase risk.

Ethnicity matters statistically: rates are higher among women who are Hispanic/Latina, South Asian, Middle Eastern, Black, or Native American. Prior pregnancy outcomes — such as a baby delivered over about 9 pounds (4,000 grams), unexplained stillbirth, or recurrent pregnancy loss — can also be a red flag.

Common clinical and social contributors

Beyond classic risk factors, practical realities like nutritional access, physical activity levels, and income influence risk and management. Women living in food deserts, working long shifts, or lacking maternity coverage face greater obstacles to keeping glucose in range. These social determinants of health often shape both development and outcome of gestational diabetes.

Knowledge of these contributors is essential to tailor care. Two people with the same BMI may need different supports depending on their food access, childcare resources, or language barriers when receiving education and prescriptions.

How and when screening is performed

Most pregnant people are screened for gestational diabetes between 24 and 28 weeks’ gestation, though testing may occur earlier if risk factors are present. Providers use one of two common approaches: the one-step 75-gram oral glucose tolerance test (OGTT) or the two-step strategy beginning with a 50-gram glucose challenge screening followed, if positive, by a diagnostic 100-gram OGTT.

Both strategies are accepted by major organizations, and choice of test often follows local practice patterns. Early screening (first trimester) is considered when there’s a history of diabetes or strong risk factors; if initial testing is normal, repeat screening at 24–28 weeks remains appropriate for most people.

Diagnostic thresholds at a glance

The numbers matter. Different criteria have slightly different cutoffs, and interpretation depends on which approach is used. The table below lays out commonly used thresholds so you can see how a single set of blood draws translates to a diagnosis.

Test	Blood draw	Threshold (mg/dL)
One-step (IADPSG/WHO) 75 g OGTT	Fasting	≥ 92
	1 hour	≥ 180
	2 hour	≥ 153
Two-step (Carpenter–Coustan) 100 g OGTT	Fasting	≥ 95
	1 hour	≥ 180
	2 hour	≥ 155
	3 hour	≥ 140

Note: different labs and organizations use slightly different cutoffs; your provider will interpret results in context. Hemoglobin A1c is not a reliable sole test for gestational diabetes because normal pregnancy changes alter its accuracy.

Why control matters: risks to you and your baby

Uncontrolled gestational diabetes increases the chance of several complications. For the baby, excess maternal glucose can lead to fetal overgrowth (macrosomia), which raises the risk of birth injury, shoulder dystocia, and cesarean birth.

Newborns of mothers with high glucose may experience low blood sugar shortly after birth, jaundice, breathing difficulties, or admission to a neonatal unit. Babies exposed to high glucose in utero are also more likely to develop obesity and glucose intolerance later in life.

For the parent, persistent high glucose during pregnancy raises the risk of preeclampsia, cesarean delivery, and a higher chance of developing type 2 diabetes in the years following pregnancy. Being diagnosed is an opportunity to start prevention strategies that have long-term benefits.

First-line management: nutrition, activity, and monitoring

Medical nutrition therapy provided by a registered dietitian is the foundation of treatment and often the only therapy required. The focus is on spreading carbohydrate intake across meals and snacks, choosing lower-glycemic options, and meeting pregnancy nutrient needs without excessive caloric intake.

A practical rule many clinicians use is about 30–45 grams of carbohydrate at each main meal and 15–30 grams at snacks, but personalization matters. A dietitian will consider pre-pregnancy weight, stage of pregnancy, nausea or other symptoms, and cultural food preferences to build an achievable plan.

Regular, moderate exercise is recommended unless contraindicated. Thirty minutes of brisk walking most days of the week helps insulin sensitivity and is generally safe in uncomplicated pregnancies. Strength training tailored to pregnancy is also useful when performed under guidance.

Frequent blood glucose monitoring is essential, especially early after diagnosis. Typical testing schedules include fasting and either one-hour or two-hour post-meal checks, recorded in a log so your care team can identify patterns and adjust treatment promptly.

Glycemic targets and monitoring frequency

Targets used in many practices aim to minimize fetal exposure to high glucose while avoiding maternal hypoglycemia. A commonly used set of goals is fasting glucose ≤95 mg/dL, one-hour postprandial ≤140 mg/dL, and two-hour postprandial ≤120 mg/dL.

People often monitor four times daily — fasting and either one-hour or two-hour after the three main meals. If blood sugars are consistently above targets despite lifestyle changes, medication addition is the next step.

When medication is needed: insulin and oral options

If dietary changes and exercise don’t bring glucose into range within about one to two weeks, medication is appropriate. Insulin is the traditional gold standard because it does not cross the placenta and allows fine-tuned dosing for pregnancy’s changing needs.

Metformin and glyburide (a sulfonylurea) are oral options that some providers use. Metformin crosses the placenta but has been used widely; it can reduce maternal weight gain and may be preferred by patients who avoid injections. Glyburide has been associated in some studies with higher neonatal hypoglycemia and is less commonly favored today.

Choice of medication depends on glucose patterns, patient preferences, and local practice. If starting insulin, education on injection technique, dose timing, and hypoglycemia recognition is essential. Frequent follow-up is needed, as insulin requirements often rise as pregnancy progresses.

Medication considerations and safety

Insulin dosing is individualized and may involve a combination of basal and rapid-acting insulin to cover fasting and meal-related glucose rises. Providers balance the risk of high glucose against hypoglycemia, which is especially concerning in pregnancy.

When metformin is used, it is often started when fasting and post-meal glucose values are mildly elevated and when the patient prefers an oral agent. Long-term effects on offspring are under study; current evidence supports short-term safety but ongoing monitoring of children is part of many research programs.

Fetal surveillance and delivery planning

Once gestational diabetes is diagnosed, fetal surveillance is tailored to degree of control. Well-controlled gestational diabetes often needs only routine prenatal care with maybe an ultrasound to assess growth in the third trimester.

Poorly controlled glucose or suspected macrosomia prompts more frequent growth ultrasounds and nonstress tests in the late third trimester. If the baby is very large or the mother has additional complications (hypertension, preeclampsia), induction or planned cesarean may be discussed to reduce delivery risks.

Timing of delivery must balance fetal maturity and risks from continuing the pregnancy. In many cases with well-controlled gestational diabetes, delivery occurs at term. When complications exist, earlier delivery after fetal lung maturity testing might be recommended.

Immediate newborn care and what to expect after delivery

Newborns of mothers with gestational diabetes are closely monitored after birth for low blood sugar, which can happen as the baby’s insulin production, stimulated by maternal glucose, continues in the absence of maternal glucose supply. Early feeding and monitoring reduce this risk.

Staff coordinate care so that breastfeeding or formula is started promptly, and blood glucose checks are done per unit protocol. Most infants do well with timely intervention and avoid long neonatal unit stays.

Breastfeeding benefits both parent and child: it helps maternal glucose control and supports infant metabolic health. Lactation support is an important part of the postpartum plan for people who choose to breastfeed.

Postpartum follow-up and preventing future diabetes

The metabolic story doesn’t end at delivery. Pregnancy unmasks risk — about half of people who had gestational diabetes will develop type 2 diabetes within 10 years if no preventive steps are taken. Early postpartum follow-up is therefore crucial.

Guidelines recommend a 75-gram OGTT at 4–12 weeks postpartum to check glucose status; if that test is normal, repeat screening with fasting blood glucose or HbA1c is advised every one to three years depending on individual risk. Lifestyle changes after delivery — weight loss if needed, healthy diet, physical activity, and breastfeeding — lower long-term risk.

Structured programs modeled on the Diabetes Prevention Program (DPP) are effective in reducing progression to type 2 diabetes. Referral to community resources, weight loss counseling, or digital DPP programs can convert a diagnosis into an opportunity for long-term health improvement.

Contraception and planning for future pregnancies

After a pregnancy with gestational diabetes, family planning conversations are important. Some contraceptives are metabolically neutral, while pregnancy spacing and preconception glucose control are strong predictors of outcomes in future pregnancies.

If you plan another pregnancy, aim to optimize weight, screen for diabetes early, and achieve stable glucose control before conception if possible. Preconception counseling with a provider helps outline medication adjustments, vitamin supplementation, and a monitoring plan for early pregnancy.

Emotional, cultural, and practical challenges

A diagnosis can trigger stress, guilt, and worry. People often fear harming their baby or feel ashamed about dietary changes. Normalizing these feelings and connecting patients with support — peer groups, culturally tailored education, or mental health care — improves adherence and well-being.

Food advice must also be realistic and culturally sensitive. A Mediterranean-style plate won’t help if it relies on foods someone can’t access or doesn’t eat. Effective counseling uses familiar foods and practical swaps, not exotic ingredients or rigid rules.

From my experience working with pregnant people and families, concrete tools make the difference: a simple meal plan that fits cultural preferences, a phone timer for glucose checks, or a local peer group for shared recipes and encouragement. Small changes every day add up.

Practical tips and a simple checklist

Here’s a brief, practical set of actions to help you navigate a diagnosis and stay in control. These aren’t medical orders but common steps recommended by clinicians who manage gestational diabetes regularly.

1. Get clear testing: Ask which screening method is being used and when follow-ups will occur.
2. Arrange a consult with a registered dietitian for individualized meal planning.
3. Start a simple blood glucose log: fasting and one- or two-hour post-meal checks daily.
4. Build an exercise plan that fits your pregnancy and lifestyle — aim for moderate movement most days.
5. If medication is needed, learn dosing, injection technique (if insulin), and how to manage low blood sugar safely.
6. Plan postpartum glucose testing and consider enrollment in a diabetes prevention program.

Use this checklist as a conversation starter with your provider. Everyone’s situation is different, and your team can help adapt these steps to your needs and preferences.

Real-life example: a story of manageable change

Last year I worked with a patient named Maria (name changed). She was diagnosed at 28 weeks after a high screening test and brought to the clinic worried she had done something wrong. Her most urgent concern was caring for her toddler while attending appointments and learning to test her blood sugar.

We created a plan that fit her life: short walks with her child after dinner, a plate-focused meal plan using foods from her local grocery store, and home glucose monitoring that took less than five minutes. Within two weeks her fasting and post-meal sugars improved, and she avoided medication. At delivery her baby was healthy and of appropriate size, and Maria felt empowered rather than judged by the diagnosis.

This kind of outcome isn’t guaranteed, but it shows how practical, culturally aware support and small, consistent changes can turn a scary diagnosis into a manageable chapter in pregnancy.

When to call your provider: warning signs and urgent issues

Contact your care team if blood sugars remain consistently above targets despite changes, if you experience symptoms of very high or low blood sugar (excessive thirst, confusion, shakiness), or if you have decreased fetal movement in the third trimester. These are signals that adjustments or urgent evaluation may be needed.

Also call if you have signs of preeclampsia such as severe headache, visual changes, sudden swelling, or upper abdominal pain. Preeclampsia and gestational diabetes can coexist and require coordinated management to keep you and the baby safe.

Resources and support to explore

Reliable organizations provide patient-friendly guidance: the American Diabetes Association, the American College of Obstetricians and Gynecologists, and the Centers for Disease Control and Prevention offer evidence-based materials on screening, treatment, and postpartum care. Local health departments and community clinics may offer group classes or nutrition counseling on sliding scales.

Peer support groups — in-person or online — can provide recipes, troubleshooting tips for glucose monitoring, and emotional encouragement. Ask your provider to recommend programs that are culturally and linguistically appropriate for you.

Putting it all together: managing risk and protecting health

Gestational diabetes is a common complication of pregnancy that can feel overwhelming at first, but in most cases it is manageable. Early detection, personalized nutrition and exercise plans, reliable glucose monitoring, and timely use of medication when necessary reduce risks for both parent and baby.

Beyond immediate pregnancy care, a diagnosis is a signal to adopt long-term habits that protect future health: breastfeeding if possible, maintaining a healthy weight, and participating in prevention programs can dramatically lower the risk of type 2 diabetes. With a supportive care team and practical strategies, many people with gestational diabetes deliver healthy babies and use the experience to build stronger lifelong health habits.