Gestational Diabetes: Your Complete Patient Guide

Overview

Gestational diabetes is a form of diabetes that develops for the first time during pregnancy in people with no prior history of the condition. It is usually diagnosed between 24 and 28 weeks of pregnancy, though it may be identified earlier in people with high risk factors. Gestational diabetes occurs when your body cannot produce enough insulin to overcome increased insulin resistance caused by pregnancy hormones, leading to high blood sugar levels. With proper management, most people with gestational diabetes have healthy pregnancies and babies, and blood sugar levels typically return to normal within 6 weeks after delivery. However, having gestational diabetes increases your risk of developing type 2 diabetes later in life.

Signs & Symptoms

Most people with gestational diabetes experience no obvious symptoms, which is why routine prenatal screening is critical for early diagnosis. In some cases, mild symptoms may appear that are similar to type 2 diabetes, including increased thirst, more frequent urination, unusual fatigue, blurred vision, or recurring yeast and urinary tract infections. These symptoms are also common in uncomplicated pregnancies, so they are not a reliable way to diagnose gestational diabetes on their own.

Causes & Risk Factors

During pregnancy, the placenta produces hormones that help your baby grow, but these hormones also make your body less responsive to insulin (a condition called insulin resistance). Your body normally produces extra insulin to compensate for this resistance, but if it cannot make enough, blood sugar levels rise, leading to gestational diabetes. You are at higher risk of developing gestational diabetes if you have one or more of the following factors:

• Previous diagnosis of gestational diabetes in a prior pregnancy
• Body mass index (BMI) of 30 or higher before pregnancy
• Family history of type 2 diabetes
• Diagnosis of prediabetes before pregnancy
• Polycystic ovary syndrome (PCOS)
• Prior delivery of a baby weighing 9 pounds (4.1 kilograms) or more
• Age over 25 at the start of pregnancy (risk increases further for people over 35)

Diagnosis

All pregnant people are offered routine screening for gestational diabetes between 24 and 28 weeks of pregnancy. If you have high risk factors, your provider may screen you as early as your first prenatal appointment. Diagnosis typically involves two tests:

Treatment & Management

The goal of gestational diabetes treatment is to keep your blood sugar levels within a target range to reduce risks for you and your baby. Most people manage the condition with lifestyle changes first, while some require medication to keep blood sugar controlled. Your provider will give you a personalized blood sugar target, but common goals include: fasting blood sugar under 95 mg/dL, 1-hour post-meal blood sugar under 140 mg/dL, and 2-hour post-meal blood sugar under 120 mg/dL.

• Blood sugar monitoring: You will test your blood sugar 4 or more times a day using a small finger-prick device, and log your results to share with your care team.
• Personalized meal planning: Work with a registered dietitian to create a meal plan focused on whole grains, lean protein, non-starchy vegetables, and limited added sugars and refined carbohydrates to keep blood sugar stable.
• Regular moderate exercise: Aim for 30 minutes of activity most days, such as walking, swimming, or prenatal yoga, which helps your body use insulin more effectively and lower blood sugar.
• Medication if needed: If lifestyle changes do not keep your blood sugar in your target range, your provider may prescribe insulin or oral medications like metformin, which are safe to use during pregnancy.

Living With It

With consistent, proactive care, most people with gestational diabetes have uncomplicated pregnancies and healthy babies. You will have more frequent prenatal appointments to monitor your blood sugar control and your baby's growth, and your provider may recommend extra ultrasounds to track your baby's size. After delivery, your blood sugar will be tested within 24 hours, and again at your 6-week postpartum checkup to confirm it has returned to normal. Because gestational diabetes increases your long-term risk of type 2 diabetes, it is important to get screened for diabetes every 1-3 years after pregnancy, and maintain healthy lifestyle habits like balanced eating and regular physical activity.