Gestational Diabetes: Symptoms, Causes, and How to Manage It

You’re not alone if you’re worried about gestational diabetes during pregnancy. It’s a common issue for expecting moms, and it may affect you regardless of whether you suffered from diabetes before pregnancy.

Read on to learn what the symptoms of gestational diabetes are, who’s most at risk, and how to manage it during your pregnancy.

Gestational diabetes mellitus (GDM), also known simply as gestational diabetes, is a form of diabetes that exclusively affects pregnant women.

Much like regular diabetes, it affects how your cells use sugar (glucose) for energy. When you’re pregnant, your body goes through changes to accommodate your growing baby (e.g., weight gain and increased hormonal levels).

These changes can cause insulin resistance, where your body doesn’t process glucose as effectively (insulin is a hormone that helps your body’s cells absorb glucose from your blood). 1

Left untreated, gestational diabetes can cause serious health problems for you or your baby. Fortunately, doctors screen for it carefully, and if they catch it, it’s treatable.

Gestational diabetes usually shows up in the second or third trimester. Doctors tend to spot it between week 24 and week 28 of pregnancy, when you’ll have a test called the glucose screening.

How common is gestational diabetes?

Gestational diabetes is more common than you might think—the Centers for Disease Control and Prevention (CDC) found that 8.3% of pregnant women had it in 2021. 2

Risk factors for gestational diabetes

While it’s common for pregnant women to have at least a little insulin resistance, if you already have an increased need for insulin, your risk of developing gestational diabetes may be higher. 1

Several factors are known to increase your risk, including being overweight. Having a body mass index (BMI) of 30+ before becoming pregnant is one of the biggest risk factors for developing the condition.

You may also have a greater chance of developing gestational diabetes if you: 1

• Aren’t physically active
• Are older than 25
• Have a history of diabetes in your family
• Had gestational diabetes in a previous pregnancy
• Suffer from polycystic ovary syndrome (PCOS)
• Previously delivered a large baby (over 9 pounds)

Because many people have at least one of these risk factors, healthcare providers recommend universal screening for all expectant mothers during the second trimester.

One of the trickier aspects of gestational diabetes is that it often lacks noticeable symptoms. If you do have symptoms, they may be subtle and easy to mistake for the normal discomforts of pregnancy.

With that said, GDM sometimes causes: 4

• Unusual thirst
• Frequent urination
• Persistent fatigue

To reiterate, a lot of these signs can also be normal pregnancy symptoms, and many cases of gestational diabetes are asymptomatic.

The only way to check whether you have the condition is to undergo the screenings that your doctor recommends.

As mentioned, to check for gestational diabetes, you’ll need to have a glucose screening test performed by your doctor. You’ll usually get this when you’re between 24 and 28 weeks pregnant, although your doctor may recommend that you get tested earlier if they think you’re particularly at risk.

What will happen during your glucose screening test

At your doctor’s office, you’ll drink a sugary beverage. One hour later, your doctor will take a blood sample to measure your blood sugar level.

If your blood sugar levels are normal, it’s a sign that you passed your glucose test and don’t have gestational diabetes. Conversely, if you have elevated blood sugar levels, it could indicate an issue with how your body processes sugar.

What happens if you don’t pass your glucose test?

An elevated result on your screening test doesn’t automatically mean you have GDM. Your doctor will perform a follow-up test, called an oral glucose tolerance test (OGTT).

For this test, you’ll need to fast for at least 8 hours. Your doctor will draw blood to get a fasting glucose level, then you’ll drink another sugary drink (with a higher concentration of glucose). Your doctor will continue to draw blood multiple times over the next two to three hours. 4

If your blood sugar levels are high on two or more of the readings taken during the OGTT, your doctor will diagnose you with gestational diabetes.

If you’re diagnosed with gestational diabetes, know that you can still have a healthy pregnancy as long as you follow your doctor’s guidance.

However, if you don’t manage gestational diabetes, it can lead to potential problems for both you and your developing baby.

Complications for your baby

When a mother’s blood has excess sugar, it crosses the placenta, causing the baby’s pancreas to work overtime to produce more insulin. This can lead to: 5

• High birth weight: The extra glucose gets stored as fat, which can lead to a baby growing unusually large (a condition called macrosomia). A baby weighing 9 pounds or more is at a higher risk of birth injuries or needing a Cesarean (C-section) delivery.
• Preterm birth: High blood sugar can increase the risk of going into labor early. Your doctor may recommend inducing labor earlier if your baby is very large.
• Breathing difficulties: Babies born prematurely may experience respiratory distress syndrome.
• Low blood sugar (hypoglycemia) after birth: Your baby’s pancreas may continue producing extra insulin for a short time after delivery, causing her own blood sugar to drop dangerously low.
• Increased future health risks: Babies exposed to high sugar levels in the womb have a higher risk of developing obesity and type 2 diabetes later in life.
• Stillbirth: In rare cases, untreated gestational diabetes can result in a baby’s death before or shortly after birth.

Complications for you

Along with the risks to your developing baby, gestational diabetes also puts you at risk of: 6

• High blood pressure and preeclampsia: Having gestational diabetes increases your risk of developing high blood pressure during pregnancy. You’ll also be more at risk of preeclampsia, a dangerous form of high blood pressure that can also cause damage to other organ systems.
• Requiring a C-section: Again, due to the likelihood of having a larger-than-average baby, you’ll have a higher chance of needing a C-section.
• Developing diabetes in the future: If you suffer from gestational diabetes, your risk of developing it again in a future pregnancy is much higher. You’ll also have a 50% chance of developing type 2 diabetes later in life. 4

Remember, these risks are mainly associated with unmanaged gestational diabetes. If you take the right steps to manage GDM, you’ll probably be fine.

After being diagnosed with gestational diabetes, your doctor will keep a close eye on you for the remainder of your pregnancy. You’ll have more frequent checkups to monitor your blood sugar levels, and more ultrasounds to check in on your baby. 4

You’ll also need to make a few lifestyle adjustments to manage your blood sugar levels.

How to take care of yourself with gestational diabetes

Follow these steps to look after yourself and your baby after being diagnosed with gestational diabetes:

Monitor your blood sugar levels

With gestational diabetes, you’ll need to regularly monitor your blood sugar at home. Using a small device called a glucose meter (glucometer), you’ll prick your finger with a tiny needle (a lancet) to get a drop of blood, which you’ll place on a test strip inserted into the meter. 4

Your doctor will probably instruct you to test your blood several times a day, typically:

• First thing in the morning, before you eat (to check your blood sugar’s fasting level)
• One or two hours after each meal (breakfast, lunch, and dinner)

Keep a log of these numbers along with a record of what you ate to identify patterns. You’ll need to make adjustments if your glucose levels are too high.

Eat a balanced diet

Maintaining a healthy pregnancy diet is always important, but watching what you eat and drink becomes essential when you’re dealing with gestational diabetes. You’ll need to:

• Eat whole foods: Build your meals around vegetables, fruits, whole grains, lean proteins (fish, poultry, and beans), and healthy fats (avocado, nuts, and seeds).
• Limit sugar and refined carbs: Avoid sugary drinks, desserts, and processed foods made with white flour.
• Watch your portion sizes: Eat smaller, more frequent meals to help your blood sugar levels stay stable.
• Pair carbs with protein: Eating protein along with carbohydrates can slow down the absorption of sugar and prevent spikes. 7
• Stay hydrated: Make sure you drink enough water (around 8 to 12 cups a day, or 64 to 96 oz), as this dilutes your blood, making it easier for your kidneys to get rid of excess sugar. 4 8

Your doctor will probably put you in touch with a registered dietitian, who will help you create a personalized meal plan.

Along with watching what you eat, continue to take your daily prenatal vitamins and avoid wine, beer, and all other alcohol entirely during pregnancy (which, of course, you should do regardless of whether you have gestational diabetes or not).

Stay active

You’ll also need to stay active to keep your blood sugar levels in check. Exercise makes your body more sensitive to insulin and can lower your glucose levels for up to 24 hours. 9

Aim for about 150 minutes of moderate-intensity activity each week as long as your doctor doesn’t tell you otherwise. 10

You don’t need a strenuous gym routine. Excellent options during pregnancy include:

• Taking a brisk walk, especially after meals
• Swimming or water aerobics
• Riding a stationary bike
• Prenatal yoga

Even short bursts of activity, like taking the stairs instead of the elevator or going for a 15-minute walk after lunch, can make all the difference to your glucose levels.

Take medication (if necessary)

If diet and exercise aren’t enough to keep your blood sugar in a healthy range, your doctor may suggest that you take medication.

This could be in the form of insulin injections, which you’ll need to take anywhere from once every day to multiple times per day. Your doctor will let you know the right dosage—never take more than they recommend. 4

Your blood sugar levels should return to normal shortly after you give birth. However, having gestational diabetes significantly increases your risk of developing type 2 diabetes later on.

This makes postpartum follow-up care essential. After your pregnancy, make sure to:

• Get tested for diabetes: Your doctor will recommend getting a blood sugar test about 6 to 12 weeks after you deliver to confirm your levels have returned to normal. 11 You should continue to screen for diabetes every 1–3 years for the rest of your life.
• Maintain a healthy lifestyle: You’ll need to continue the healthy habits you picked up during pregnancy to stave off type 2 diabetes. Regularly exercise (once you’ve recovered sufficiently from labor and delivery) and maintain a healthy diet.
• Consider breastfeeding: Research suggests that breastfeeding may lower your risk of developing type 2 diabetes after having GDM. 12

Will your baby be at risk of diabetes?

Unfortunately, as your child grows, she’ll have a higher-than-average risk of being obese and developing type 2 diabetes. 13

Immediately after delivery, your doctor will monitor your baby’s blood sugar to make sure it isn’t too low (hypoglycemia). This is a simple blood test and a standard precaution for all babies born to mothers with gestational diabetes. 14

The good news is that you can protect your baby’s future health by establishing healthy habits as a family, feeding her a nutritious diet (once she starts eating solid foods), and encouraging her to be active from an early age.

While there’s no guaranteed way to prevent gestational diabetes, you’ll be less likely to develop it if you lead a healthy lifestyle before getting pregnant.

If you’re trying to get pregnant, make sure you stay active, keep your weight in a healthy range, and follow a nutritious diet to lower your risk of gestational diabetes and naturally boost your fertility.

You should also speak to your doctor if you’re particularly at risk of gestational diabetes (e.g., it runs in your family). That’s why it’s important to book your preconception appointment before you get pregnant.

Gestational diabetes affects many women during pregnancy. Since the symptoms are often hard to spot, your glucose screening test is the only reliable way of determining whether you have it or not.

Remember that having gestational diabetes isn’t a failure on your part, nor does it necessarily mean you can’t go on to have a healthy pregnancy. With your doctor’s support and the right lifestyle adjustments, you’ll still be able to take care of yourself and your little bundle of joy.