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Precisely Understanding Gestational Diabetes

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  • Post last modified:September 26, 2023

During pregnancy, the levels of your hormones go through a variety of changes to support the growth of your baby. For instance, your breasts will enlarge to assist with milk production, and your joints, particularly those around your pelvis, become more relaxed to accommodate your expanding uterus. Pregnancy can even alter the way your body metabolizes blood sugar, and in severe cases, some expectant mothers can develop gestational diabetes.

“Gestational diabetes causes elevated blood sugar that can impact your pregnancy and the health of your baby,” says Jodie Horton, M.D., a fellow of the American College of Obstetricians and Gynecologists (ACOG) and chief wellness advisor at Love Wellness. “Typically, various hormones work to regulate your blood sugar, but during pregnancy, hormone levels change, making it more difficult for your body to effectively process blood sugar.”

What Is Gestational Diabetes?

Gestational diabetes is a form of diabetes that occurs in pregnant women who did not have a diabetes diagnosis before becoming pregnant, according to the Centers for Disease Control and Prevention (CDC).

During pregnancy, your body does not tolerate the sugar you consume as well as it does when you are not pregnant, which leads to gestational diabetes, says Heather Irobunda, M.D., a board-certified obstetrician-gynecologist based in New York City.

Insulin is a hormone produced in the pancreas that keeps your blood sugar levels normal by controlling the conversion of sugar into energy. However, during pregnancy, the placenta releases high levels of pregnancy hormones—estrogen, cortisol, and human placental lactogen—which can interfere with insulin production. This makes it more challenging for your body to regulate blood glucose, explains Dr. Irobunda.

While gestational diabetes and type 2 diabetes may seem similar initially as they are both caused by insulin resistance, they are not the same. “Type 2 diabetes occurs when your body is unable to effectively utilize insulin to lower your blood sugar,” whereas “gestational diabetes develops in pregnant women because their body is unable to properly produce and utilize insulin,” explains Dr. Horton. (

If you receive a diagnosis of gestational diabetes, there are two categories available: A1 and A2. According to Dr. Horton, “A1 can be managed with diet alone, while A2 requires medication to maintain proper blood sugar control.”

Although gestational diabetes can resolve after giving birth, women with this condition have an elevated risk of developing type 2 diabetes in the postpartum period. Therefore, it is crucial to identify and treat it promptly.

Factors that Increase the Risk of Gestational Diabetes

Any pregnant woman can develop gestational diabetes, regardless of whether they had prediabetes or preexisting type 2 diabetes before pregnancy, as explained by Dr. Irobunda. According to the CDC, approximately 6 to 9 percent of pregnant women develop this condition.

However, certain individuals face a higher risk. The following are gestational diabetes risk factors that may increase the likelihood of developing the condition, according to the ACOG:

  • Leading a sedentary lifestyle
  • Being overweight or obese
  • Being 35 years old
  • History of gestational diabetes in a previous pregnancy
  • Previous delivery of a baby weighing 9 or more pounds at birth
  • High blood pressure
  • History of heart disease
  • Having polycystic ovary syndrome (PCOS)
  • Being Black, Hispanic/Latino, Native American, Asian, or Pacific Islander

The chance of developing gestational diabetes is higher for women aged 35 and older due to reduced insulin sensitivity and progressive dysfunction of the pancreas with age, as explained by Dr. Horton.

Moreover, compared to white women, BIPOC women have an increased risk of gestational diabetes. Specifically, one study published in Diabetologia found that Hispanic women had a 7.7 times greater risk, Asian and Pacific Islander women had a 6.3 times greater risk, and Black women had a 9.9 times greater risk of developing gestational diabetes compared to white women. (

The exact reason for this racial disparity in risk is not clear. However, as Dr. Horton states, “what is known is that BIPOC individuals do not have equal access to healthcare.” Even financially stable and college-educated women are likely to experience systemic racism within the healthcare system, leading to preventable medical complications.

Furthermore, the high prevalence of obesity and hypertension in BIPOC communities can increase their chances of developing gestational diabetes. Socioeconomic status, housing, and transportation may also contribute to this disparity, as they play significant roles in accessing nutrient-dense foods and quality healthcare to maintain a healthy pregnancy.

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Symptoms of Gestational Diabetes

Symptoms of gestational diabetes may involve increased appetite and thirst, exhaustion, frequent urination, detection of sugar in the urine (found through a urine test), as well as blurry vision, queasiness, throwing up, and weight loss despite increased appetite, according to Standford Children’s Health. However, often there are no indications of gestational diabetes or the symptoms are very mild. This is why it is crucial for every pregnant individual to be screened for gestational diabetes, or to be tested earlier in pregnancy if they are at high risk. (

Test for Gestational Diabetes

Screening for gestational diabetes is advised for all expectant individuals. Although gestational diabetes can develop at any time during pregnancy, you usually undergo screening for the condition between the 24th and 28th week of pregnancy.

“Screening for gestational diabetes occurs during this period in the second trimester because it is when insulin resistance reaches its peak due to hormones produced by the placenta,” states Dr. Horton. “However, there is a higher occurrence of type 2 diabetes in women of childbearing age, so some women with risk factors will be screened earlier in pregnancy.”

There is a one-step or two-step screening for gestational diabetes, according to the U.S. National Library of Medicine. You will need to consult with your doctor to determine which test they recommend for you.

Two-Step Test for Gestational Diabetes: The initial step is the one-hour glucola test, which does not require fasting beforehand. You consume a highly sweetened beverage, and then your blood is drawn an hour later to assess how effectively your body processes the glucose. If your blood glucose level is above 140, you will proceed to step two, known as the three-hour glucola test, as stated by Dr. Horton.

For this second step, you need to abstain from eating or drinking anything for at least eight hours prior to the three-hour glucola test. Your doctor will first draw blood to check your initial blood glucose level. Afterwards, you consume the sugary drink. From here, your blood is drawn every hour for the next three hours. If two out of the four blood test results indicate elevated levels, you will be diagnosed with gestational diabetes.

One-Step Test for Gestational Diabetes: The two-hour glucola test serves as a one-step diagnostic. Just like the three-hour test, you are instructed to fast for 8 hours before the test is administered. Your blood will be drawn for an initial glucose screening before consuming the same sweetened beverage. Then, your blood will be drawn at one and two-hour intervals, according to Dr. Horton. If one blood sugar test yields elevated results, you will be diagnosed with gestational diabetes.

Complications of Gestational Diabetes

Gestational diabetes entails concerns for both the baby and the mother, and puts you at a higher risk for the following:

Difficult Childbirth

“Pregnancies that are complicated by gestational diabetes are deemed high risk and undergo closer monitoring throughout the pregnancy,” says Dr.

Horton. “Gestational diabetes that is not adequately managed may result in elevated levels of glucose in the blood, which can give rise to difficulties for the mother, including a higher probability of requiring a cesarean section for delivery.” This is due to the fact that having elevated levels of glucose in the blood can lead to the excessive growth of your baby (weighing 9 pounds or greater). Delivering a baby of such dimensions through the birth canal, “may result in harm to the baby, such as nerve injury to the arm or a fractured collarbone,” states Dr. Irobunda. (

In addition, “occasionally, infants of mothers with gestational diabetes experience low blood sugar (hypoglycemia) after birth, which can result in seizures in the infant,” states Dr. Horton. When the mother has elevated blood glucose levels, the fetus will also have elevated levels, causing the infant to produce excessive insulin to regulate blood sugar, explains Dr. Horton. After birth, the fetus is no longer exposed to elevated blood glucose levels, but in certain cases, the newborn may still produce high amounts of insulin, leading to very low blood sugar levels.

Due to potential difficulties in controlling their blood sugar after birth, the infant may require monitoring by pediatricians in the NICU (neonatal intensive care unit), says Dr. Irobunda. According to a study involving 766 mothers published in the Journal of Clinical Neonatology, infants born to mothers with gestational diabetes had longer hospital stays (approximately six days) compared to infants of mothers without gestational diabetes (three days).

Gestational diabetes can also result in stillbirth, preterm birth, and significant respiratory problems for the baby, according to the Mayo Clinic.

High Blood Pressure

Gestational diabetes is also linked to heightened blood pressure during pregnancy, also referred to as gestational hypertension. This can lead to preeclampsia, a severe condition during pregnancy characterized by the onset of high blood pressure and indications of organ damage, typically affecting the liver and kidneys, according to the Mayo Clinic. If left untreated, preeclampsia can be deadly for both the mother and the baby. This condition is usually diagnosed after 20 weeks of pregnancy.

Yeast Infections and Bacterial Vaginosis

Furthermore, “elevated blood glucose levels can cause an overgrowth of yeast and bacteria, increasing the risk of vaginal infections,” explains Dr. Horton. “Yeast and bacteria thrive on the surplus sugar in the body. In particular, pregnant women with diabetes also have a compromised immune system and reduced ability to combat infections such as yeast and bacterial vaginosis.” Bacterial vaginosis can also heighten the risk of preterm delivery, although it is unclear whether treating it can reduce the chances of this, as stated by the JAMA Network.

Type 2 Diabetes

“Women who experienced gestational diabetes during pregnancy have an approximately 50 percent increased risk of developing type 2 diabetes at a later stage in life,” states Dr. Irobunda. “There is also some evidence to suggest that it can raise the future risk of diabetes in the child.”

To ensure that you do not develop type 2 diabetes after giving birth, the CDC suggests undergoing screening within four to 12 weeks following delivery. Additionally, if you do not have diabetes, it is recommended to continue getting tested every one to three years to confirm that your blood sugar levels remain within the normal range.

Furthermore, experiencing gestational diabetes is linked to the development of type 2 diabetes, high blood pressure, and heart disease after giving birth, as concluded by a study in PLoS Medicine. Researchers discovered that women with gestational diabetes were 20 times more likely to develop type 2 diabetes, 2.8 times more likely to develop ischemic heart disease, and twice as likely to develop hypertension within the first few years postpartum.

How to Prevent Gestational Diabetes

According to Dr. Horton, adopting healthy lifestyle habits prior to pregnancy can assist in decreasing your overall risk of gestational diabetes. While there is no specific diet for gestational diabetes, she advises consuming foods abundant in fiber and low in fat, staying physically active, and maintaining a healthy weight before getting pregnant. Furthermore, it is important to avoid exceeding the recommended weight gain during pregnancy.

The recommended weight gain during pregnancy is dependent on your body mass index (BMI) before conceiving and whether you are carrying one or multiple babies, as stated by the CDC. For instance, if you fall into the “normal weight” category with a BMI ranging from 18.5 to 24.9, a weight gain of 25 to 35 pounds during pregnancy is deemed healthy. However, if your BMI is 30 or higher, doctors recommend a weight gain of only 11 to 20 pounds throughout pregnancy.

Incorporating regular exercise and staying active during pregnancy can also contribute to reducing the risk of gestational diabetes, gestational hypertension, and preeclampsia, as concluded by a review in the British Journal of Sports Medicine. The ACOG recommends that pregnant women engage in at least 150 minutes of moderate-intensity exercise each week, which can be achieved through five 30-minute workouts per week.

Consider collaborating with a certified trainer who specializes in pre- and postnatal fitness to help you determine a routine that aligns best with your lifestyle and objectives. Just keep in mind to cease exercising completely — and reach out to your doctor immediately — if you encounter any bleeding, difficulty breathing, chest discomfort, lightheadedness, muscle fatigue, headache, painful contractions, or fluid leakage from the vagina.

Management of Gestational Diabetes

Numerous measures advised for preventing gestational diabetes are also employed in its treatment. Adhering to a gestational diabetes meal plan that is abundant in dietary fiber will aid in maintaining normal blood sugar levels. Women with gestational diabetes can also derive benefits from adhering to a workout regimen comprising moderate-intensity aerobic exercises and strength training, as stated in a review published in the World Journal of Diabetes. Research has demonstrated that pregnant women with gestational diabetes who engage in exercise exhibit lower glucose levels and give birth to babies with a lower birth weight compared to those who did not engage in as much physical activity during pregnancy.

“Mothers diagnosed with gestational diabetes should check their blood sugar levels four times a day — once after fasting in the morning and subsequently after each meal” in order to monitor their blood sugar, as per Dr. Horton. “Another crucial element of the treatment plan involves close monitoring of the baby. Ultrasounds will be conducted periodically to assess the baby’s growth and development throughout the pregnancy. If the mother is taking medication to reduce her blood sugar levels, the fetal heart rate is also monitored starting in the third trimester.” This is carried out to ensure that the baby is not experiencing any distress.

Having gestational diabetes may induce stress and apprehension in any expectant mother, but with proper care and regular screenings, it is possible to have a healthy baby and diminish the risk of birth complications and postpartum health issues.