Medically Reviewed and Compiled by Dr. [Adam N. Khan], MD.
Quick summary
Gestational diabetes is high blood sugar first recognized during pregnancy. Most people have no clear symptoms, so screening matters. When detected, treatment focuses on keeping blood glucose in target ranges using diet, monitoring, activity, and medication when needed. Proper care reduces risks to both mother and baby.
What is gestational diabetes?
Gestational diabetes mellitus, or GDM, is glucose intolerance that shows up during pregnancy. It usually appears in the second half of pregnancy, but recent evidence shows some women have hyperglycemia earlier and may benefit from earlier screening. GDM differs from preexisting type 1 or type 2 diabetes because it is first identified in pregnancy. Untreated GDM increases risks such as large-for-gestational-age baby, birth complications, and later life type 2 diabetes for both mother and child.
How common is it?
GDM is one of the most common medical complications in pregnancy. Reported rates vary by population and screening method, but many high-income countries screen all pregnant people and find substantial rates. Rising obesity and older maternal age are part of the reason it is more common now than decades ago.
Typical symptoms
Most people with gestational diabetes do not notice symptoms. When symptoms occur they are usually mild and nonspecific:
- Increased thirst and dry mouth.
- Needing to urinate more often than usual.
- Fatigue and feeling unusually tired.
- Blurred vision, though this is uncommon.
Because symptoms are often absent, routine screening is standard. Self-reporting of symptoms should not replace glucose screening tests.
Who should be screened and when
Standard practice in many guidelines is universal screening in pregnancy, typically between 24 and 28 weeks. People with risk factors may be screened earlier, at the first prenatal visit. Risk factors that prompt early screening include prior GDM, obesity, strong family history of type 2 diabetes, and some ethnic groups with higher GDM prevalence. Recent research argues for earlier testing in many women because early hyperglycemia also harms outcomes.
How gestational diabetes is diagnosed
Two common approaches are used worldwide:
- One-step 75 gram oral glucose tolerance test with diagnostic thresholds recommended by some international groups.
- Two-step approach with an initial glucose challenge test followed by a 100 gram oral glucose tolerance test if the screen is positive.
Your care team will use the approach recommended in your region. The key point is confirmation by standardized testing rather than relying on symptoms alone.
Goals of treatment
The main goal is to keep blood glucose levels in ranges that reduce risk to baby and mother while minimizing treatment burden. Typical targets used in many centers are:
- Fasting plasma glucose often targeted around 70 to 95 mg/dL.
- 1-hour post-meal targets often <140 mg/dL and 2-hour post-meal targets often <120 mg/dL, depending on the protocol used by your clinic.
Exact targets may differ by guideline and individual situation. The treatment plan should balance safety, practicality, and the patient’s values.
First-line treatments (non-medication)
Most people start with lifestyle-focused care. This is often enough to reach glucose targets.
Medical nutrition therapy
A tailored meal plan from a registered dietitian experienced in pregnancy is the backbone of care. Advice includes:
- Spreading carbohydrate intake through the day with consistent portions.
- Choosing whole grains, vegetables, and protein with each meal to blunt post-meal glucose spikes.
- Avoiding very low calorie diets which are unsafe in pregnancy.
- Tracking carbohydrate types and amounts, not just calories.
Physical activity
Regular, moderate activity such as brisk walking for 20 to 30 minutes after meals can lower post-meal glucose. Any exercise plan should be safe for pregnancy and discussed with your clinician.
Blood glucose monitoring
Self-monitoring with fingerstick glucose checks is standard. Typical schedules include fasting measurements and 1 or 2-hour postprandial checks. The frequency depends on how controlled glucose is. Continuous glucose monitoring (CGM) is increasingly used and may improve time in range for some patients.
When medication is needed
If lifestyle measures do not achieve targets within 1 to 2 weeks, medication is the next step.
Insulin
Insulin is the most established and widely recommended medication because it does not cross the placenta in clinically relevant amounts and provides flexible control. It is safe and effective in pregnancy. Dosing is individualized and often starts with basal insulin or combination basal plus bolus when needed.
Oral agents
Metformin and glyburide have been studied as alternatives. Metformin is widely used in some settings because it can lower glucose and is taken orally, but it crosses the placenta. Guidelines differ on whether it should be first line after diet. Many clinicians prefer insulin if strict control is required or if metformin does not achieve targets. Discuss risks and benefits with your provider.
Choosing therapy
Choice depends on severity, patient preference, access to insulin and training for injections, and local guideline recommendations. Close follow up is essential whenever medication is used.
Monitoring pregnancy when GDM is present
When gestational diabetes is diagnosed, clinicians increase surveillance:
- More frequent fetal growth ultrasounds to check for excess growth.
- Fetal movement monitoring and nonstress tests later in pregnancy if indicated.
- Planning delivery timing and mode based on fetal size and maternal control.
- Screening for hypertensive disorders and other complications.
Good glucose control often lets pregnancy proceed normally with routine obstetric care plus targeted monitoring.
Delivery and immediate postpartum care
Many people with GDM deliver without immediate complications if glucose is well controlled. Key elements:
- Blood glucose monitoring during labor.
- Newborn monitoring for hypoglycemia after birth because baby insulin production may be high.
- Postpartum glucose testing for the mother, typically a 75 gram oral glucose tolerance test at 4 to 12 weeks postpartum, because GDM raises the risk of persistent diabetes. Long term follow up for type 2 diabetes risk is essential.
Long-term health: mother and child
A history of gestational diabetes increases the mother’s lifetime risk of type 2 diabetes. Children born after GDM are at higher risk of childhood obesity and metabolic problems. Postpartum lifestyle measures and periodic screening help reduce long-term risk.
Unique Clinical Takeaways
This section highlights clinical perspectives and practical insights that go beyond basic symptom lists. These are original, actionable, and grounded in current evidence.
1. Early glycemic patterns matter — treat proactive, not reactive
Screening only at 24 to 28 weeks misses women with significant hyperglycemia earlier in pregnancy. Several recent analyses and expert groups suggest that earlier abnormal glucose — even in the first trimester — is associated with poor outcomes and benefits from treatment. If a woman has strong risk factors, consider early testing and, if elevated, start management rather than waiting for routine screening. This reduces fetal overgrowth risk and shortens the period of uncontrolled glucose exposure. Action: flag patients with prior GDM, BMI over 30, or strong family history for first-trimester glucose testing.
2. Postprandial control often trumps fasting numbers for fetal risk
Fetal overgrowth relates more closely to post-meal glucose excursions than to fasting glucose in many studies. That means focusing on blunting postprandial spikes through carbohydrate distribution, protein paired with carbs, and post-meal activity can give outsized benefits even when fasting values look acceptable. Action: teach patients a simple post-meal testing plan and carbohydrate plate model rather than only emphasizing fasting checks.
3. Mental health and social context change the success of therapy
GDM is not only metabolic. Anxiety about injections, food insecurity, language barriers, or lack of safe places to exercise often blocks successful management. Screening for food access, mental health, and social supports at diagnosis identifies obstacles early. Action: add a quick social needs checklist at the time of diagnosis and link patients to a dietitian, social worker, or community resource. That modest step increases adherence and glucose control. Evidence links GDM with higher postpartum depression risk and worse outcomes when social needs are unmet.
4. Continuous glucose monitoring deserves selective use
Real-time CGM can improve “time in range” and reduce clinic visits for some patients, particularly those on insulin or those finding fingerstick testing difficult. It is not necessary for everyone, but in clinics that can provide access, CGM can sharpen titration decisions and reveal nocturnal and postprandial patterns missed by spot checks. Action: reserve CGM for patients on insulin, with poor control despite therapy, or with barriers to frequent fingersticks. Recent trials are clarifying which patients benefit most.
5. Plan for long-term prevention starting in pregnancy
Pregnancy is a teachable moment for long-term cardiometabolic prevention. Women diagnosed with GDM should get a clear postpartum plan: 4 to 12 week glucose testing, annual diabetes screening thereafter, and a structured referral for weight management or diabetes prevention programs. Action: give a written “6-point postpartum plan” at discharge that lists date for OGTT, lifestyle steps, and local prevention programs to improve follow up rates.
Common patient questions (short answers)
Will my baby be born with diabetes? No. The baby will not be born with diabetes, but exposure to high glucose can cause overgrowth and immediate metabolic issues at birth and increase later risk of obesity and metabolic disease.
Can I treat GDM without medication? Many people can with diet, activity, and monitoring. If targets are not met, medication is added.
Is insulin safe in pregnancy? Yes. Insulin is the preferred agent when medication is needed because of its track record and safety.
Practical patient checklist at diagnosis
- Meet with a dietitian experienced in pregnancy within 1 week.
- Start self-monitoring: fasting and 1- or 2-hour post-meal checks as directed.
- Aim for moderate, pregnancy-safe activity after meals.
- If glucose targets are not met within 1–2 weeks, expect prompt medication discussion.
- Book a postpartum glucose test at 6 to 12 weeks after birth.
When to call your provider immediately
- Repeated glucose readings far above target despite following plan.
- New signs of preeclampsia such as severe headache, visual changes, or sudden swelling.
- Decreased fetal movement in the third trimester.Gestational Diabetes: Symptoms and Treatments
References and Citations
Below are the key authoritative sources used to compile this article. These are current, high-quality references for patients and clinicians.
- ACOG Practice Bulletin: Gestational Diabetes Mellitus. American College of Obstetricians and Gynecologists. ACOG
- Centers for Disease Control and Prevention: Gestational Diabetes. CDC. CDC
- NHS: Gestational Diabetes — treatment and symptoms pages. National Health Service (UK). NHS+1
- Mayo Clinic: Gestational diabetes — Symptoms, causes, and treatment. Mayo Clinic+1
- American Diabetes Association / Diabetes.org: Gestational Diabetes information and Standards of Care (Diabetes Care supplement). American Diabetes Association+1
- The Lancet series and recent papers on gestational diabetes and early screening. The Lancet+1
- Recent systematic reviews and clinical updates (e.g., StatPearls, PubMed articles) used for evidence synthesis. NCBI+1
Medical disclaimer
This article provides general information and does not replace personalized medical advice. Follow the recommendations of your obstetrician, endocrinologist, or diabetes care team. If you have concerns about gestational diabetes, contact your care provider promptly.