GUIDE
Gestational diabetes develops when your body cannot produce enough insulin to manage the increased blood sugar demands of pregnancy — affecting 6 to 9 percent of pregnancies.
A gestational diabetes diagnosis can feel overwhelming, but with the right management, outcomes are excellent. Most people control it with diet and monitoring, and blood sugar typically returns to normal after delivery.
Be prepared from day one
During pregnancy, the placenta produces hormones — including human placental lactogen, cortisol, and progesterone — that help your baby grow. These same hormones make your cells more resistant to insulin. In most pregnancies, the pancreas compensates by producing two to three times more insulin than usual. Gestational diabetes develops when the pancreas cannot keep up with this increased demand.
Gestational diabetes is typically diagnosed between 24 and 28 weeks of pregnancy through a glucose screening test. This timing coincides with when placental hormones reach levels high enough to significantly affect insulin resistance. If you have risk factors, your provider may screen you in the first trimester as well.
It is important to understand that gestational diabetes is not caused by eating too much sugar. It is a metabolic condition driven by pregnancy hormones, and it can happen to anyone — including people who eat well and exercise regularly.
Having risk factors does not mean you will develop gestational diabetes. Many people with no risk factors are diagnosed, and many with multiple risk factors are not.
The standard approach involves a two-step screening process. First, the one-hour glucose screening: you drink a 50-gram glucose solution and have your blood drawn one hour later. If your blood sugar is at or above the threshold (130 or 140 mg/dL, depending on your provider), you proceed to the three-hour diagnostic test.
For the three-hour test, you fast overnight, then drink a 100-gram glucose solution. Blood is drawn at fasting, 1 hour, 2 hours, and 3 hours. Gestational diabetes is diagnosed if two or more of the four values are elevated. For a detailed walkthrough of what to expect, see our complete glucose test guide.
About 15 to 25 percent of people fail the one-hour screening, but only about one-third of those go on to be diagnosed with gestational diabetes after the three-hour test. Failing the one-hour screening is common and does not mean you have the condition.
When blood sugar is too high, the extra glucose crosses the placenta to the baby. The baby's pancreas responds by producing more insulin, which acts as a growth hormone — potentially causing the baby to grow larger than expected (macrosomia). A baby over 9 pounds (4 kg) increases the risk of a difficult delivery, shoulder dystocia, and birth injuries.
After birth, babies born to mothers with uncontrolled gestational diabetes may experience low blood sugar (hypoglycemia) because their bodies are still producing extra insulin. They may also have a higher risk of jaundice and breathing difficulties in the first few hours. These are temporary and treatable, but they highlight why blood sugar management during pregnancy matters.
The good news is that well-managed gestational diabetes rarely causes these complications. When blood sugar is kept within target ranges, babies typically grow to a normal size and do well after birth.
Diet is the cornerstone of gestational diabetes management. About 80 to 85 percent of people manage the condition with dietary changes alone, without needing medication. The goal is not to eliminate carbohydrates but to eat them strategically.
Never eat carbohydrates alone. Pairing them with protein and healthy fats slows digestion and prevents blood sugar spikes. For example, have apple slices with peanut butter instead of an apple alone. Whole-grain toast with eggs instead of toast with jam. This simple principle is the foundation of gestational diabetes diet management.
Aim for three moderate meals and two to three snacks spaced evenly throughout the day. Eating every 2 to 3 hours keeps blood sugar levels stable and prevents the highs and lows that come from large meals followed by long gaps. A bedtime snack with protein (like cheese and crackers or yogurt) helps manage fasting blood sugar levels overnight.
Replace white bread, white rice, and sugary cereals with whole grains, sweet potatoes, quinoa, and brown rice. Complex carbohydrates break down more slowly, resulting in a gentler rise in blood sugar. Read nutrition labels — look for foods with at least 3 grams of fiber per serving.
Most gestational diabetes meal plans recommend 30 to 45 grams of carbohydrates per meal and 15 to 20 grams per snack. You do not need to eliminate carbs — they are essential fuel for you and your baby — but controlling portions is key. A registered dietitian can help you create a personalized plan.
A 10 to 15 minute walk after eating can significantly lower post-meal blood sugar levels. Gentle movement helps your muscles absorb glucose from the bloodstream. Even slow walking counts. If you cannot walk, gentle stretching or light activity can also help.
Keeping a log of your blood sugar readings alongside what you ate and your activity level helps you and your provider identify patterns. Many people discover specific foods that spike their blood sugar and can adjust accordingly. Your readings are your best tool for managing this condition effectively.
Your provider may adjust these targets based on your individual situation. These are the most commonly used ACOG-recommended thresholds.
About 15 to 20 percent of people with gestational diabetes need medication in addition to diet changes. This is not a failure — some placentas produce more insulin-blocking hormones than others, and no amount of dietary adjustment can overcome that.
Insulin is the first-line medication for gestational diabetes because it does not cross the placenta and has the longest safety record. It is injected — typically before meals or at bedtime — and your provider will teach you the technique. Metformin and glyburide are oral alternatives that some providers use, though they do cross the placenta and current ACOG guidelines favor insulin when medication is needed.
If you need medication, your provider will work closely with you to find the right dose. Blood sugar monitoring becomes even more important to ensure the medication is working effectively and to avoid episodes of low blood sugar.
Gestational diabetes means more frequent monitoring in the third trimester. You will likely have additional growth ultrasounds to check the baby's size, non-stress tests to monitor the baby's heart rate, and more frequent prenatal visits. This extra attention is a good thing — it ensures both you and your baby are closely watched.
Most providers recommend checking blood sugar four times a day: once in the morning before eating (fasting) and once after each meal (1 or 2 hours after, depending on your provider). Some also recommend a bedtime check. You will use a glucometer with test strips, and the process becomes routine quickly.
If you are considered high-risk due to gestational diabetes combined with other factors, your provider may recommend referral to a maternal-fetal medicine specialist for additional oversight.
Well-managed gestational diabetes with normal-range blood sugars and a normal-sized baby may not change your delivery plan at all. However, if blood sugar has been difficult to control or the baby is measuring large, your provider may recommend induction between 37 and 39 weeks or a planned cesarean delivery.
During labor, your blood sugar will be monitored, and you may receive IV fluids with glucose to keep levels stable. After delivery, the baby's blood sugar will be checked in the first few hours. Most babies do fine, especially when gestational diabetes has been well-managed throughout pregnancy.
Blood sugar levels typically return to normal within hours to days after delivery. Your provider will recommend a follow-up glucose test 6 to 12 weeks postpartum to confirm that your levels have normalized.
Your care team is there to help you fine-tune your management plan. Do not hesitate to reach out with questions.
These symptoms need urgent evaluation. Do not wait to see if they resolve on their own.
Gestational diabetes resolves after delivery for most people, but it does increase your long-term health risks. About 50 percent of people with gestational diabetes develop type 2 diabetes within 5 to 10 years. The best way to reduce this risk is maintaining a healthy weight, staying physically active, and eating a balanced diet after pregnancy.
Your provider will order a 75-gram oral glucose tolerance test at your 6 to 12 week postpartum visit, and annual screening is recommended going forward. Breastfeeding may help improve insulin sensitivity and reduce your risk of type 2 diabetes — one more reason to consider it if you are able.
For related information, see our glucose test guide, pregnancy diet guide, pregnancy exercise guide, and high-risk pregnancy guide. If you are managing other pregnancy symptoms alongside gestational diabetes, our guide on pregnancy fatigue may also be helpful.
This guide is for informational purposes only and is not a substitute for professional medical advice. Always consult your healthcare provider with any questions about your pregnancy.
