Managing Gestational Diabetes: Tips for a Healthy Pregnancy and Beyond
Pregnancy is like a deep sea diver, shining a light on cardiometabolic issues that might not otherwise be found for decades, when they manifest as prediabetes or even full-blown diabetes. The complex connections between our changing metabolism and hormone levels, alongside the need for increased energy to make a whole new person, can reveal important information about your metabolic health.
For people who get diagnosed with gestational diabetes, this can be life-changing, but it can be so in a good way. Discovering metabolic problems that manifest themselves as gestational diabetes means that you are now empowered to take control of your health in pregnancy, which will also prepare you for a healthier postpartum recovery and can change the course of your health lifelong.
Together we’ll discuss what gestational diabetes is and what it means for your health, as well as ways to support your cardiometabolic health in pregnancy and postpartum.
Understanding Gestational Diabetes: What You Need to Know
Gestational diabetes is a condition where blood sugar levels rise during pregnancy, often revealing hidden metabolic issues like insulin resistance.
While it may feel overwhelming, it’s also an opportunity to address your health, improve pregnancy outcomes, and set the stage for long-term well-being. Managing gestational diabetes can empower you to take control of your health now and in the future.
Gestational Diabetes Mellitus (GDM): Definition
Gestational diabetes mellitus (GDM), which affects one in every six pregnancies, is high blood sugar first diagnosed during pregnancy.
It develops because pregnancy hormones make the body less responsive to insulin, an important hormone that helps regulate blood sugar. If the pancreas can’t compensate by producing more insulin, blood sugar levels rise.
Why GDM Matters
GDM can cause pregnancy complications like high blood pressure, larger-than-average babies (macrosomia), and an increased risk of cesarean delivery. Long-term, it raises the risk of type 2 diabetes and heart disease for the mother and metabolic issues for the child.
Who’s at Risk for GDM?
The following risk factors make it more likely that a pregnant person will develop GDM:
Lifestyle: obesity, lack of exercise, cigarette smoking, and past pregnancies with GDM or large babies.
Genetics/Ethnicity: family history of diabetes or being African American, Latino, or Asian American.
Health Conditions: polycystic ovary syndrome (PCOS), high blood pressure, or insulin resistance (e.g., darkened skin patches called acanthosis nigricans).
Excessive weight gain in pregnancy
Prior Pregnancy Complications: issues like spontaneous abortion, fetal anomalies, or preeclampsia can raise the risk.
Does GDM Require Medication?
Not always. GDM is usually categorized into two types: diet-controlled (A1GDM) or requiring medication (A2GDM).
Women with high blood pressure in pregnancy may require medication; this is important to discuss with your doctor.
Pathophysiology of GDM: How Does GDM Develop?
Insulin is a hormone made by the pancreas that helps control blood sugar levels. After you eat, insulin allows sugar (glucose) to move from your blood into your cells, where it’s used for energy or stored for later. It also helps your liver store glucose as glycogen and supports the creation of fat and protein. Insulin works by attaching to receptors on cells, activating transporters (GLUT) that let glucose enter cells, and ensuring your blood sugar stays balanced.
Normally, your body should respond quickly to rising insulin levels by letting blood sugar into cells to be used as energy.
In pregnancy, though, things change. Placental hormones like human placental lactogen increase insulin resistance to prioritize glucose supply (aka energy) for the growing fetus.
Normally, maternal insulin production rises to compensate, but in GDM, this adaptive response is inadequate due to underlying insulin resistance.
This results in high blood sugar in the mother: this excessive blood sugar can cross the placenta and cause excessive fetal insulin production, leading to increased fetal growth and complications.
Diagnosis and Screening
GDM is typically screened between 24-28 weeks of pregnancy. However, different experts recommend different testing. Common testing methods include:
One-Step Method: a 2-hour 75g oral glucose tolerance test (OGTT) with strict diagnostic criteria. It can be tough because it requires fasting beforehand and during the test.
One study found that using the 1-step test for gestational diabetes diagnosed nearly twice as many women compared to the 2-step test, but it didn’t lead to better results for moms or babies, like fewer large babies or lower rates of high blood pressure or C-sections. This raises questions about whether the 1-step test offers enough benefits to make it worth using more often.
Two-Step Method: a 50g glucose challenge test followed by a 3-hour 100g OGTT if the initial test is abnormal. The two-step method is recommended by ACOG, and is generally easier to implement in most doctors’ offices.
Postpartum Monitoring
Women with GDM are at increased risk for developing type 2 diabetes.
Blood sugar should be monitored within 24 to 72 hours of giving birth, as insulin resistance usually improves once the placenta is gone. This means insulin or other medications can often be reduced.
Blood sugar should again be tested within 4-12 weeks after delivery in women with GDM, using either fasting plasma glucose or a 75g OGTT. Continued screening every 1-3 years is essential for long-term health.
Management of GDM
Management begins with lifestyle interventions. We’ll dive deeper into these in a moment, but for now, it’s important to know expert recommendations.
Lifestyle Interventions
Eat foods that balance your carbs, with 33-55% of daily calories from carbs, and focus on low-glycemic foods that don’t spike blood sugar.
Include whole grains, lean proteins, healthy fats, and portion control to keep blood sugar steady and support healthy baby growth.
Do regular moderate exercise, like walking or light workouts, to help your body use insulin better and keep blood sugar in check.
Walking after meals is especially good for lowering blood sugar.
Testing blood sugar regularly helps to make sure it stays within recommended goals:
Before meals: ≤95 mg/dL
1 hour after eating: ≤140 mg/dL
2 hours after eating: ≤120 mg/dL
Self-monitoring can be used to adjust your diet or treatment plan as needed.
In some cases, medication may also be required to help women maintain healthy blood sugar levels.
Pharmacologic Treatment
If lifestyle changes aren’t sufficient, treatment may include:
Insulin Therapy: insulin is the standard treatment for GDM as it doesn’t cross the placenta.
Oral Medications: options like metformin or glyburide exist, though these are less commonly used due to potential risks. Glyburide is associated with significant transfer to the baby across the placenta and increased health complications in babies, while metformin is linked to concerns about long-term effects on the child’s health.
Why Addressing Gestational Diabetes Matters
Gestational diabetes is more than a temporary condition—it’s a wake-up call.
Research shows that women who experience GD are at a higher risk of developing type 2 diabetes, insulin resistance, and cardiovascular issues later in life. Addressing it during pregnancy is a chance to safeguard your long-term health and take proactive steps to support your body.
Additionally, managing GD helps protect your baby’s health. High blood sugar levels can lead to complications such as larger-than-average birth weight, early delivery, or an increased risk of your child developing metabolic conditions later in life.
Prevention and Management of Gestational Diabetes
The good news is that there are effective ways to prevent or manage gestational diabetes. Taking these steps can help support your cardiometabolic health in pregnancy and postpartum:
Focus on a Balanced Diet
Food has great power to heal, or harm. Choose whole foods like vegetables, lean proteins, plant-based fats like olive oil and avocado, and high-fiber carbohydrates like beans and whole grains.
It’s also important to limit sugar and refined carbs: sugary drinks, processed snacks, and refined grains like white breads, cakes, and pastries spike blood sugar levels. This is especially important in pregnancy and postpartum, as your body needs more nutrients from healthy foods than it has ever needed: sugary foods and refined carbs are high-calorie, nutrient-poor foods.
Follow the Mediterranean Diet
In my book POST: The Essential Guide to Creating Your Postpartum Self-Care Plan in Pregnancy I dive deep into the health benefits of the Mediterranean diet for pregnant and postpartum people.
As a whole foods-based, nutrient-rich diet with TONS of recipes, pre-made items, and information easily available, the Mediterranean diet is a delicious and sustainable choice for your health now, and in the future. It’s also got research to back it up as a great way to reduce the risk of developing gestational diabetes.
One study linked the Mediterranean diet to better blood sugar control, with lower fasting and 2-hour post-meal glucose levels in women with and without gestational diabetes. It stated that key nutrients in the Mediterranean diet like healthy fats (MUFAs), antioxidants, polyphenols, and fiber may help reduce insulin resistance and oxidative stress, both of which are tied to GDM.
Another study conducted in Iran found that pregnant women with greater adherence to a modified Mediterranean diet (MedDiet) during early pregnancy had a 41% lower risk of developing gestational diabetes mellitus (GDM) compared to those with low adherence.
The Mediterranean diet is full of great superfoods:
Olive Oil – rich in healthy monounsaturated fats, olive oil has research-demonstrated antioxidant and anti-inflammatory properties.
Tomatoes – packed with vitamins, minerals, and antioxidants including lycopene.
Leafy Greens – includes spinach, kale, arugula, and Swiss chard, which are high in vitamins E, K, folate, and plant-based antioxidant compounds like lutein.
Legumes – chickpeas, lentils, and beans, which provide fiber and plant-based protein.
Fish – fatty fish like salmon, sardines, mackerel, and tuna, which are rich in omega-3 fatty acids.
Nuts and Seeds – almonds, walnuts, chia seeds, and flaxseeds, which have healthy fats and protein.
Fruits – citrus fruits, berries, grapes, and pomegranates, are some fruits that are loaded with plant-based antioxidant compounds like flavonoids, phenols, anthocyanins and carotenoids to protect cell health.
Whole Grains – quinoa, farro, bulgur, and whole-grain bread are high in fiber.
Garlic – known for its immune-boosting and anti-inflammatory properties.
Herbs and Spices – herbs like basil, oregano, rosemary, thyme, and turmeric add flavor and health benefits.
Avocado – a great source of monounsaturated fats, potassium, and fiber.
Eggplant – full of fiber, vitamins, and antioxidants.
Greek Yogurt – high in protein and probiotics for gut health.
Feta Cheese – a flavorful source of calcium and protein when consumed in moderation.
Eat Organic When Possible
A Mediterranean diet is linked to a lower risk of gestational diabetes (GDM), but foods that contain persistent organic pollutants (POPs), including vegetables, fruits, fish and animal products which are Mediterranean diet staples, can increase GDM risk.
A study of 2,802 pregnant women found the lowest GDM risk in those with high adherence to the Mediterranean diet and low POP levels. Women with high MedDiet scores but high POP exposure did not see the same benefits.
This suggests promoting healthy diets for GDM prevention should also address reducing environmental pollutants like POPs, which is most easily done by choosing organic foods when possible.
Stay Active
Regular exercise such as walking, swimming, or prenatal yoga can help regulate blood sugar levels during pregnancy. The recommendation for exercise in pregnancy is generally 150 minutes of moderate exercise per week, but always consult your doctor before starting or continuing an exercise routine.
Consistency is key to reaping the benefits, and can provide long-term changes to your health.
Monitor Blood Sugar Levels
Collaborate with your healthcare team to learn how to check your blood sugar levels and make adjustments as needed. Keeping a journal of your meals, exercise, and blood sugar readings can help you identify patterns and track your progress, ensuring better management of your health.
In my pregnancy and postpartum I used continuous glucose monitors to make sure I was balancing food intake with activity.
Prioritize Stress Management
Stress can impact blood sugar control, so it’s essential to find good ways to manage stress levels. Practicing mindfulness techniques like deep breathing, meditation, or journaling, or connecting with other pregnant women or speaking with a counselor can also provide support and help reduce feelings of isolation.
Plan for Postpartum Health
Your cardiometabolic health doesn’t end with pregnancy. Managing blood sugar during and after pregnancy can reduce your risk of future health problems. This is where planning ahead becomes vital.
The Importance of Postpartum Preparation
The postpartum period is a critical time to focus on your recovery and long-term health. Hormonal changes, sleep deprivation, and stress can impact your blood sugar regulation and overall well-being. That’s why creating a postpartum care plan during pregnancy is essential.
I wrote my book, POST: The Essential Guide to Creating Your Postpartum Self-Care Plan in Pregnancy, during my postpartum experience to be an invaluable resource for navigating this transition.
It offers actionable, research-based strategies to support your recovery, balance your hormones, and build a strong foundation for lifelong health. Whether you’re managing gestational diabetes or simply want to prepare for a healthy postpartum experience, this book provides the tools you need.
Talk to Your Doctor
If you’ve been diagnosed with gestational diabetes—or are at risk—discuss your cardiometabolic health with your doctor. Together, you can create a personalized plan to manage your blood sugar, support your pregnancy, and set yourself up for a healthier future.
Take Charge of Your Health Today
Gestational diabetes may feel daunting, but it’s also a call to action. By making thoughtful choices now, you can protect your health, nurture your baby, and lay the groundwork for a vibrant future.
Focus on balanced nutrition, regular exercise, stress management, and proactive planning for postpartum recovery. And don’t forget to explore resources like my book POST to help you every step of the way.
References
ACOG Practice Bulletin No. 190: Gestational Diabetes Mellitus. (2018). Obstetrics and gynecology, 131(2), e49–e64. https://doi.org/10.1097/AOG.0000000000002501
Arreola, R., Quintero-Fabián, S., López-Roa, R. I., Flores-Gutiérrez, E. O., Reyes-Grajeda, J. P., Carrera-Quintanar, L., & Ortuño-Sahagún, D. (2015). Immunomodulation and anti-inflammatory effects of garlic compounds. Journal of immunology research, 2015, 401630. https://doi.org/10.1155/2015/401630
Borghi, S. M., & Pavanelli, W. R. (2023). Antioxidant Compounds and Health Benefits of Citrus Fruits. Antioxidants (Basel, Switzerland), 12(8), 1526. https://doi.org/10.3390/antiox12081526
Burlina, S., Dalfrà, M. G., Chilelli, N. C., & Lapolla, A. (2016). Gestational Diabetes Mellitus and Future Cardiovascular Risk: An Update. International journal of endocrinology, 2016, 2070926. https://doi.org/10.1155/2016/2070926
Collins, E. J., Bowyer, C., Tsouza, A., & Chopra, M. (2022). Tomatoes: An Extensive Review of the Associated Health Impacts of Tomatoes and Factors That Can Affect Their Cultivation. Biology, 11(2), 239. https://doi.org/10.3390/biology11020239
Dave HD, Preuss CV. Human Insulin. [Updated 2023 Aug 28]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK545190/
Diaz-Santana, M. V., O'Brien, K. M., Park, Y. M., Sandler, D. P., & Weinberg, C. R. (2022). Persistence of Risk for Type 2 Diabetes After Gestational Diabetes Mellitus. Diabetes care, 45(4), 864–870. https://doi.org/10.2337/dc21-1430
Fatemeh Mohtashaminia, Hosseini, F., Jayedi, A., Majid Mirmohammadkhani, Emadi, A., Takfallah, L., & Sakineh Shab-Bidar. (2023). Adherence to the Mediterranean diet and risk of gestational diabetes: a prospective cohort study. BMC Pregnancy and Childbirth, 23(1). https://doi.org/10.1186/s12884-023-05960-4
Gaforio, J. J., Visioli, F., Alarcón-de-la-Lastra, C., Castañer, O., Delgado-Rodríguez, M., Fitó, M., Hernández, A. F., Huertas, J. R., Martínez-González, M. A., Menendez, J. A., Osada, J., Papadaki, A., Parrón, T., Pereira, J. E., Rosillo, M. A., Sánchez-Quesada, C., Schwingshackl, L., Toledo, E., & Tsatsakis, A. M. (2019). Virgin Olive Oil and Health: Summary of the III International Conference on Virgin Olive Oil and Health Consensus Report, JAEN (Spain) 2018. Nutrients, 11(9), 2039. https://doi.org/10.3390/nu11092039
Hillier, T. A., Pedula, K. L., Ogasawara, K. K., Vesco, K. K., Oshiro, C. E. S., Lubarsky, S. L., & Van Marter, J. (2021). A Pragmatic, Randomized Clinical Trial of Gestational Diabetes Screening. The New England journal of medicine, 384(10), 895–904. https://doi.org/10.1056/NEJMoa2026028
Kominiarek, M. A., & Peaceman, A. M. (2017). Gestational weight gain. American journal of obstetrics and gynecology, 217(6), 642–651. https://doi.org/10.1016/j.ajog.2017.05.040
Lawrence, J. M., Black, M. H., Hsu, J. W., Chen, W., & Sacks, D. A. (2010). Prevalence and timing of postpartum glucose testing and sustained glucose dysregulation after gestational diabetes mellitus. Diabetes care, 33(3), 569–576. https://doi.org/10.2337/dc09-2095
Mahjoub, F., Ben Jemaa, H., Ben Sabeh, F., Ben Amor, N., Gamoudi, A., & Jamoussi, H. (2021). Impact of nutrients and Mediterranean diet on the occurrence of gestational diabetes. The Libyan journal of medicine, 16(1), 1930346. https://doi.org/10.1080/19932820.2021.1930346
Morris, M. C., Wang, Y., Barnes, L. L., Bennett, D. A., Dawson-Hughes, B., & Booth, S. L. (2018). Nutrients and bioactives in green leafy vegetables and cognitive decline: Prospective study. Neurology, 90(3), e214–e222. https://doi.org/10.1212/WNL.0000000000004815
Odabaş, T., Odabaş, O., & Meseri, R. (2024). Impact of Mediterranean diet in lowering risk of gestational diabetes mellitus: A cross-sectional study. Medicina Clínica (English Edition), 162(7), 321–327. https://doi.org/10.1016/j.medcle.2023.11.009
Rahaman, M. M., Hossain, R., Herrera-Bravo, J., Islam, M. T., Atolani, O., Adeyemi, O. S., Owolodun, O. A., Kambizi, L., Daştan, S. D., Calina, D., & Sharifi-Rad, J. (2023). Natural antioxidants from some fruits, seeds, foods, natural products, and associated health benefits: An update. Food science & nutrition, 11(4), 1657–1670. https://doi.org/10.1002/fsn3.3217
Rodriguez, B. Q., Heba Mahdy, & Vadakekut, E. (2024, July 14). Gestational Diabetes. StatPearls. https://www.statpearls.com/point-of-care/22231
Sharma, K., Akre, S., Chakole, S., & Wanjari, M. B. (2022). Stress-Induced Diabetes: A Review. Cureus, 14(9), e29142. https://doi.org/10.7759/cureus.29142
Sweeting, A., Wong, J., Murphy, H. R., & Ross, G. P. (2022). A Clinical Update on Gestational Diabetes Mellitus. Endocrine reviews, 43(5), 763–793. https://doi.org/10.1210/endrev/bnac003
The American College of Obstetricians and Gynecologists. (2019, July). Exercise During Pregnancy. Www.acog.org. https://www.acog.org/womens-health/faqs/exercise-during-pregnancy
YU, G., WEI PANG, W., YANG, J., & ZHANG, C. (2024). 130-OR: Mediterranean Diet and Gestational Diabetes—What Is the Role of Exposure to Persistent Organic Pollutants. Diabetes, 73(Supplement_1). https://doi.org/10.2337/db24-130-or