Gestational Diabetes: Glucose Test, What to Eat and Birth

What it is

• Pregnancy hormones make the body less able to use insulin, so blood sugar runs high. It affects up to about 1 in 10 pregnancies in the US.
• It is not caused by something you ate or did. Risk is higher with a family history of diabetes, higher weight, age over 35, PCOS, a past large baby, and in some Black, Hispanic, Asian, Native American and Pacific Islander families.
• Well-managed, most people with it have healthy pregnancies and babies.

Testing

• Usually at 24-28 weeks, earlier if you have risk factors.
• Common US approach: a 1-hour test after a sweet drink, with no fasting needed. If high, a 3-hour fasting test follows. Some practices use a single 2-hour fasting test instead.

Eating with gestational diabetes

• You don't need to cut out carbohydrates. Spread them out: three moderate meals and two or three snacks, including a bedtime snack.
• Pair carbs with protein or fat (apple with cheese, toast with egg).
• Choose fiber-rich carbs: whole grains, beans, vegetables, whole fruit. Limit juice, soda, sweets and large portions of rice, bread or pasta.
• Ask for a session with a dietitian or diabetes educator; they can work with your family's foods and culture, not just a generic list.
• A 10-15 minute walk after meals can help lower blood sugar.

Checking blood sugar

• You'll usually check with a finger stick on waking and 1 or 2 hours after each meal.
• Common targets: fasting under 95 mg/dL (5.3 mmol/L); 1 hour after eating under 140 (7.8); or 2 hours after under 120 (6.7). Your team may set different numbers.
• Log readings with what you ate; patterns matter more than one number.

If diet isn't enough

• Some people, roughly 1 in 4 or fewer, need medicine. Insulin is the usual first choice; some are offered metformin or another pill. Needing medicine is not a failure.

Late pregnancy and birth

• Expect extra checks of the baby's growth and well-being, especially if you take medicine.
• Birth is often planned around 39-40 weeks if sugar is controlled with diet, and around 39 weeks with medicine. Earlier if there are other concerns.
• Babies can grow large, which raises the chance of a hard delivery or cesarean, and can have low blood sugar in the first hours. The baby's sugar will be checked after birth; skin-to-skin and feeding early help.
• Ask whether hand-expressing and saving colostrum in the last weeks of pregnancy is right for you.

After the birth

• Get a 2-hour glucose test 4-12 weeks after birth, then diabetes screening every 1-3 years. The lifetime chance of type 2 diabetes is higher.
• Breastfeeding and staying active lower that risk. Test early in any future pregnancy.

When to check in

• Call your team if readings are above target several times in a week, or you're unsure about food.
• Contact your provider the same day for blood sugar readings that stay high despite your plan, or if you feel shaky, sweaty or confused on insulin and it doesn't improve with fast sugar.
• If you can't be woken or have a seizure, someone should call 911.