Pregnancy can change many things — how hungry you feel, how much energy you have, even how your body handles food. Most of these changes can be expected, but there is one change that often comes as a surprise: gestational diabetes mellitus (GDM).
GDM is the name given when high blood sugar is detected for the first time during pregnancy. The tricky thing is that it may not cause obvious symptoms. Many women who develop it have never had diabetes before. That’s why health professionals often encourage screening as a routine part of prenatal care.
Statistics show that this should not be taken lightly. Globally, approximately 14.7% of pregnancies may be affected by high blood sugar. In Southeast Asia, it may be closer to one in four. In India, studies vary – some rural areas in central and western India show rates of 1.9% and 12.7% respectively, while in urban centres, the figure has been reported to range from 6.6–27.2%. And since approximately 85–90% of diabetes diagnosed in pregnancy is gestational, most guidelines now recommend that screening be offered to all pregnant women, not just those seen as “high risk.”¹
How can high blood sugar affect mothers and babies?
for mothers
So why does GDM matter? High blood sugar during pregnancy may increase the chance of certain complications. Women with GDM may be more likely to develop high blood pressure or pre-eclampsia, which can affect both mother and baby. Other issues may include too much amniotic fluid, a longer or more difficult labor, or sometimes the need for a cesarean delivery.
Even after delivery, the risks do not always go away immediately. Some women may face problems like improper contraction of the uterus, heavy bleeding or infection. And looking beyond pregnancy, research shows that women who have had GDM are at higher risk.¹ Likely to develop type 2 diabetes within five to ten years¹There may also be a possible increase in heart-related problems in later life.
for babies
If maternal blood sugar remains high, the baby may also be affected. Glucose crosses the placenta, and the baby may respond by producing additional insulin. This can sometimes lead to macrosomia (a larger than average baby), which makes delivery more complicated and increases the chance of birth injury.
Soon after birth, some newborns may have low blood sugar, jaundice, or breathing problems. And later in life, children exposed to high maternal blood sugar during pregnancy may face other health concerns, including obesity, diabetes, or heart and nerve problems. This is often described as a transgenerational effect, where risks can transfer from one generation to the next.
Why is testing advised to every mother now?
Not long ago, only women seen as “at risk”, i.e. older mothers, those who were overweight, or those who had a family history of diabetes, were tested for GDM. But given the increasing prevalence of diabetes worldwide and the large number of live births due to GDM, it is necessary to timely screen all women even in the absence of symptoms.¹
The DIPSI (Diabetes in Pregnancy Study Group of India) method could be a suitable solution to address this. The test is simple: A pregnant woman is given 75 grams of oral glucose, and her blood sugar is measured two hours later. If the reading is 140 mg/dL or higher, it may indicate GDM.
One of the main benefits is convenience. The test does not require fasting and can be done during routine prenatal checkups. Guidelines generally suggest testing at the first prenatal appointment, ideally before 12 weeks. If the results are normal (negative), the test can be repeated at 24-28 weeks, with a gap of at least 4 weeks between the two tests. Early detection of GDM gives families and doctors more time to manage it.
Managing gestational diabetes: what can help
nutrition first¹
Diet usually plays a central role in managing blood sugar. The aim is not to eat less but to create a healthy balance so that both mother and baby get the necessary nutrients.
A simple “plate method” is often suggested by healthcare providers:
- Half plate of vegetables (green leafy vegetables, vegetables with high water content, other traditional vegetables, and a variety of legumes)
- One quarter with protein (such as pulses, lentils, or lean meat)
- a quarter with grain, buckwheat or millet
- Extra – 200 ml curd for all three meals and snack (roasted gram/sprouted grains/salad)
General guidelines also recommend about 175 grams of carbohydrates, 71 grams of protein and 28 grams of fiber per day.¹ Micronutrients such as iron, calcium, zinc, folic acid, vitamins C and B12, and iodine are also important. Healthy fats are encouraged, while saturated and trans fats are kept low. 2.3 liters of water per day is recommended, caffeine is often limited to less than 200 mg per day, and alcohol is avoided altogether.¹
Calorie needs usually increase during pregnancy – about 1,800 kcal/day in the first trimester, 2,200 kcal in the second, and 2,400 kcal in the third. That said, every woman’s needs are different, so it’s best to follow a plan designed with a doctor or dietitian.
stay active
Staying active within safe limits can help the body use insulin more effectively. Walking, light aerobics or yoga are common suggestions for pregnancy. But the right activity level depends on individual health, so it’s always best to check with a health care professional first.
sugar level monitoring
Keeping track of blood sugar during pregnancy can make a big difference. The DIPSI 2023 guidelines say regular checks can help both moms and doctors see how well blood sugar is being managed and adjust plans if needed.
Women who are on insulin may be asked to do a seven-point test – before and two hours after each meal, and again before bedtime. For most others, four tests a day, i.e. one before breakfast and one two hours after each main meal, usually give enough information. This helps the care team, especially if insulin is required, to adjust treatment for optimal glycemic control.
If sugars remain stable with dietary changes and more frequent testing is not possible, weekly fasting and postprandial testing may be sufficient, as long as it is done under medical advice. Where available, for more comprehensive insight into glucose trends, some health care professionals may recommend the use of continuous glucose monitoring (CGM).
Many women now use mobile apps that record these readings and share them securely with their doctors. This makes it easier for care teams to follow progress and decide when a change in treatment is needed.
The general goal is to keep the reading around 90 mg/dL before meals and around 120 mg/dL two hours after eating. These levels, recommended by DIPSI and the American College of Obstetricians and Gynecologists (ACOG), are associated with healthy outcomes for both mother and baby.
When lifestyle changes are not enough
For many women, adjustments in diet and activity may be sufficient. But if blood sugar remains high, doctors may suggest insulin therapy. The treating physician will advise on the best approach, which may include specific types of insulin that are approved and considered safe for use during pregnancy. The exact medication and dosage are tailored to each woman and will be adjusted by the treating doctor as the pregnancy progresses.
Pregnancy and Childbirth: What to Expect
Because GDM is generally considered a high-risk condition, women may be advised to attend more prenatal visits, have at least three ultrasound scans, and frequently monitor blood pressure, blood sugar levels, and the baby’s growth.
Most women can still plan for a vaginal delivery, but if the baby is very large or complications are seen, a cesarean may be recommended by the treating doctor after evaluation. Early delivery before 39 weeks is usually avoided unless there is a clear medical indication. During delivery, blood sugar is closely monitored, and the insulin dose can be adjusted if necessary.
After birth: why follow-up matters
for newborn baby
Babies born to mothers with GDM often need extra attention in their first hours. Their blood sugar is usually checked within the first hour and then every four hours until the readings fall into the target range as advised by the treating physician. Exclusive breastfeeding is strongly encouraged, as it can aid glucose control and healthy development.
for mom
For mothers, the journey does not always end with delivery. Having GDM may be considered one of the predictors of type 2 diabetes in later life. That’s why a glucose tolerance test is generally recommended about six weeks postpartum, followed by an annual checkup. Postpartum counseling may also include advice on healthy eating, regular exercise, weight management, and family planning. These lifestyle choices can be important in reducing future risks.
breaking the cycle
If left unchecked, gestational diabetes can set up a cycle in which both mother and baby will face higher risks for years to come. But with prompt diagnosis, proper management and regular follow-up, that cycle can be broken.
Gestational diabetes doesn’t always cause obvious symptoms, but its effects can be far-reaching. This condition can increase the risk of complications during pregnancy and may also increase the chances of diabetes for both mother and baby in the years to come. The reassuring fact is that prompt and even universal testing, with timely management and regular follow-up, can make a meaningful difference.
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Note to reader: This article is created by HT Brand Studio on behalf of Roche Diabetes Care India Pvt. Ltd. Ltd. The information provided is for informational purposes only and does not constitute medical advice or endorsement. Please consult a registered medical practitioner for personal medical advice or before making any decisions regarding your health conditions or treatment options.
