What is Gestational Diabetes?

Introduction

Pregnancy is a beautiful journey in a woman’s life, especially if she has been yearning to mother a child. A wonderful yet also powerful process where a woman goes through many changes, both physically and mentally. While the female body prepares itself to carry a child, it goes through a lot of changes. These changes result in the expecting mother experiencing common pregnancy symptoms like sore breasts, nausea, vomiting, changes in breast size and shape, abdominal cramps, spotting, fatigue and more, which can be felt as early as 4 weeks after conception. While most of these symptoms occur due to normal hormonal changes that are supposed to follow post-conception, there are also a large number of women who undergo hormonal imbalances during pregnancy. While these imbalances are mostly temporary, they require to be diagnosed and treated at the right time to eliminate any life-threatening risk to the mother or the baby. One such condition that is caused by hormonal imbalances during pregnancy is gestational diabetes. In this article, we are going to be looking at what gestational diabetes is, its symptoms, causes and risk factors and ways to effectively manage gestational diabetes to prevent further harm to the mother or the baby.

What is Gestational Diabetes?

Gestational Diabetes is a condition where diabetes is diagnosed for the very first time in a pregnant woman. Gestational diabetes mellitus is usually the result of β-cell dysfunction on a background of chronic insulin resistance during pregnancy, with contribution from the hormones produced from the placenta^[1]. It occurs when the hormone produced by the placenta (the organ that provides nutrition and oxygen to the growing baby) hinders the body’s natural ability to use insulin effectively. Insulin is a hormone produced by the pancreas that plays an important role in lowering blood sugar levels and converting them into energy. When the body is not able to produce or respond to insulin, the blood sugar levels can build up and become very high, resulting in complications during pregnancy.

Hyperglycemia in pregnancy affects more than 6 million women per year in India^[2]. Today, it is estimated that around 4 million women in India have been affected by gestational diabetes.

Symptoms of Gestational Diabetes

Most of the time there may be no noticeable sign of gestational diabetes as few of the symptoms are very similar to the symptoms of pregnancy, so it may be difficult to identify it at first. However, if you do have a combination of the following gestational diabetes symptoms, it is better to consult a doctor at the earliest to determine this or any other condition.

• Blurry vision
• Infections in the vagina, bladder or skin.
• Tiredness
• Excessive thirst with dry mouth.
• Excessive need to urinate/large volume of urination.

It is important to note that tiredness, nausea and frequent urination are also very common symptoms of pregnancy. However, one of the most evident and noticeable symptoms of diabetes is blurry vision (the inability to see fine and precise details, including sharpness and the focus in your vision). Both long-term and short-term diabetes may cause blurry vision in patients. However, it is also possible to have a high sugar level with no noticeable symptoms initially.

To Summarize

• Most of the symptoms of Gestational Diabetes are very similar to the common experiences of pregnancy, so it may be difficult to identify it at first.
• One of the most evident and noticeable symptoms of diabetes may be blurry vision.
• Excessive thirst with a dry mouth and an excessive need to urinate are also symptoms of gestational diabetes.

What Causes Gestational Diabetes?

One of the main causes of Gestational Diabetes is hormonal changes. During pregnancy, a woman’s body develops the placenta, which is an organ that provides oxygen and nutrients to the baby and removes wastes from the baby’s blood.

The majority of the time, the pancreas can release enough insulin to handle this hormone overload. But in some cases, these placental hormones may block insulin from doing its job properly. This is known as insulin resistance. As the pregnancy advances, the placenta grows and produces more hormones, making the risk of insulin resistance even greater. When the body is unable to produce enough insulin, there is an extra build-up of glucose in the body, which then leads to Gestational Diabetes. Gestational diabetes mellitus usually occurs in the second half of the term and can be diagnosed in about 20 – 24 weeks into the pregnancy – It can also be diagnosed earlier or later in pregnancy depending upon the individual’s case.

Who is at risk of Gestational Diabetes in India?

Gestational Diabetes is most likely to affect women with the following factors:

• If you already had other medical conditions like PCOS before pregnancy.
• If you were overweight before pregnancy or if you gained weight quickly during pregnancy.
• If you had gestational diabetes in your past pregnancies.
• If you had/have pre-diabetes (i.e. high blood sugar level that is not high enough to be diagnosed with diabetes)
• If any member of your immediate family (mother, brother or sister) has type 2 diabetes.
• If your child from your previous pregnancy weighed more than 4.1 kg at birth.
• In addition to the above-mentioned factors, diet and nutrition are also equally important factors for Gestational Diabetes. If the usual diet of the expecting mother has been unhealthy or unbalanced even before pregnancy, it can lead to Gestational Diabetes in pregnancy. Pregnant or not, a well-balanced diet and a healthy lifestyle can prevent several medical conditions during pregnancy and also at the later stages of life.

To Summarize

• One of the main causes of Gestational Diabetes is insulin resistance.
• In some cases, the placental hormones of a pregnant woman may cause a blocking effect on the body’s insulin – a condition that is also called the contra-insulin effect or insulin resistance.
• If you were overweight before pregnancy or suffered from PCOS, there are chances of you being diagnosed with gestational diabetes.
• If the usual diet of the expecting mother has been unhealthy or unbalanced even before pregnancy, it can lead to Gestational Diabetes in pregnancy.

How is Gestational Diabetes Diagnosed?

If you have the above-mentioned symptoms or if you have any of the above-mentioned factors that put you at risk of developing the condition, it is best to consult your doctor for immediate treatments and precautions to prevent any serious complications during childbirth. Most hormonal imbalances that occur during pregnancy usually resolve by themselves after the child is born, and for most women, gestational diabetes goes away after childbirth. However, it is very important to understand that half of the women who had gestational diabetes in their pregnancies may go on to develop type 2 diabetes later in their lives. Therefore, you will likely be advised to get tested more frequently for any possible changes in blood sugar levels. The following are important gestational diabetes tests that are done to diagnose the condition:

1. Oral glucose tolerance test (OGTT)

This is the prime diagnostic test for gestational diabetes (also used to test Type 2 Diabetes) that shows how well your body can break down or handle sugar from foods. It can determine if you are at risk of developing the condition or/and if you already have it. OGTT is a simple blood test that is done after you fast for 8 – 12 hours. Blood will be drawn in the morning before your breakfast. This is done to test your starting blood sugar level. You will then be asked to consume a sugary drink, which is a mixture of glucose and water. Your next glucose tolerance test will be taken two hours later (or up to four times at different time intervals, depending on your case), where the nurse will draw more blood to see how your body has handled the sugar^[3].

Additionally, your doctor will diagnose Gestational diabetes by an elevated level of blood glucose found in a screening test like fasting blood sugar or random blood sugar, which may be advised multiple times during pregnancy and an oral glucose tolerance test, which is the most important test for gestational diabetes.

2. Fasting blood sugar test

A fasting blood sugar test is taken on an empty stomach. For the 8 hours leading up to the test, you won’t be permitted to eat or drink anything but water. A nurse will draw blood from a vein in the arm for further testing.

3. Random blood sugar test

RBS is the blood sugar test that is done at any time of the day irrespective of the time lapsed after meals. This gives an overview of the blood sugar levels and is used as a screening tool for diabetes.

Doctors usually depend on blood tests, either OGTT or Fasting Blood sugar, Random blood sugar or both, to determine diabetes. For gestational diabetes, you will most likely have one or more blood tests to confirm the presence of the condition. Once confirmed, you will be given some treatment for Gestational Diabetes Mellitus.

To Summarize

• Most hormonal imbalances that occur during pregnancy resolve by themselves after the child is born, and for the majority of women, gestational diabetes too goes away after childbirth.
• Half of the women who had Gestational diabetes mellitus in their pregnancies may go on to develop type 2 diabetes later in their lives.
• Oral Glucose Tolerance Test (OGTT) is a gestational diabetes test (also used to test Type 2 Diabetes) that shows how well your body can break down or handle sugar from foods. It can determine if you are at risk of developing the condition or/and if you already have it.

Gestational Diabetes Treatment

If you are diagnosed with Gestational Diabetes, you can rest assured that the condition can be effectively managed with ease. Most women with gestational diabetes go on to have healthy, active babies, and there is no threat to their future babies and pregnancies when diabetes is managed well. It is important to stay stress-free and relaxed during your pregnancy to keep your baby safe and healthy. Managing gestational diabetes includes simple lifestyle changes, a positive mindset and above all, a good doctor or gynaecologist who would be able to advise you with the right management or treatment plan suited to your diagnosis.

Treatment for pregnancy diabetes requires timely medications, a few lifestyle changes and timely attention, following which you will be able to have a healthy pregnancy and baby. Patients with gestational diabetes will be advised to maintain a healthy and balanced diet after pregnancy to keep diabetes at bay. Once you consult your doctor, you will be given a set of treatment options depending on your case.

How to treat gestational diabetes?

First things first, if you have been diagnosed with gestational diabetes, never think of venturing into any form of self-treatment. It is absolutely vital to consult your doctor to ensure the right treatment is administered that will protect you and your baby throughout the pregnancy term. The following are a few Gestational Diabetes treatment options that your doctor may suggest:

1. Monitoring blood sugar levels

Once you have been diagnosed with gestational diabetes, your physician will ask you to keep a close eye on your blood sugar levels, maybe four times or more in a day (i.e. First reading in the morning before food and then one to two hours after all meals in a day). You can easily do this in the comfort of your home with a glucometer. Ensuring this, you will be able to keep your blood sugar levels within the normal range, which will help you and your baby stay healthy and happy.

2. Insulin treatment for gestational diabetes mellitus

Most of the time, simple diet changes are enough to keep your blood sugar levels in control. However, for about 30% of women who are diagnosed with gestational diabetes, these diet changes are not enough. These patients will then be advised to take insulin. In fact, insulin is necessary to keep you and your baby safe from pregnancy complications. It is a traditional, first-choice Gestational Diabetes treatment option that is also considered most effective.

Insulin injections are usually given in the upper arm or in the thigh. It is important to educate yourself on insulin and take the utmost care when administering it yourself. Make sure you have the right doses, practice taking your shot or have someone with a steady hand assist you in doing so and always store the insulin properly to ensure that each dose works to its maximum level.Continue to monitor your glucose levels at regular intervals and adjust your doses as advised by treating Endocrinologist/Physician.

3. Diet for gestational diabetes

The following are some guidelines for diet for gestational diabetes that your doctor or dietitian may ask you to follow to keep your blood sugar levels in control:

• Eat smaller meals that are more frequent.
• Include an adequate amount of healthy carbohydrates in your meals. Carbohydrates break down to glucose during digestion and are highly beneficial for you and your baby. But remember to consume carbohydrates in a controlled amount, not to overeat.
• Avoid eating high sugary and processed foods. This is a golden rule for any person, pregnant or not.
• Consume less sugary fruits and plenty of vegetables. If you crave sweets during pregnancy, opt for fruit instead of sugary food.
• Include a good amount of protein and fibre-rich food in every meal^[3].

4. Exercises

Exercise has proved to be beneficial for women with gestational diabetes. It helps the body to become sensitive to the insulin produced and helps regulate blood sugar levels. Most doctors recommend aerobic exercise^[7] like walking, dancing and swimming with moderate intensity for about 30 minutes to an hour, three to five days a week. It is important to consult your doctor and understand the right exercises for yourself depending upon your health conditions^[4].

To Summarize

• Most women with Gestational Diabetes go on to have healthy, active babies, and there is no threat to their future babies and pregnancies.
• Treatment for pregnancy diabetes requires a few lifestyle changes and timely attention, following which you will be able to have a healthy pregnancy and baby.

Complications of Gestational Diabetes

While gestational diabetes is fairly easy to control, there are some complications that may occur during and after pregnancy if the condition is left undiagnosed or untreated. In this section, we are going to make you aware of the complications with gestational diabetes, so if you do have to face a situation like this, you can deal with the condition with a positive and relaxed mindset.

1. Early birth

One of the biggest complications of Gestational diabetes is the risk of the child being born prematurely. When the mother’s blood sugar levels are not controlled, the unborn child tends to receive too much glucose through the placenta and can grow too big for the mother to carry throughout the 9-month term. This is why it is extremely important to keep your blood sugar under control.

2. Breathing difficulties

When babies are born early or before their due date, they are likely to experience breathing issues that are caused by an insufficiency of a certain substance produced in the baby’s lungs during gestation that plays an important role in helping the child inhale and exhale.

3. Getting type 2 diabetes later in life

Mothers and children born with gestational diabetes are at a higher risk of developing Type 2 diabetes in their later stages of life. It is crucial to set and maintain a healthy diet after pregnancy for the mother and right from the start for the children.

4. Stillbirth

Women with gestational diabetes mellitus are 5 times more likely to give birth to stillborns and 3 times more likely to give birth to babies who might not survive after the first few months^[5].

5. Low levels of calcium in the blood

This is a complication that occurs in infants and is mainly caused due to low levels of magnesium in the blood of the diabetic mother. Gestational Diabetes causes frequent urination which may result in excessive magnesium loss during pregnancy.

6. New born babies that are larger than usual

As mentioned above, women with gestational diabetes have high levels of glucose that are passed down to the baby through the placenta. This results in newborn babies being larger in size and heavier in weight than usual. Gestational diabetes affects 15% – 45% of newborns, and these babies are at a higher risk of developing several health concerns in their adult life.

7. Obesity in children

Children born to women with gestational diabetes are more likely to be overweight and obese as they grow up. This is caused due to high levels of blood glucose being converted and stored as fat during the gestation period^[6].

It is important to note that there is no hard and fast rule that all the above complications of Gestational Diabetes Mellitus will develop in you or your child. If the condition is left undiagnosed or untreated, these complications are generally bound to arise. However, diabetes can be controlled and maintained, so rest assured that you and your child can live healthy, happy lives with a little extra determination and care.

To Summarize

• One of the biggest complications of Gestational diabetes is the risk of preterm labour. When babies are born early or before their due date, they are likely to experience breathing difficulties.
• Mothers and children born with gestational diabetes are at a higher risk of developing Type 2 diabetes in their later stage of life.
• Gestational Diabetes causes frequent urination, which may result in excessive magnesium excretion during pregnancy. This in turn could be responsible for low levels of blood calcium in the newborn baby.
• Children born to women with gestational diabetes are more likely to be overweight and obese as they grow up.

How to Prevent Gestational Diabetes?

While gestational diabetes cannot always be prevented, here are some ways you can help lower your risk of developing the condition:

1. Monitoring your weight is most important

One of the simplest yet most effective way to keep your blood sugars under control is by monitoring it along with your weight. Make sure both metrics are within the normal range, and pay extra care if you have diabetes in your immediate family history. While every woman’s body is different and may react differently to foods, it is advised to consult a good gynaecologist and a nutritionist for advice on meal plans and diabetes exercise that is suited specifically to your diagnosis. It is absolutely vital to eat healthy during pregnancy, but the occasional sweet treat will not cause any harm, especially if there is no threat of gestational diabetes.

2. Good meal planning and a healthy lifestyle

Include a lot of greens in your diet with a good amount of fruits and vegetables. It is said to include one portion of vegetables, one portion of carbohydrates and one portion of proteins and iron to have a full balanced meal. Refrain from alcohol, smoking and other substances to have a safe and happy pregnancy for both you and your baby.

3. Exercise and physical activity

If your doctor gives you the green signal, include exercise and physical activity with moderate intensity in your everyday routine. Walking, dancing, swimming and exercises with the giant exercise ball are great exercises that can be carried out after consulting your doctor.

Gestational Diabetes is fairly common, and there is no need to lose sleep over it. Thanks to recent medical advances and medications, many women with Gestational Diabetes have delivered healthy babies and maintained their good health through proper meal plans and determination. It is very important to consult your doctor to ensure that you and your baby are not at risk during pregnancy.

To Summarize

• Lower your risks of getting high sugar levels during pregnancy by monitoring it throughout.
• Plan a healthy lifestyle for yourself.
• Exercise daily. Consult your doctor in case of any problems concerning physical activity during pregnancy.

Also Read: Diabetes and Obesity: A Growing Health Crisis

Frequently Asked Questions (FAQs)

References

1. Plows JF, Stanley JL, Baker PN, Reynolds CM, Vickers MH. The Pathophysiology of Gestational diabetes mellitus. International Journal of Molecular Sciences. 2018 [cited 2025 Mar 4]. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC6274679/
2. India diabetes report 2000 — 2045. International Diabetes Federation. [cited 2025 Mar 4]. Available from: https://diabetesatlas.org/data/en/country/93/in.html
3. Maternal Health Division, Ministry of Health and Family Welfare, New Concept Information Systems (P) Ltd. National Guidelines for Diagnosis & Management of Gestational Diabetes Mellitus. 2014 [cited 2025 Mar 4]. Available from: https://nhm.gov.in/images/pdf/programmes/maternal-health/guidelines/National_Guidelines_for_Diagnosis_&_Management_of_Gestational_Diabetes_Mellitus.
4. Padayachee C. Exercise guidelines for gestational diabetes mellitus. World Journal of Diabetes. 2015 [cited 2025 Mar 4]. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC4515443/
5. American College of Obstetricians and Gynecologists (ACOG). Management of stillbirth. American College of Obstetricians and Gynecologists. 2020 [cited 2025 Mar 4]. Available from: https://www.acog.org/clinical/clinical-guidance/obstetric-care-consensus/articles/2020/03/management-of-stillbirth
6. Buchanan TA, Xiang AH, Page KA. Gestational diabetes mellitus: risks and management during and after pregnancy. Nature Reviews Endocrinology [Internet]. 2012 Jul 3;8(11):639–49. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC4404707/
7. Igwesi-Chidobe CN, Okechi PC, Emmanuel GN, Ozumba BC. Community-based non-pharmacological interventions for pregnant women with gestational diabetes mellitus: a systematic review. BMC Women’s Health. 2022 [cited 2025 Mar 5]. Available from: https://bmcwomenshealth.biomedcentral.com/articles/10.1186/s12905-022-02038-9

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