Gestational Diabetes: What It Is, What to Do, and What to Expect

Medically reviewed by Dr. Ahmad Raza, MD (Pediatrics) — ChildBloom Medical Review Panel. Last updated: August 03, 2026.

Editorial & affiliate disclosure: our guidance is written and reviewed by clinicians. ChildBloom may earn a commission from qualifying purchases made through links on this page, which never changes what our pediatric reviewers recommend.

If you are searching for answers about gestational diabetes, you are in the right place. This pediatrician-reviewed guide explains what is normal, what the likely causes are, the red flags that mean you should call your doctor, and what you can safely do at home — all based on current AAP, CDC and NIH guidance on gestational diabetes.

What Is Gestational Diabetes?

Gestational diabetes mellitus (GDM) is a condition in which hormonal changes during pregnancy cause insulin resistance, leading to elevated blood sugar levels. It typically develops around the 24th to 28th week of pregnancy and affects 2–10% of pregnancies in the United States each year. This guide covers just diagnosed with gestational diabetes what to do first week to help parents make informed decisions.

Furthermore, as a pediatrician, I understand how concerning these moments can be for parents. My goal is to provide you with evidence-based guidance that helps you make informed decisions for your child, while also knowing exactly when to seek medical attention. This guide draws on current AAP recommendations and clinical experience to give you the clarity you need.

During pregnancy, the placenta produces hormones that help the baby grow and develop. These same hormones — including human placental lactogen, estrogen, and progesterone — also block the action of insulin in the mother’s body. This is called insulin resistance, and it is a normal part of pregnancy. For most women, the pancreas produces enough extra insulin to overcome this resistance. But for women who develop GDM, the pancreas cannot keep up, and blood sugar levels rise.

The key point GDM is not caused by anything you did before pregnancy. It is a physiological response to the hormonal changes of pregnancy, and it can happen to anyone. Common risk factors include being over 25, having a family history of type 2 diabetes, being overweight before pregnancy, having had GDM in a previous pregnancy, or being of certain ethnic backgrounds (Hispanic, African American, Native American, Asian American, or Pacific Islander). However, many women with no risk factors develop GDM as well. For expert-reviewed guidance, the American Academy of Pediatrics offers reliable information on this topic.

How Is Gestational Diabetes Diagnosed?

For example, testing for GDM is a standard part of prenatal care. Most obstetricians screen between 24 and 28 weeks of pregnancy using a two-step process. The first step is the glucose challenge test, where you drink a sweet glucose solution and have your blood drawn one hour later. If your blood sugar is above a certain threshold (usually 130–140 mg/dL), you move to the second step.

The second step is the oral glucose tolerance test (OGTT). This requires fasting overnight. Your blood sugar is measured fasting, then again at 1 hour, 2 hours, and 3 hours after drinking a higher-concentration glucose solution. If two or more of these values are elevated, the diagnosis of gestational diabetes is confirmed. Some practices use a single-step 2-hour OGTT, which is also acceptable.

Early screening may be recommended at the first prenatal visit if you have significant risk factors such as a previous GDM diagnosis, a body mass index above 30, or a family history of type 2 diabetes. If early screening is normal, the test is repeated again at 24–28 weeks.

Managing Blood Sugar During Pregnancy

As a result, the cornerstone of gestational diabetes management is blood sugar monitoring, dietary changes, and physical activity. Most women with GDM can manage their blood sugar with these lifestyle measures alone. The goal is to keep blood sugar levels within target ranges: fasting below 95 mg/dL, one hour after meals below 140 mg/dL, and two hours after meals below 120 mg/dL.

You will be asked to check your blood sugar four times per day: first thing in the morning (fasting) and one to two hours after each meal. Your healthcare provider will give you a glucose meter and show you how to use it. Keeping a log of your readings helps identify patterns and adjust your meal plan accordingly.

Dietary management focuses on three principles: consistent carbohydrate intake, pairing carbohydrates with protein and fat, and choosing complex carbohydrates over simple sugars. Aim for three small meals and two to three snacks per day, spaced evenly. Avoid skipping meals, which can cause blood sugar to drop and then spike. Each meal should include a balance of lean protein, healthy fats, fiber-rich vegetables, and complex carbohydrates like whole grains, legumes, and starchy vegetables.

In addition, physical activity is equally important. Moderate exercise helps lower blood sugar by increasing insulin sensitivity. Aim for 30 minutes of moderate activity most days of the week, unless your doctor advises otherwise. Walking, swimming, prenatal yoga, and stationary cycling are all safe options during pregnancy. Always check with your obstetrician before starting a new exercise routine.

Medication Options: When Lifestyle Changes Are Not Enough

About 15–30% of women with GDM need medication to achieve target blood sugar levels. This is not a failure of your efforts — it simply means your body needs additional support. The two main options are oral medication and insulin injections.

Metformin and glyburide are the most common oral medications used for GDM. Metformin works by decreasing the amount of glucose produced by the liver and improving insulin sensitivity. It is generally well-tolerated, though some women experience gastrointestinal side effects. Glyburide increases insulin secretion from the pancreas. Both medications cross the placenta to some extent, and their long-term safety data for the baby are still being studied.

Specifically, insulin is the gold standard for GDM treatment because it does not cross the placenta and provides precise control over blood sugar levels. It is given as injections, typically once or twice per day. Your healthcare team will teach you how to administer insulin, how to adjust doses based on your blood sugar readings, and what to do if your blood sugar drops too low (hypoglycemia). Many women find that insulin injections are less intimidating than they expected, and the ability to fine-tune blood sugar control provides peace of mind.

How GDM Affects Your Baby

When your blood sugar is elevated, the excess glucose crosses the placenta and reaches your baby. Your baby’s pancreas responds by producing extra insulin, which acts as a growth hormone. This can lead to macrosomia, meaning a baby who is larger than average at birth, typically weighing 9 pounds or more. Large babies are more likely to experience shoulder dystocia (the shoulder getting stuck during delivery), birth injuries, and the need for a cesarean section.

After birth, your baby may experience neonatal hypoglycemia (low blood sugar) because their pancreas is still producing high levels of insulin in response to the excess glucose they were receiving during pregnancy. This is temporary and is managed by monitoring your baby’s blood sugar after birth and feeding them early and frequently. Other potential complications include jaundice, respiratory distress syndrome, and an increased risk of obesity and type 2 diabetes later in life.

Additionally, the good news is that good blood sugar control during pregnancy dramatically reduces these risks. Women who maintain tight glucose control have outcomes that are very similar to women without GDM. The goal of treatment is not just to protect your health — it is to protect your baby’s health as well.

Delivery and Postpartum: What to Expect

Most women with GDM can have a vaginal delivery. Your obstetrician will monitor your baby’s growth closely in the third trimester with ultrasound, and if the baby is estimated to be very large, an early induction or planned cesarean may be discussed. Blood sugar control during labor is important to prevent neonatal hypoglycemia, so your blood sugar will be monitored during labor and you may receive insulin or glucose intravenously as needed.

After delivery, the placenta is removed, and the hormones that were causing insulin resistance disappear almost immediately. For most women, blood sugar returns to normal within hours to days. You will have a postpartum glucose tolerance test at 6 to 12 weeks after delivery to confirm that your blood sugar has normalized. Women who have had GDM have a 50% chance of developing type 2 diabetes within 10 years, so ongoing monitoring with annual blood sugar checks is recommended.

However, breastfeeding is encouraged for women with GDM. Breastfeeding may reduce the risk of the baby developing obesity and type 2 diabetes later in life, and it can also help the mother lose pregnancy weight and improve her own metabolic health. GDM is not a contraindication to breastfeeding in any way.

Long-Term Health After GDM

A diagnosis of gestational diabetes is a wake-up call for long-term health. The same lifestyle changes that helped you manage blood sugar during pregnancy — healthy eating, regular physical activity, weight management — are the same strategies that reduce your risk of developing type 2 diabetes later in life. Studies show that women who lose weight after pregnancy, maintain a healthy diet, and stay physically active can reduce their risk of type 2 diabetes by more than 50%.

Your postpartum care should include an annual blood sugar check, blood pressure monitoring, and cholesterol screening. Maintaining a healthy weight, staying active, and eating a balanced diet are your best tools for long-term health. If you become pregnant again, you will be screened for GDM earlier in the pregnancy, and the management strategies that worked for you before will likely work again. Some women find that working with a registered dietitian or diabetes educator after pregnancy helps them maintain healthy habits. Many communities offer diabetes prevention programs that provide support and accountability for maintaining lifestyle changes.

Frequently Asked Questions

For example, Read more: formula feeding newborn guide for new

Medical disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult your obstetrician or midwife for guidance on your specific pregnancy.

📖 More from the Pediatrician’s Corner Hub: your complete pediatrician-reviewed guide to your baby’s first year — milestones, feeding, sleep, vaccines, common illnesses, and more.

When to Call Your Pediatrician About Feeding Concerns

As a result, while many feeding challenges resolve with time and patience, contact your pediatrician if:

• Your baby is not regaining birth weight by day 10-14
• Your newborn has fewer than 6 wet diapers per day after the first week
• Your baby seems consistently hungry after feeds or is not gaining weight appropriately
• There are signs of dehydration (sunken soft spot, dry mouth, fewer wet diapers)
• Your baby is vomiting forcefully (projectile vomiting) after every feed
• You notice blood or green mucus in your baby’s stool
• Your baby is refusing feeds for more than one feeding cycle
• You are concerned your milk supply is low and baby is not thriving

Your pediatrician can assess growth patterns, evaluate latch and feeding technique, and rule out underlying medical issues. Never hesitate to call.

Safety Considerations and Red Flags

Parents should be aware of the following safety considerations when managing their child’s health at home:

• Never ignore persistent or worsening symptoms
• Keep emergency numbers (pediatrician, poison control, emergency services) readily accessible
• Follow medication dosing instructions precisely — never estimate or use household spoons
• Trust your gut: if you feel something is seriously wrong, seek medical attention immediately

The Bottom Line

In addition, gestational Diabetes is a common concern for parents, and most of the time it resolves with simple home care and patience. As a pediatrician, I encourage parents to trust their instincts, stay informed with evidence-based resources, and maintain open communication with their healthcare provider. You know your child best — if something does not feel right, speak up. Every question you ask is valid, and every concern you raise helps us provide better care for your little one.

Clinical Pearl: What the Research Actually Says

One of the most valuable skills a parent can develop is the ability to evaluate health information critically. In the age of social media and parenting influencers, misinformation about child health spreads faster than evidence-based guidance. When you encounter a new parenting recommendation — whether about sleep, feeding, development, or safety — ask yourself three questions: Who is making this recommendation and what are their credentials? Is the recommendation supported by peer-reviewed research or is it based on anecdote and tradition?

Does the recommendation align with guidance from major medical organizations like the American Academy of Pediatrics, the Centers for Disease Control and Prevention, or the World Health Organization? If a recommendation contradicts established medical guidance, it should be viewed with skepticism, regardless of how compelling the testimonial may be. When in doubt, bring what you have read or heard to your pediatrician. We are trained to help you separate evidence from anecdote and to make decisions that are right for your individual child.

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Gestational Diabetes: quick pediatrician summary

Most of the time this is a normal newborn or infant variation that settles on its own, and the job of a parent is to know the small number of red flags that change the plan. Watch feeding, breathing, alertness and wet diapers — those four tell you more than the symptom itself. Call your pediatrician the same day for fever in a baby under 3 months, laboured or fast breathing, refusal to feed, fewer wet diapers, unusual floppiness or sleepiness, or a symptom that is clearly getting worse rather than better.

Common mistakes parents make

• Treating a single measurement or one bad day as a trend instead of watching the pattern over several days.
• Trying several remedies at once, so it becomes impossible to tell what helped.
• Waiting for a convenient time to call when a red flag is already present — feeding, breathing and alertness changes are always worth a same-day call.
• Following advice from an unsourced social post rather than your own pediatrician, who knows your child’s history and growth curve.

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• More expert answers in Pediatrician’s Corner

References and further reading

• AAP HealthyChildren: symptoms & when to call the doctor
• CDC child health & development
• NIH MedlinePlus infant and newborn care

Medical disclaimer

This article is for general education and is not a substitute for individual medical advice, diagnosis or treatment. Every child is different — talk to your own pediatrician about your baby, and seek urgent care for breathing difficulty, poor feeding, dehydration, unusual sleepiness, fever in an infant under 3 months, or any sudden change in your child’s condition.