Gestational Diabetes: What Every Expectant Mother Must Know
She came to my clinic convinced she had “sweet urine” because her mother had diabetes — but had never been tested in this pregnancy. At 28 weeks she had gained weight rapidly, felt thirsty at night, and her routine scan showed a big baby. This is a common late surprise in urban India, and it can be prevented or managed safely when we act early.
Why this matters now
Gestational diabetes mellitus (GDM) affects up to 10–18% of pregnancies in Indian cities — higher in women with risk factors. With changing diets, sedentary jobs, delayed pregnancies and rising obesity, more urban women face high blood sugar during pregnancy. Left unchecked, GDM increases the risk of large babies (shoulder dystocia), cesarean birth, pre-eclampsia, neonatal hypoglycaemia, and later life diabetes for both mother and child. The good news: with timely screening, appropriate lifestyle changes and treatment, most pregnancies result in healthy mothers and babies.
Medical explanation — in plain language
Gestational diabetes is high blood sugar first identified during pregnancy. Pregnancy hormones from the placenta cause insulin resistance — the body’s glucose-regulating hormone works less effectively. If the pancreas cannot make enough extra insulin, blood glucose rises. We typically screen between 24–28 weeks when insulin resistance is most pronounced; however, women with risk factors are screened earlier. Treatment aims to keep fasting and post-meal blood sugars in a safe range to minimize risks to baby and mother.
Risk factors (Indian context)
– Overweight or obesity (BMI ≥23 kg/m² often used for South Asian thresholds)
– Previous gestational diabetes or family history of type 2 diabetes
– Age over 30 years at conception (rising trend in urban women)
– Polycystic ovarian syndrome (PCOS) or irregular periods prior to pregnancy
– Prior delivery of a large baby (>4 kg) or unexplained stillbirth
– Sedentary lifestyle, high-calorie refined-carbohydrate diet
– History of hypertension or metabolic syndrome
Warning signs women must never ignore
Most women with GDM have no symptoms. Still, seek prompt evaluation if you notice:
– Excessive thirst, frequent urination or unexplained fatigue
– Rapid, excessive weight gain after the first trimester
– Reduced fetal movements in the third trimester
– Recurrent urinary tract infections or vaginal yeast infections
When to see your gynecologist immediately
– You have known diabetes before pregnancy or had GDM before — see early in pregnancy.
– Positive screening tests for high blood sugar.
– Persistent symptoms of high sugar (thirst, polyuria) or signs of pre-eclampsia (headache, vision changes, swelling).
– Any decreased fetal movements or abnormal non-stress test results.
Doctor-recommended management
Diet guidance
– Aim for balanced meals: complex carbohydrates (whole grains, millets, dals), adequate proteins (lentils, eggs, lean poultry, fish), healthy fats (nuts, ghee in moderation) and ample vegetables.
– Avoid refined sugars, sweets, fruit juices and deep-fried snacks.
– Distribute carbohydrates over three small meals and two to three healthy snacks — avoid large carbohydrate loads at one time.
– Follow portion control rather than calorie starvation — pregnant women still need adequate nutrition.
Lifestyle changes
– Aim for at least 30 minutes of moderate activity most days — brisk walking, prenatal yoga, or swimming as advised.
– Break long periods of sitting; short walks after meals help lower post-meal sugars.
– Adequate sleep and stress reduction matter — high stress can worsen sugar control.
Required tests
– Early fasting blood glucose or HbA1c if high risk at first visit.
– Universal 75 g oral glucose tolerance test (OGTT) at 24–28 weeks as per WHO/ACOG/FOGSI recommendations; earlier if high-risk.
– Regular capillary blood glucose monitoring at home (fasting and 2-hour post-meal) once diagnosed.
– Periodic fetal growth scans and non-stress tests in the third trimester if needed.
Treatment approach
– Dietary modification and exercise are first-line. Many women control sugars this way.
– If targets are not met (fasting and 2-hour post-meal as advised by your doctor), medication is required. Insulin remains the most established safe option and is the gold standard per ACOG and FOGSI guidance.
– Oral agents such as metformin are used in some protocols and by many practitioners in India when appropriate, but discuss benefits and risks with your obstetrician — while convenient, metformin crosses the placenta; recent studies show acceptable safety but individualization is key.
– Frequent monitoring, dose adjustments and teamwork between obstetrician, diabetologist and dietitian achieve the best outcomes.
Prevention strategies
– Preconception counseling for women with obesity, PCOS or family history of diabetes — lose weight sensibly, optimize glycaemic health, and start exercise.
– Early screening in future pregnancies if you had GDM before.
– Breastfeeding lowers long-term diabetes risk for mother and baby.
Normal delivery vs C-section clarity
GDM itself is not an automatic indication for cesarean. Mode of delivery depends on obstetric indications:
– Well-controlled GDM with appropriate fetal size and no obstetric complications: vaginal delivery is usually safe and encouraged.
– Poorly controlled sugars with estimated macrosomia, failed trial of labour, or obstetric emergencies: cesarean may be recommended.
– Elective cesarean is sometimes considered for very large babies, but precise ultrasound estimates can be imprecise, so individualized counselling matters.
Guideline references
In practice I follow evidence-based guidance — routine 75 g OGTT screening at 24–28 weeks as recommended by WHO and echoed by ACOG and national bodies. For management, ACOG supports insulin as first-line pharmacologic therapy, with metformin used selectively. FOGSI protocols adapt these recommendations to Indian maternal health realities, emphasizing early screening in high-risk women, dietary counselling, and multidisciplinary care.
Practical tips from my clinic experience
– Carry a log of home glucose readings and food intake — it helps fine-tune treatment.
– Avoid “sugar-free” sweets that are high-calorie; focus on whole foods.
– If insulin is advised, learn injection technique calmly; insulin does not harm the baby but uncontrolled sugar does.
– Keep appointments for growth scans — timing of delivery often depends on fetal growth and maternal control.
– If diagnosed, join a support group or trusted online community — many women find practical diet and exercise ideas helpful.
Reassuring conclusion
A diagnosis of gestational diabetes is stressful but treatable. With prompt screening, realistic diet and activity changes, and the right medical plan, the vast majority of women deliver healthy babies and return to normal metabolic health. Early communication, realistic goals and a supportive care team turn what seems scary into a manageable chapter of pregnancy.
Frequently asked questions
1. What blood sugar levels mean gestational diabetes?
– We use specific fasting and 2-hour OGTT cut-offs; your obstetrician will explain the values and targets for home monitoring.
2. Can I control GDM with diet alone?
– Many women can, especially with early diagnosis and disciplined lifestyle changes; others will need medication.
3. Is insulin safe during pregnancy?
– Yes. Insulin is safe and effective for both mother and baby and is the preferred drug when medication is needed.
4. Will my baby get diabetes if I have GDM?
– Not directly. GDM raises the child’s long-term risk of obesity and type 2 diabetes, but breastfeeding, healthy diet and activity reduce that risk.
5. When should I be screened if I had GDM in a previous pregnancy?
– Early in pregnancy and again at 24–28 weeks; postpartum glucose testing is also important to detect persistent diabetes.
Dr Uma Mishra
MD, Obstetrics & Gynecology
High Risk Pregnancy Care Expert | Normal Delivery Specialist
Leading Gynecologist in Noida
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