Pregnancy

Gestational Diabetes: Symptoms, Diet, Treatment and What It Means for Your Baby

By the Find Her Doctor editorial team · Updated November 1, 2026 · 6 min read

Gestational diabetes is high blood sugar that first develops during pregnancy. It usually has no symptoms and gets picked up by the glucose test at 24 to 28 weeks. Most people manage it with changes to what and when they eat, some walking, and finger-stick checks at home; some also need medication such as insulin. With good control, most people with gestational diabetes have healthy pregnancies and healthy babies.

The diagnosis tends to land hard. A lot of people hear "diabetes" and think they did something wrong. You didn't. Here's what's going on and what the next few weeks actually look like.

Why it happens (and why it's not your fault)

The placenta makes hormones that make your cells more resistant to insulin, the hormone that moves sugar out of your blood and into your cells. That resistance climbs as pregnancy goes on, peaking in the third trimester. Most bodies just make more insulin to keep up. When yours can't make quite enough, blood sugar rises. That's gestational diabetes. It isn't caused by eating too much sugar.

Who's at higher risk?

• Overweight or obesity before pregnancy
• Gestational diabetes in a previous pregnancy
• A parent or sibling with type 2 diabetes
• Prediabetes
• Polycystic ovary syndrome (PCOS)
• High blood pressure
• A previous baby weighing more than about 9 pounds
• Being Black, Hispanic/Latina, Native American, Asian American or Pacific Islander
• Being older at pregnancy

Many people with gestational diabetes have none of these.

Symptoms

Usually none. When they happen:

• Feeling very thirsty
• Peeing more than usual
• Fatigue
• Blurry vision

All of those overlap with ordinary pregnancy, which is why screening is the only reliable way to know. Our glucose test guide explains the one-hour and three-hour tests, including the famously sweet drink.

What it can mean for your baby

When your blood sugar is high, extra sugar crosses the placenta. The baby makes extra insulin and stores that energy as fat. Poorly controlled gestational diabetes raises the chance of:

• A large baby (macrosomia), which makes shoulder injuries at birth and C-section more likely
• Low blood sugar in the newborn right after birth
• Breathing problems and jaundice in the newborn
• Preeclampsia for you
• Stillbirth, when blood sugar isn't well controlled

The key word is controlled. Good blood sugar control lowers every one of these risks.

Your first two weeks after diagnosis

Week 1: the meter and the numbers

You'll usually get a glucose meter, test strips and lancets, and a quick lesson from a nurse or diabetes educator. You'll check by finger stick several times a day: when you wake up (fasting) and after meals. Some providers use continuous glucose monitors instead.

What people say about the finger sticks: the first few feel like a big deal, and by day four it's routine. Use the sides of your fingertips (fewer nerve endings), and wash your hands first, since fruit residue can throw off a reading.

Your provider gives you your targets. ACOG's commonly used targets are:

Your team will tell you whether to check at 1 hour or 2 hours. Follow their numbers if they differ.

Week 1 to 2: meeting the dietitian

Most people meet a registered dietitian or diabetes educator. The common principles:

• Spread carbs through the day: three moderate meals and two or three snacks, including a bedtime snack, which often helps the morning number
• Pair carbs with protein, fat or fiber: an apple with peanut butter, rice with chicken and vegetables, a tortilla with eggs and beans
• Pick high-fiber carbs: whole grains, beans, lentils, vegetables and whole fruit over white bread, juice and sweets
• Watch portions of starchy foods like rice, pasta, bread, potatoes, roti and tortillas
• Skip sugary drinks, including juice and the sweetened coffee drinks from the corner cart
• Keep breakfast lower in carbs, since blood sugar often runs highest in the morning

Don't cut carbs out completely. You and your baby still need them. Ask for a plan built around the food you actually eat, whether that's rice and beans, dal and chapati, congee, or a bagel on the way to work. A good dietitian will work with your culture, not against it.

Week 2: patterns and adjustments

Bring your log (or your meter) to every visit. Your provider is looking for patterns, like a fasting number that's always high, or one meal that keeps spiking. One high reading after a birthday slice of cake isn't a crisis. A week of high fasting numbers is worth a call.

Movement

Activity helps your body use insulin. A 10- to 15-minute walk after meals can noticeably lower your blood sugar; walking to the next subway stop instead of the closest one counts. ACOG recommends about 150 minutes of moderate activity a week for most pregnant people. See exercise during pregnancy.

When food isn't enough: medication

If your numbers stay above target despite diet and exercise, your provider may prescribe medication:

• Insulin is the most commonly recommended medicine, because it doesn't cross the placenta in meaningful amounts. The pen needles are tiny; most people say it hurts less than the finger sticks.
• Metformin is sometimes used, though it does cross the placenta and its long-term effects on children are still being studied.

Needing medication doesn't mean you failed. Insulin resistance usually rises in the third trimester, and many people need help as pregnancy goes on. Your provider sets your dose.

Extra monitoring in the third trimester

Depending on your control, you may have:

• More frequent prenatal visits
• Growth ultrasounds to estimate the baby's size
• Fetal monitoring, such as non-stress tests (about 20 to 40 minutes with two belts on your belly), especially if you take medication

Your provider will talk with you about delivery timing. People with well-controlled, diet-managed gestational diabetes can usually wait for labor to start on its own until close to their due date.

If you had diabetes before pregnancy, or your blood sugar is hard to control, you'll often be co-managed with a maternal-fetal medicine specialist.

After the baby

For most people, blood sugar goes back to normal soon after birth. But gestational diabetes is a heads-up about your future health:

• The CDC reports that about half of people who had gestational diabetes go on to develop type 2 diabetes.
• ACOG recommends a glucose test 4 to 12 weeks after delivery, then diabetes screening every 1 to 3 years.
• Gestational diabetes often comes back in later pregnancies.

That postpartum test is easy to skip with a newborn at home. Put it on the calendar before you leave the hospital, and ask whether it can happen at your postpartum checkup.

Breastfeeding, staying active and reaching a healthy weight can lower your risk of type 2 diabetes. Tell your baby's pediatrician about the gestational diabetes too, since your child may have a higher chance of obesity and type 2 diabetes later.

Gestational diabetes care in New York

Diabetes education, glucose meters and test strips are usually covered by insurance, including NY Medicaid. Many hospitals across NYC, Long Island and the Hudson Valley run diabetes-in-pregnancy programs with dietitians and educators; ask your OB which one they work with. If you need an OB/GYN or MFM specialist, try maternal-fetal medicine in Queens or search the directory by your county and insurance.

When to call your provider

Call your provider if:

• Your readings are often above your targets
• You have readings below the low level your team gave you, or symptoms of low blood sugar (shakiness, sweating, confusion, racing heart), especially if you take insulin
• You can't eat normally because of vomiting or illness
• Your baby is moving less than usual
• You have a severe headache, vision changes, sudden swelling or upper belly pain, which can be signs of preeclampsia

If you take insulin and have a low that doesn't respond to fast-acting sugar, or you become confused or can't stay awake, someone should call 911.

Frequently asked questions

Sources

• ACOG — Gestational Diabetes Mellitus (Practice Bulletin 190)
• ACOG — Gestational Diabetes FAQ
• CDC — Gestational Diabetes
• American Diabetes Association — Standards of Care in Diabetes: Management of Diabetes in Pregnancy
• NIH NIDDK — Gestational Diabetes

This article is for general education and is not medical advice. It does not replace an evaluation by a licensed clinician who knows your history. If you think you have a medical emergency, call 911.