Gestational Diabetes (GDM) – Your Most-Asked Questions, Answered
Adapted from the DiabetesSisters Reddit AMA with Kartik K. Venkatesh, MD, PhD. This article is for education and peer support and does not replace medical advice. Always follow your clinical team’s guidance.
Introduction
Pregnancy can bring unexpected twists—like a gestational diabetes diagnosis. Suddenly, your meal choices, glucose checks, and doctor visits take on new meaning. We get it. At DiabetesSisters, we believe that knowledge is power, and community is strength.
That’s why we teamed up with Dr. Kartik Venkatesh, an OB-GYN and maternal-fetal medicine expert, for a live Reddit Q&A that brought real questions from real women (and their loved ones) into focus. From diet and exercise to delivery and life after pregnancy, Dr. Venkatesh offered thoughtful, evidence-based answers that put empowerment, not fear, at the center of the GDM journey.
Below, you’ll find the full conversation exactly as it happened, with every question and answer shared in full. Whether you’re newly diagnosed, supporting someone with GDM, or planning for a healthy pregnancy, this dialogue is a reminder: you’re not alone, and you have options.
Gestational Diabetes Q&A with Dr. Kartik Venkatesh
Q: I’ve lost 7 pounds since being diagnosed with gestational diabetes (diet-controlled) and had only gained 2 pounds during the pregnancy before my diagnosis at 26 weeks. My midwife isn’t concerned since my pre-pregnancy BMI is 35, but I’m a bit worried because my baby has gone from measuring in the 70th percentile eight weeks ago (which made sense to me since my husband and I are tall) to the 30th percentile at our latest scan. Is it really okay to be losing weight? I struggle not to lose a bit, as I’m vegetarian and many of my usual foods cause higher glucose levels and have to be limited.
The key to GDM management is balance and I am concerned whether caloric restriction and excessive diet changes have had a negative impact on your health and well being. First, a balanced diet is critical in pregnancy for you and your developing baby, this does mean eating carbohydrates! For many women with GDM and we know this from Europe and countries with single payer healthcare systems where women can get easier access to timely GDM care than the US, about 1 in 2 to 3 women with GDM will require medication to also control their glucose levels. I would consider medication at this point to control your blood sugar, for you and your baby to have the best outcomes, and to be able to struggle less personally with a more stable and sustainable diet.
Q: My wife got diagnosed with GDM during pregnancy. Does it mean she is prone to diabetes in the future? What care should we take to avoid it?
GDM is likely the primary risk factor for type 2 diabetes for women who have had GDM. GDM is associated with high blood pressure, and long-term heart disease, including stoke and heart attacks. In fact, GDM is a bigger risk factor for maternal heart disease than even preeclampsia, something we all too often forget. The best proven interventions to decrease this risk are breastfeeding, and the longer the better and even six months has a huge preventive impact on diabetes, and taking metformin which is also a safe and effective intervention even while breastfeeding. Additional interventions that are good for everybody is exercise and physical activity and eating a heart healthy diet. An area of growing interest that we need more data about is the use of new medications like GLP1/SGLT2 agents like Ozempic and wagovy that could also dramatically impact this risk. We summarize some of these recommendations in this article in the Journal of the American Medical Association: https://pubmed.ncbi.nlm.nih.gov/37561508/.
Q: What are your thoughts on women with gestational diabetes who are overweight and managing it with diet and light exercise? However, due to these lifestyle adjustments, they are gradually losing weight during pregnancy. I know that losing weight during pregnancy is generally not recommended, but in a situation like this—if the mother feels good with the lifestyle changes, the baby is growing well, and maternal blood glucose levels are well maintained—would you still be concerned? Are there any complications you’ve seen in cases like this?
While we do not have specific recommendations or guidelines about weight loss or weight gain for people with diabetes in pregnancy, data do suggest that more stringent weight gain recommendations for pregnant people with diabetes may be warranted and even beneficial and may be associated with a decreased risk of adverse pregnancy outcomes. At this time, we use the same guidance about weight gain in pregnancy and recommendations for all pregnant people regardless of diabetes status, though this could very much change in coming years given the above data. With regard to your specific example, I do not see any immediate cause for concern as long as caloric intake is adequate, a healthy diet is being followed, glucose levels are being adequately managed, and the baby is growing appropriately.
Q: Is there a way to avoid getting gestational diabetes?
While many studies and trials have looked at behavior changes including to diet and physical activity, as well as medications including metformin and other medications to decrease the risk of GDM, these studies have not demonstrated that they work. It is likely that the risk for GDM has already happened before pregnancy and to date we just have not been able to identify interventions that work in early pregnancy. It is possible that the pre-pregnancy period where we have more time to intervene may hold promise for GDM prevention, and this is a space we need more data and research to best inform patients and providers.
Q: I’ve been controlling my GDM through diet and managing well until this week, but my fasting levels recently changed and I’m 34 weeks pregnant, will I need to go on insulin?
If you need medication, most women with GDM have two time tested and effective treatment options with metformin and insulin. The earlier you start the better with regard to preventing adverse outcomes. Both medication work, are safe, and are well tolerated. They have been used for nearly a century and have been rigorously studied for at least 50 years. Both medications are used throughout pregnancy for individuals for other conditions too including PCOS and type 1 and 2 diabetes. While in the US we have used insulin more frequently, nearly 50% of US women with GDM now receive metformin and globally including in Europe metformin is most commonly used. The ongoing DECIDE study, a national US initiative to better learn about patient level outcomes and preferences is an exciting initiative and opportunity for women with GDM who need medication. The website is www.decidestudy.org and this initiative is now happening at over 20 leading academic medical centers across the US.
Q: I was recently diagnosed with GDM and am nervous about what this means for labor and delivery. Will I have to be induced? What can I expect from my hospital experience now that I have GMD?
The major reason we work so much of vigilant, thoughtful, and close glucose management in those months before delivery is to have a safe, uncomplicated, and ideally natural birth experience for the mom and baby. The glucose control through diet, activity, and medication in real time over months is what prevents the very complications that make patients and their families most concerned about.
All women with GDM should be able to make it to full term or at least 39 weeks if GDM is well managed and they do not have other medical problems or complications. Should they require medication, we recommend delivery generally after 39 weeks, but the truth is any pregnant person can have an elective delivery after 39 weeks.
The other point to remember is obstetrics and labor and delivery is unpredictable, bad outcomes can happen to anybody, and things can happen fast. Access to an accredited hospital and birth facility with doctors and nurses who know about GDM and medical complications is critical for the best outcomes for mom and baby. The best experience is a safe experience that respects patient autonomy and their wishes but also provides the very best evidence-based and patient-centered care. This is true for any pregnancy regardless of GDM.
Q: I had GDM with my first pregnancy and didn’t get it on my second one. Does this mean I have less risk for future diabetes diagnosis. Also does breastfeeding the baby for over 2 years reduce the likelihood of developing diabetes later in life for someone who’s had GD. (Extra info: I was diagnosed with GD in USA with my first child , with my second pregnancy I was in India, so in retrospect I feel my OBGYN missed my GD due to different metrics here. I ended up having a large baby at 3.5kg)
GDM is likely the primary risk factor for type 2 diabetes for women who have had GDM. GDM is associated with high blood pressure, and long-term heart disease, including stoke and heart attacks. In fact, GDM is a bigger risk factor for maternal heart disease than even preeclampsia, something we all too often forget. The best proven interventions to decrease this risk are breastfeeding, and the longer the better and even six months has a huge preventive impact on diabetes, and taking metformin which is also a safe and effective intervention even while breastfeeding. Additional interventions that are good for everybody is exercise and physical activity and eating a heart healthy diet. An area of growing interest that we need more data about is the use of new medications like GLP1/SGLT2 agents like Ozempic and wagovy that could also dramatically impact this risk.
Q: When is gestational usually screened for?
You want to ideally be screened for GDM by the end of the second trimester and the ideal window is 20-24 weeks. The reason being if GDM is a journey, and getting diagnosed and figuring out how best to treat you and your baby is a process. After that initial screening test, you need a confirmatory test which is scheduled within 1 week of the initial test, and then you need to start collecting your blood sugar for 1-2 weeks to even make an initial plan that is right for you! So it takes time and effort and many times patient and providers forget that!
Q: Post baby what are questions should you ask your doctor to make sure you are regularly screened for early detection and management of T2 diabetes? How soon after the birth?
Start by a glucose test or 2 hour OGTT 6 weeks postpartum and then ideally a hemoglobin A1C with your PCP 12 months postpartum. Right now in the US only 30% of women are getting any meaningful screening within the first 12 months postpartum. We are trying to change this as part of the DECIDE initiative (www.decidestudy.org) that connects pregnancy GDM to postpartum cardiometabolic health for the mom and child.
Q: How does high blood sugar affect my baby?
Multiple mechanisms which include inflammation, oxidative stress, placental perfusion, basically a high glucose environment is a toxic environment for the developing fetus. That is why its so important that glucose values in pregnancy with GDM be interpreted and acted upon by a skilled OBGYN or MFM expert who knows the physiology of glycemia in pregnancy, because a regular doctor may not see these glucose values as a problem when indeed they are NOT normal for the developing fetus.
Q: Is there any research on why GDM is more prevalent in South Asian communities?
Great question and a very important area of research to better understand why this is the case, the best theories to date suggest beta cell dysfunction more common in south asians may partly explain this.
Q: I thought it was just the placenta causing my blood sugar issues, but I later found out that I actually have LADA. How much harm might I have caused my baby? I wasn’t watching my diet before 24 weeks because I had no idea I had type 1 diabetes. Now I’m worried about the possible effects on my baby.
It is never too late to take action and better understand the impact of glycemia and diabetes on the mother or infant. Make sure you have a good doctor who can provide you with the information you need for your child.
Q: What are some risk factors for gestational diabetes?
The reality is GDM is very common and affects between 1 in 10 to as many as 1 in 5 pregnancies every year in the US. Because GDM is just so common, it’s important to remember that while some people may have what we call “risk factors” many people simply do not have clearly identifiable risk factors. Risk factors for GDM include higher BMI or obesity, family history of diabetes, increasing age, and certain groups of people including individuals of Black, Latina, and Asian ancestry are at increased risk. Probably the biggest risk factor is age alone, we need to remember that 30 years ago the average age of pregnancy in the US was close to 20 years and now its approaching 30: we all develop insulin resistance as we age. While societal factors like changes in diet and more sedentary behaviors may be contributing to GDM, we still need more research to understand why that may be so.
Q: The learnings here today are so informative. Are there trusted resources for women to go to for themselves and for their family and friends to learn more about how to manage this during and post pregnancy?
You can start with some resources here, curated by our partner Diabetes Sisters: https://diabetessisters.org/resources/
Also check out:
https://diabetes.org/living-with-diabetes/pregnancy/gestational-diabetes
https://www.acog.org/womens-health/faqs/gestational-diabetes
Q: What can we do to prevent gestational diabetes? Before or during pregnancy?
While many studies and trials have looked at behavior changes including to diet and physical activity, as well as medications including metformin and other medications to decrease the risk of GDM, these studies have not demonstrated that they work. It is likely that the risk for GDM has already happened before pregnancy and to date we just have not been able to identify interventions that work in early pregnancy. It is possible that the pre-pregnancy period where we have more time to intervene may hold promise for GDM prevention, and this is a space we need more data and research to best inform patients and providers.
Q: Does stress make GDM worse?
The important thing to remember is GDM is treatable and predictable. Being stressed in pregnancy and with any new diagnosis in pregnancy is anxiety provoking and normal. The key is to engage in timely and effective treatment and care. Denial can be major barrier to effective care, and the problem with denial in GDM is time is of the essence. You only have a few weeks to figure this out and that is one of the key reasons where active and timely engagement with a trusted healthcare provider is critical as delayed treatment can mean the real difference with regard to pregnancy outcomes.
Q: When is gestational diabetes usually screened for?
You want to ideally be screened for GDM by the end of the second trimester and the ideal window is 20-24 weeks. The reason being if GDM is a journey, and getting diagnosed and figuring out how best to treat you and your baby is a process. After that initial screening test, you need a confirmatory test which is scheduled within 1 week of the initial test, and then you need to start collecting your blood sugar for 1-2 weeks to even make an initial plan that is right for you! So it takes time and effort and many times patient and providers forget that!
Q: How does Metformin intake work in our body? What is its role for diabetic patients? When and how is it best to be taken?
Metformin works by making your body use the insulin it alreay had, it is an insulin sensitizer, It is really an herbal medication that has been used in various formulations from the time of the Egyptians through the Middle ages and then was extracted from the French lilac plant. Its best taken after a meal, either once or twice a day. It is perhaps one of the most commonly used and effective treatments for diabetes along with insulin.
Q: What should I eat when managing gestational diabetes to help keep my blood sugar in control?
A diet that is rich in complex carbs, protein, dairy works great, Think a Mediterranean diet for example a a sample. It is important to remember that about 1 in 3 women will also require medication in addition to diet changes to achieve glucose control. The reality is glucose control gets harder as pregnancy progresses due to placentally mediated insulin resistance, so diet is where we start and then layer on additional strategies to meet the needs of each patient.
Q: I have type 1 diabetes, but sometimes I receive questions about gestational diabetes, for example:
What is the next step to do when they receive that diagnosed?
Are there support groups for gestational diabetes woman?
What doctor do they need to reach to help treat the gestational diabetes?
While the first step after a diagnosis of GDM is making diet and activity changes if possible, many times and up to 1 in 3 women with GDM will need medication as well as to help control blood sugar. We know from data from Europe and other countries with national health systems where pregnant women can access treatment in a timely manner most women who need medication will need it within the first weeks after diagnosis when it quickly becomes apparent that a treatment approach that combines diet plus medication will be needed. A major barrier in the US is timely access to GDM treatment when needed, and such a delay is important and probably a major reason for why outcomes for GDM remain poor and sometimes similar to conditions like preterm birth and preeclampsia for which we do not have effective treatment. An increasing problem we are seeing is that despite decades of robust data or nearly a century of data demonstrating the importance and safety and benefits of medications like metformin and insulin for GDM, the internet is full of incorrect information that can misguide people. That is a major reason we are leading this reddit initiative today.
Q: If I have PCOS, does that mean I will be more likely to have gestational diabetes during my pregnancy?
Yes, we increasingly understand PCOS as an important risk factor for GDM. The same risk factors that may contribute to PCOS also contribute to GDM. Increasing data also highlight the potential benefits for improving pregnancy outcomes with metformin with PCOS. Metformin is also an effective treatment for GDM. Whether metformin may be of particular value for treating GDM in women with PCOS is an important research question that could really help the many women with PCOS and at high risk for GDM. This is a question we will help answer in the ongoing DECIDE trial (www.decidestudy.org), which is a great opportunity for women with PCOS who develop GDM and need medication for their GDM.
Q: Do you recommend any books about gestational diabetes or pregnancy with diabetes?
The below are guidance from experts:
https://www.diabetes.org.uk/about-diabetes/gestational-diabetes
https://diabetes.org/living-with-diabetes/pregnancy/gestational-diabetes
https://www.acog.org/womens-health/faqs/gestational-diabetes
Q: Some symptoms of late-onset preeclampsia can overlap with gestational diabetes, such as swelling, headaches, or rapid weight gain. For patients with gestational diabetes, what red flags would make you suspect late-onset preeclampsia rather than routine GDM-related changes?
Great question, one of the first signs of placental insufficiency that is serious due to preeclampsia when you have GDM is AM hypoglycemia or very low blood sugar. All of a sudden you may notice your blood sugar is running in the 50-60s or you don’t need to take medication like metformin or insulin because your blood sugar is dropping too low.
Q: What do you suggest for managing the mental and emotional health when you receive this diagnosis? What are the first things you suggest to do?
GREAT question. It is natural to feel like your body is failing you, and to feel anxious and a sense of uneasiness. What I would say i embrace these feelings because it is normal to feel that way. Next, remember this is a diagnosis for which highly effective and time tested treatment exists. You are not alone. 1 in 8 American women get this diagnosis in pregnancy. While treatment takes time and effort, it pays off, GDM treatment when done right and on time works!
Q: After a GDM diagnosis, what is a woman’s risk of developing T2D later on in life?
GDM is likely the primary risk factor for type 2 diabetes for women who have had GDM. GDM is associated with high blood pressure, and long-term heart disease, including stoke and heart attacks. In fact, GDM is a bigger risk factor for maternal heart disease than even preeclampsia, something we all too often forget. We summarize some of these recommendations in this article in the Journal of the American Medical Association: https://pubmed.ncbi.nlm.nih.gov/37561508/.
Q: Where can women learn more from others who have experienced this – to hear from them and share – in addition to the support of their healthcare team?
DiabetesSisters is a free community that supports women with diabetes through peer support groups, workshops, videos, articles, and resources. We support women across all stages of life including pregnancy and postpartum.
Q: Are there any exercises that aren’t safe if you have gestational diabetes?
Any physical activity or exercise that is safe when pregnant is also safe when you have GDM. The key to effective GDM management is to listen to your body, which means listening to your blood glucose levels. That means trying out different diet changes, trying to stay physically active, and considering medication if you also need it. A successful GDM treatment strategy is often a combined and integrated treatment approach.
Here’s a helpful resource, Guidelines for Exercise with Diabetes.
Q: Are there any supplements you recommend for managing blood sugar with gestational?
There are really no supplements. The time tested and best approach is glucose control and getting it back to the right range, which is fasting less than 95 and ideally even 90 for some and less than 120 2 hours after meals. This can be done most often with a combination of behavior changes namely diet changes and safe and effective medication when needed.
Q: What is the difference between the 1-hour and 3-hour glucose test?
This is the testing protocol most frequently used in the US or a 2 step test, this means you complete an initial screening test. This initial test is that “gross glucose drink” you do in the OB/GYN office, but this is not a diagnosis! If that test is positive then you do a more formal 3-hour glucose test which means you are fasting, takes three hours, and you get a total of 3 blood draws. It is the second test that gives you the diagnosis of GDM. This testing strategy does take extra time and effort for both patients and providers, but it is important to remember it is time tested and proven to lead to the most accurate results. A two step test most accurately identifies women with GDM and minimize the risk of missing people who have GDM or identifying people who do not have GDM.
Q: How accurate are tests?
The test for GDM is very accurate when done at that right time in pregnancy that optimizes an accurate diagnosis which is in that window in the late second trimester between 20-24 weeks.
Q: Can gestational diabetes be managed with diet alone, or will I need insulin?
While the first step after a diagnosis of GDM is making diet and activity changes if possible, many times and up to 1 in 3 women with GDM will need medication as well as to help control blood sugar. We know from data from Europe and other countries with national health systems where pregnant women can access treatment in a timely manner most women who need medication will need it within the first weeks after diagnosis when it quickly becomes apparent that a treatment approach that combines diet plus medication will be needed. A major barrier in the US is timely access to GDM treatment when needed, and such a delay is important and probably a major reason for why outcomes for GDM remain poor and sometimes similar to conditions like preterm birth and preeclampsia for which we do not have effective treatment. An increasing problem we are seeing is that despite decades of robust data or nearly a century of data demonstrating the importance and safety and benefits of medications like metformin and insulin for GDM, the internet is full of incorrect information that can misguide people. That is a major reason we are leading this reddit initiative today.
Q: Will I need to be induced?
Not necessarily. All women with GDM should be able to make it to full term or at least 39 weeks if GDM is well managed and they do not have other medical problems or complications. Should they require medication, we recommend delivery generally after 39 weeks, but the truth is any pregnant person can have an elective delivery after 39 weeks.
Q: Having a new baby and trying to stay healthy for myself is so hard, any suggestions for extra resources or support?
https://www.acog.org/womens-health/pregnancy
Q: What foods should I eat or what should I avoid?
The key is a well balanced and nutritious diet. This is going to look different for each person. Some general recommendations are try to cut the extra sugar in processed food and sweets and go for more complex carbohydrates that can be found in whole grain bread, pasta, brown rice. Dairy is great like yoghurt with plenty of vegetables and making sure you are getting adequate protein too. It is important to remember that diet changes will help with post meal high blood sugar but we increasingly understand that fasting or first thing in the morning blood sugar has significant impact on your baby. Fasting blood sugar generally cannot be controlled with diet changes and will require a small amount of medication at night before bedtime to control, whether it be insulin or metformin. The point here is to appreciate the important of a multi-pronged and personal approach to GDM management which will look different for each person.
Closing & Next Steps
Gestational diabetes doesn’t define your pregnancy—it’s just one chapter in your story. With the right care, support, and information, you can have a healthy pregnancy, a thriving baby, and peace of mind.
If you found this conversation helpful, keep your momentum going:
Explore our Gestational Diabetes Hub for practical tips, personal stories, and expert resources.
Join our next live Q&A and support group to connect with women who truly understand this journey.
Remember, you’re already doing something powerful—seeking knowledge and community. We’re honored to walk this path beside you.
DiabetesSisters provides evidence-based education and compassionate peer support for women with all types of diabetes. This content follows our person-first language and the ADCES7™ Self-Care Behaviors framework to empower women to live well with diabetes.
