How Do I Know If I Have or Am at Risk for Gestional Diabetes?
Pregnancy is a time of excitement, change, and discovery. For some, it also brings a new diagnosis – gestational diabetes (GDM). Knowing the risk factors and getting screened for GDM are the first steps toward a healthy pregnancy.
GDM Explained
Although the term “gestational diabetes” sounds intimidating, it simply means that glucose levels are higher than normal during pregnancy. This happens because hormones made by the placenta affect how the body uses insulin, the natural hormone that helps manage blood glucose. As a result, insulin doesn’t work as effectively as before. This is called insulin resistance.
Starting around 16 weeks, insulin resistance begins to increase and continues to build as pregnancy progresses, which can make glucose levels harder to manage over time. Extra care and monitoring can help keep both mother and baby healthy.
Early Screening, Early Peace of Mind
The 2025 Standards of Care evidence-based guidelines for diabetes care recommend ideally getting glucose checked prior to becoming pregnant because sometimes women have prediabetes or type 2 diabetes and don’t know it. Tight glucose management during pregnancy is essential to promote healthy growth and development for your baby.
Screening is as simple as adding a fasting glucose or A1C test to routine prenatal labs. Elevated glucose is indicated by a fasting glucose of 110 to 125 or greater, or an A1C of 5.7 to 6.4 or greater.
This early screening is especially important if you had GDM in a prior pregnancy OR if you are carrying a few extra pounds (BMI > 25; >23 if of Asian ancestry) and have any of the following risk factors:
- First-degree relative with diabetes
- High-risk ethnicity (including African American, Latino, Native American, and Asian American)
- Heart disease
- High blood pressure
- Low HDL cholesterol and/or elevated triglycerides
- Polycystic ovary syndrome (PCOS) or other conditions associated with insulin resistance
Risk for GDM can also rise with age or having had a baby weighing over 9 pounds. Even without any risk factors, some women still develop GDM – thanks to the natural changes in the pregnancy hormones. The good news? GDM is manageable, and with the right care, a healthy pregnancy and delivery are absolutely possible.
If you aren’t screened prior to pregnancy, your care team will likely do so at your first prenatal visit, particularly if you have any of the above risk factors.
Normal Glucose Early On? Here’s What Happens Next
If early screening shows normal glucose, then the 2025 Standards of Care recommend routine screening for GDM at 24 to 28 weeks. Most commonly, this is done via a “one-step” 75-gram oral glucose tolerance test (OGTT). Blood glucose is checked while you are fasting, then you drink a very sweet beverage (although some care teams use alternatives). Glucose checks are done 1 and 2 hours after to see how you respond. There is also a less common “two-step” approach that may be used. Routine screening and diagnosis allow you to begin management, get support early, and keep both you and your baby well.
Healthy Weight Gain With You In Mind
Being at a healthy weight before becoming pregnant and keeping weight gain healthy during pregnancy are the goals for healthy outcomes. The amount of weight gained in pregnancy can affect the immediate and future health of you and your baby.
Weight gain recommendations are based on pre-pregnancy BMI. BMI is typically checked at the initial prenatal visit, then appropriate weight gain goals are provided, along with nutrition and physical activity guidance to limit excessive weight gain for the best pregnancy outcomes. Women who begin pregnancy underweight typically have greater weight gain goals than those who enter pregnancy carrying extra weight. Talk to your care team about what’s best for you.
The Next Chapter: Caring For You After Delivery
If you experience GDM, there are several important actions to take after delivery:
- Get your glucose screened at 4 to 12 weeks postpartum. This is recommended by the 2025 Standards of Care to make sure your glucose has returned to normal.
- Continue with your healthy lifestyle habits. To help hold off prediabetes or type 2 diabetes, continue to eat healthy, get regular physical activity, and maintain a healthy weight. Consider that after delivery, for every unit your BMI increases above your pre-pregnancy BMI, the risk of developing type 2 diabetes increases 18%. This calls out the importance of effective weight management long-term.
- Take charge with ongoing screening. Lifelong screening for prediabetes and type 2 diabetes is recommended, and is as simple as an A1C or fasting glucose added to your annual blood work. Or, doing a 75-gram OGTT every 3 years (not the most popular screening among women!).
If you’re thinking about a future pregnancy, early screening is important. And if your BMI is above 25, even small steps toward weight loss can lower your chances of developing GDM next time around. Every step you take now supports a healthier future – for you and your family.
Connect and learn from others – Join our upcoming Reddit AMA on Gestational Diabetes.
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