Controlling Gestational Diabetes: Blood Sugar, Diet, and Treatment

Written by Dr. Albana Greca, MD, MMedSc, Family Physician

Medically reviewed by Dr. Ruden Cakoni, MD, Endocrinologist

Last medically reviewed: July 2026

A diagnosis of gestational diabetes can bring worry, guilt, and many questions: Why did this happen? Will my baby be safe? What can I eat? Will I need insulin? I want you to know first that gestational diabetes is not your fault, and it does not mean that you have failed your pregnancy.

With glucose monitoring, appropriate nutrition, safe physical activity, prenatal care, and medication when needed, most women with gestational diabetes can have a healthy pregnancy and a healthy baby.

Quick Answer

Gestational diabetes is managed by checking glucose, eating regular balanced meals, being active when pregnancy care allows, attending prenatal appointments, and using medication when lifestyle changes are not enough. Common targets are fasting glucose below 95 mg/dL, one-hour glucose below 140 mg/dL, or two-hour glucose below 120 mg/dL. Your diabetes and obstetric teams may individualize these goals.

On this page:

What Is Gestational Diabetes?

Gestational diabetes is diabetes diagnosed during pregnancy in someone who did not already have known diabetes before becoming pregnant.

It often develops during the second or third trimester and may not cause noticeable symptoms. This is why routine screening is usually performed between 24 and 28 weeks of pregnancy.

If high glucose is found early in pregnancy, your healthcare team may evaluate whether type 1 or type 2 diabetes was present before pregnancy. Preexisting diabetes and gestational diabetes are managed differently in several important ways.

Why Does Gestational Diabetes Happen?

During pregnancy, hormones from the placenta help support your baby’s growth. These hormonal changes also make your cells less responsive to insulin. This is called insulin resistance.

Your pancreas normally compensates by producing more insulin. Gestational diabetes develops when your body cannot produce enough extra insulin to keep glucose within the pregnancy target range.

Some women have a higher risk because of factors such as:

  • Gestational diabetes during a previous pregnancy
  • Prediabetes before pregnancy
  • Overweight or obesity before pregnancy
  • A close family history of type 2 diabetes
  • Polycystic ovary syndrome
  • Previous delivery of a large baby
  • Increasing maternal age
  • Ethnic or population background associated with higher diabetes risk

You may still develop gestational diabetes without any obvious risk factor. It is not proof that you ate badly or did something wrong.

Can Gestational Diabetes Harm You or Your Baby?

Gestational diabetes does not mean that a complication will occur. Appropriate treatment reduces risk considerably. However, it is important not to dismiss higher glucose simply because you feel well.

Possible risks for the baby include:

  • Growing larger than expected for gestational age
  • A more difficult delivery or shoulder injury during birth
  • Preterm birth
  • Low blood sugar after birth
  • Breathing problems after delivery
  • A higher long-term risk of obesity and type 2 diabetes

Possible risks for the mother include:

  • High blood pressure and preeclampsia
  • Cesarean delivery
  • Birth complications related to a larger baby
  • Gestational diabetes in a future pregnancy
  • A substantially higher lifetime risk of type 2 diabetes

Gestational diabetes diagnosed at the usual 24–28-week screening does not have the same early-organ-development risk as poorly controlled preexisting diabetes around conception. However, it is not accurate to say that there is no risk to the baby. Glucose management remains important throughout pregnancy.

Blood Sugar Targets for Gestational Diabetes

Your care team will tell you when and how often to check. Many women test when fasting and after meals.

Testing time Common pregnancy target
Fasting Below 95 mg/dL (5.3 mmol/L)
1 hour after beginning a meal Below 140 mg/dL (7.8 mmol/L)
2 hours after beginning a meal Below 120 mg/dL (6.7 mmol/L)

Your doctor may provide slightly different goals based on your treatment, risk of hypoglycemia, local guidance, and pregnancy circumstances. Follow the targets given by your own maternity and diabetes teams.

How to obtain useful readings

  • Wash and dry your hands before testing.
  • Use unexpired strips that match your meter.
  • Record the time, result, food, activity, and medication when advised.
  • Be consistent about measuring one or two hours from the beginning of the meal.
  • Bring your meter or glucose record to appointments.
  • Ask what to do after repeated readings above target.

One isolated result may be influenced by food, stress, illness, timing, or testing technique. A pattern of above-target readings is more important and should be reported promptly.

Does A1C Replace Daily Glucose Checks?

No. A1C is naturally somewhat lower during pregnancy because red blood cells turn over more quickly. It also may not show after-meal glucose elevations that affect fetal growth.

For diabetes during pregnancy, A1C is normally used together with—not instead of—fasting and after-meal glucose monitoring.

The ideal A1C goal during pregnancy is often below 6% when it can be achieved without significant hypoglycemia. It may be relaxed to below 7% when needed to prevent low blood sugar. Your personal goal must be set by your care team.

What Should You Eat With Gestational Diabetes?

You and your baby need adequate energy and nutrients. The goal is not to eliminate all carbohydrate, skip meals, or lose weight during pregnancy without medical direction.

I recommend asking for an individualized plan from a registered dietitian or qualified diabetes educator. The plan should consider your pre-pregnancy weight, recommended pregnancy weight gain, glucose results, food preferences, culture, nausea, activity, and medication.

Practical meal principles

gestational diabetes meal principles

Foods you can build meals around

  • Non-starchy vegetables
  • Beans and lentils in suitable portions
  • Whole or minimally processed grains
  • Eggs, fish, poultry, tofu, and other appropriate protein sources
  • Pasteurized unsweetened dairy products
  • Whole fruit in measured portions
  • Nuts, seeds, avocado, and olive oil in appropriate amounts

Use safe pregnancy food-handling practices and avoid foods your maternity team has told you to restrict.

Avoid an unsupervised ketogenic diet during pregnancy. Pregnancy requires adequate nutrition, and severe carbohydrate restriction may increase ketone production. Ask your diabetes and obstetric teams how much carbohydrate is appropriate for you.

Why fasting glucose may remain high

Fasting glucose is influenced by overnight liver glucose production and pregnancy hormones, not only by what you ate at dinner. Do not skip food, eliminate carbohydrate, or go to bed hungry simply to force the fasting result lower.

If fasting readings repeatedly remain above target, contact your team. Medication may be needed even when you are following the food plan carefully.

For meal-building ideas, see our diabetic meal plan, but remember that pregnancy requires individual adjustments.

Physical Activity With Gestational Diabetes

Physical activity can improve insulin sensitivity and help lower after-meal glucose. For many uncomplicated pregnancies, moderate activity is encouraged.

Options may include:

  • Walking
  • Pregnancy-appropriate swimming
  • Stationary cycling
  • Prenatal exercise classes
  • Light resistance exercises
  • Short walks after meals

A practical approach may be 10–15 minutes of comfortable walking after a meal or approximately 30 minutes of moderate activity on most days, if your obstetric team agrees.

Ask for medical guidance before starting or continuing exercise if you have bleeding, placenta problems, risk of preterm labor, significant heart or lung disease, severe anemia, high blood pressure complications, ruptured membranes, or another obstetric concern.

Stop exercising and contact your maternity team for vaginal bleeding, painful contractions, fluid leakage, chest pain, severe shortness of breath, dizziness, calf pain or swelling, or reduced fetal movement.

When Is Medication Needed?

Some women reach their glucose targets through nutrition and activity. Others need medication because pregnancy hormones create insulin resistance that lifestyle changes cannot overcome.

Needing medication does not mean that you failed.

Insulin

Insulin is the preferred medication for treating gestational diabetes according to the American Diabetes Association because it does not cross the placenta in the same way as oral glucose-lowering medicines.

Your team may prescribe insulin for fasting glucose, after-meal glucose, or both. Insulin needs may increase as pregnancy progresses and usually fall rapidly after delivery.

Metformin and other oral medicines

Metformin and glyburide cross the placenta and are not considered first-line treatment by the ADA. However, metformin is used in selected circumstances and is included in some clinical guidelines.

The appropriate choice depends on:

  • Your glucose pattern
  • How far you are from your target
  • Pregnancy stage
  • Access to and ability to use insulin
  • Possible side effects
  • Your medical and obstetric history
  • Your informed preferences

Do not start, stop, or change insulin or an oral medicine without guidance from the clinician managing your pregnancy.

Preventing and Treating Low Blood Sugar

Gestational diabetes managed with food alone does not usually cause hypoglycemia. The risk is greater when insulin or certain glucose-lowering medicines are used.

Symptoms may include:

  • Shaking
  • Sweating
  • Hunger
  • Dizziness
  • Palpitations
  • Weakness
  • Confusion

Ask your team:

  • What glucose level they define as low
  • Which fast-acting carbohydrate to use
  • How much to take
  • When to recheck
  • When to contact them or seek emergency help

Family members should know how to respond if you become unable to treat yourself.

How Will Your Baby Be Monitored?

The type and frequency of monitoring depend on your glucose control, medication use, blood pressure, fetal growth, and other pregnancy factors.

Your maternity team may recommend:

  • Ultrasound assessment of fetal growth and amniotic fluid
  • Monitoring of fetal movement
  • Nonstress testing or other antenatal surveillance
  • Discussion of delivery timing and method

A diagnosis of gestational diabetes does not automatically mean that you need a cesarean delivery. The plan depends on estimated fetal size, glucose control, obstetric history, and other clinical factors.

What Happens to the Baby After Birth?

Your baby may have glucose checked after delivery because exposure to higher maternal glucose can cause the baby to produce more insulin. After the umbilical cord is cut, this insulin may temporarily lower the baby’s blood sugar.

Early feeding and skin-to-skin care may be encouraged when medically appropriate. Some babies need additional monitoring or treatment.

Ask the pediatric and maternity teams about the newborn monitoring plan before delivery.

Does Gestational Diabetes Go Away After Delivery?

Glucose often returns to the nonpregnant range after the placenta is delivered and pregnancy-related insulin resistance falls. However, gestational diabetes does not always disappear completely.

Some women are found to have persistent prediabetes or type 2 diabetes after delivery. Even when postpartum glucose is normal, the lifetime risk of type 2 diabetes remains significantly higher. The CDC estimates that about half of women with gestational diabetes later develop type 2 diabetes.

Your postpartum testing plan

  • Have a 75-gram oral glucose tolerance test 4–12 weeks after delivery.
  • Continue diabetes screening every 1–3 years if the postpartum result is normal.
  • Plan glucose testing before or early in a future pregnancy.
  • Tell future healthcare professionals that you had gestational diabetes.

A1C alone is less sensitive during the early postpartum period, so the oral glucose tolerance test is generally preferred for the 4–12-week assessment.

Reducing your future risk

After you have recovered from birth, work toward sustainable family habits:

  • Choose nutritious, high-fiber foods
  • Be regularly active
  • Work toward a healthy weight when appropriate
  • Avoid smoking
  • Attend routine health checks
  • Breastfeed when possible and desired

If postpartum testing shows prediabetes, ask about a structured diabetes-prevention program and whether metformin is appropriate.

Tips for Controlling Gestational Diabetes

Consistent glucose monitoring, balanced nutrition, safe physical activity, prenatal follow-up, and medication when needed can help protect both you and your baby.

1

Check Your Blood Sugar

Test at the times recommended by your care team and record fasting and after-meal results.

  • Fasting: below 95 mg/dL
  • 1 hour after eating: below 140 mg/dL
  • 2 hours after eating: below 120 mg/dL
2

Eat Regular, Balanced Meals

Do not skip essential nutrition. Eat regular meals and planned snacks when they are included in your individualized pregnancy meal plan.

3

Spread Carbohydrates Across the Day

Avoid eating a large carbohydrate portion at one meal. Distributing carbohydrate more evenly may help reduce after-meal glucose rises.

4

Choose Better Carbohydrate Sources

Prefer vegetables, beans, suitable portions of whole grains, and whole fruit. Choose water or unsweetened drinks instead of sugary beverages.

5

Be Active When It Is Safe

A comfortable 10–15-minute walk after meals may help lower after-meal glucose when your obstetric team approves physical activity.

6

Use Medication When Needed

Some women need insulin or another prescribed treatment because pregnancy hormones continue to increase insulin resistance. This is not a personal failure.

7

Keep Prenatal Appointments

Bring your meter or glucose record to appointments and follow your maternity team’s plan for fetal growth, movement, and pregnancy monitoring.

8

Plan Follow-Up After Delivery

Arrange a 75-gram oral glucose tolerance test 4–12 weeks after delivery and continue diabetes screening every 1–3 years when results are normal.

Remember: Your glucose goals may be individualized. Follow the targets and treatment plan provided by your diabetes and obstetric teams.
Contact your maternity or diabetes team promptly for repeated readings above your assigned target, severe or recurrent low blood sugar, vomiting, moderate or high ketones, reduced fetal movement, vaginal bleeding, fluid leakage, or other concerning pregnancy symptoms.
practical tips for controlling gestational diabetes

When Should You Seek Urgent Medical Help?

Contact your maternity or diabetes team urgently for:

  • Repeated glucose readings well above the target given to you
  • Moderate or high ketones when you have been advised to test
  • Repeated vomiting or inability to keep fluids down
  • Severe or recurrent hypoglycemia
  • Reduced fetal movement
  • Vaginal bleeding or fluid leakage
  • Severe headache, vision changes, sudden swelling, or upper abdominal pain
  • Contractions or signs of labor earlier than expected

Seek emergency care for loss of consciousness, seizure, severe breathing difficulty, confusion, or another rapidly worsening condition.

A Daily Gestational Diabetes Checklist

  • ☐ Check glucose at the times my care team recommends.
  • ☐ Record fasting and after-meal results.
  • ☐ Eat regular, balanced meals without skipping essential nutrition.
  • ☐ Choose water instead of sugary drinks.
  • ☐ Be active when my obstetric team says it is safe.
  • ☐ Take insulin or medication exactly as prescribed.
  • ☐ Monitor my baby’s movement as instructed.
  • ☐ Report repeated high or low readings promptly.

Frequently Asked Questions

Can gestational diabetes be controlled without insulin?

Many women meet their targets through individualized nutrition and safe activity. Others need insulin because pregnancy hormones continue to increase insulin resistance. Needing insulin is not a failure.

What fasting glucose is too high?

The common fasting target is below 95 mg/dL. Follow the action plan from your team and report repeated readings at or above your assigned limit.

Should I avoid all carbohydrates?

No. You and your baby need adequate nutrition. Choose suitable carbohydrate sources and portions, spread them across the day, and follow an individualized pregnancy meal plan.

Can I eat fruit?

Usually, yes. Whole fruit can fit into the plan in appropriate portions. Juice raises glucose more quickly and is generally less suitable as an everyday drink.

Will gestational diabetes affect delivery?

It may influence fetal monitoring, delivery timing, or delivery method, especially if glucose is above target or the baby is growing larger than expected. Your obstetric team will individualize the plan.

Can gestational diabetes return?

Yes. Having it once increases the chance of gestational diabetes in a future pregnancy and raises your long-term risk of type 2 diabetes.

Related Questions

Related Resources

References

This information is for general education and does not replace care from your obstetric, diabetes, or maternity team.