Gestational Diabetes: Symptoms, Testing and Management

Gestational diabetes is diabetes that is first diagnosed during pregnancy. It happens when the body cannot make enough insulin or use insulin effectively to keep blood sugar within a healthy range.

Many pregnant women with gestational diabetes feel well and have no obvious symptoms. This is why routine screening during pregnancy is important. If gestational diabetes is not managed, high blood sugar can increase the risk of complications for both mother and baby. The good news is that with proper monitoring, food choices, physical activity and medication when needed, many women with gestational diabetes go on to have healthy pregnancies and healthy babies.

ACOG explains that gestational diabetes happens when a woman develops diabetes for the first time during pregnancy and needs special care both during and after pregnancy. [1]

What Is Gestational Diabetes?

Diabetes means there is too much glucose, or sugar, in the blood. During pregnancy, hormones from the placenta can make the body more resistant to insulin. Insulin is the hormone that helps move glucose from the blood into cells for energy.

For many pregnant women, the body can make extra insulin to handle this change. But for some women, the body cannot keep up. Blood sugar then becomes too high, leading to gestational diabetes.

Gestational diabetes usually develops in the second half of pregnancy and often improves after delivery. However, it increases the mother’s future risk of type 2 diabetes, so follow-up after birth is important.

Does Gestational Diabetes Have Symptoms?

Many women with gestational diabetes do not have symptoms. CDC states that gestational diabetes usually has no symptoms and that doctors should test for it between 24 and 28 weeks of pregnancy. [2]

If blood sugar becomes very high, some women may notice:

• Increased thirst
• Passing urine more often than usual
• Dry mouth
• Tiredness
• Blurred vision
• Recurrent infections, such as thrush

These symptoms can overlap with normal pregnancy symptoms, so they are not reliable for diagnosis. A glucose test is needed to confirm gestational diabetes.

Who Is More Likely to Develop Gestational Diabetes?

Gestational diabetes can happen even if a woman had no diabetes before pregnancy. However, some factors increase the risk.

HealthHub Singapore lists risk factors including family history of diabetes, pre-pregnancy BMI above 23 kg/m2, excessive pregnancy weight gain, previous gestational diabetes, previous baby weighing more than 4 kg, age 40 or above, hypertension, previous poor pregnancy outcomes associated with diabetes, and polycystic ovary syndrome. [3]

Risk factors include:

• Parent or sibling with diabetes
• Higher pre-pregnancy BMI
• Excessive weight gain during pregnancy
• Gestational diabetes in a previous pregnancy
• Previous baby weighing more than 4 kg at birth
• Age 40 years or above
• High blood pressure
• Polycystic ovary syndrome, also called PCOS
• Previous pregnancy complications linked with diabetes

Even if you do not have these risk factors, you may still be screened because gestational diabetes can occur without obvious warning signs.

How Is Gestational Diabetes Tested?

Testing usually involves drinking a glucose drink and checking how your body handles sugar. The exact test method may vary by hospital, clinic and country.

In many settings, screening is done between 24 and 28 weeks of pregnancy. HealthXchange Singapore notes that between pregnancy weeks 24 and 32, a doctor may order a glucose test to check for gestational diabetes. [4]

Common testing methods

• Glucose challenge test: You drink a sweet glucose drink, and your blood sugar is checked after a set time. If the result is high, you may need a longer test.
• Oral glucose tolerance test, or OGTT: You usually fast beforehand, drink a glucose drink, and have blood taken at different times to see how your blood sugar changes.

Follow your clinic’s instructions carefully. Some tests require fasting, while others may not. If you vomit during the test or feel unwell, tell the nurse or doctor.

Why Testing Matters Even If You Feel Well

Gestational diabetes often has no symptoms, but high blood sugar can still affect the pregnancy. Testing helps identify women who need diet advice, blood sugar monitoring or medication.

Early diagnosis allows the healthcare team to manage blood sugar before complications develop or worsen.

What Problems Can Gestational Diabetes Cause?

When blood sugar is well controlled, the risk of complications can be reduced. If gestational diabetes is not managed, possible concerns include:

• Baby growing larger than expected, also called macrosomia
• More difficult labour or shoulder dystocia
• Higher chance of caesarean delivery
• Preterm birth
• High blood pressure or pre-eclampsia
• Too much amniotic fluid
• Baby having low blood sugar after birth
• Baby needing closer monitoring after delivery
• Higher future risk of type 2 diabetes for the mother

CDC notes that diabetes during pregnancy can negatively affect the health of pregnant women and babies, and high blood sugar during pregnancy can increase the risk of caesarean delivery. [5]

How Is Gestational Diabetes Managed?

Management usually focuses on keeping blood sugar within the target range recommended by your healthcare team. This may involve food changes, activity, home blood sugar monitoring and medication if needed.

1. Food Choices

Food is a major part of gestational diabetes management. The aim is not to stop eating carbohydrates completely. Pregnant women still need balanced nutrition for baby’s growth. The goal is to choose the right type, amount and timing of carbohydrates, and to pair them with protein, fibre and healthy fats.

Helpful food principles

• Eat regular meals instead of skipping meals.
• Choose whole grains where possible.
• Spread carbohydrate intake across the day.
• Pair carbohydrates with protein and vegetables.
• Reduce sugary drinks, desserts and sweet snacks.
• Choose fruit in sensible portions instead of fruit juice.
• Include enough protein such as eggs, fish, chicken, tofu, beans or lean meat.
• Choose healthier fats from nuts, seeds, avocado or suitable fish.

Singapore-friendly meal examples

• Brown rice with steamed fish, tofu and vegetables
• Fish soup with bee hoon or rice, plus extra vegetables
• Yong tau foo with vegetables, tofu and fewer fried items
• Wholemeal bread with egg and avocado
• Oats with milk and a small portion of fruit
• Economic rice with one protein, two vegetable dishes and less gravy
• Chapati with dhal and vegetables

Foods and drinks to limit

• Sweet drinks, bubble tea, soft drinks and fruit juice
• Large portions of white rice or noodles
• Cakes, pastries, sweet biscuits and desserts
• Sweetened breakfast cereals
• Highly processed snacks
• Very large late-night meals

Diet needs can vary greatly. A dietitian can help you create a practical meal plan that fits your culture, food preferences, appetite and blood sugar readings.

2. Physical Activity

If your doctor says it is safe, gentle physical activity can help the body use glucose better. Walking after meals may help some women lower post-meal blood sugar.

CDC states that staying active is a way to help manage gestational diabetes, and if healthy eating and activity are not enough, medication may be prescribed. [6]

Pregnancy-friendly activities may include:

• Walking
• Swimming
• Prenatal exercise classes
• Gentle strength training if approved
• Light movement after meals

Do not start intense exercise suddenly. Avoid activities with a high risk of falling, overheating or abdominal injury. Follow your doctor’s advice if you have bleeding, placenta problems, contractions, high blood pressure or other complications.

3. Blood Sugar Monitoring

Many women with gestational diabetes are asked to check blood sugar at home using a finger-prick glucose meter or another approved method. Your healthcare team will tell you when and how often to check.

Common check times may include:

• Fasting blood sugar in the morning
• One or two hours after meals
• Before meals, in some cases

Bring your readings to appointments. They help your doctor decide whether food and activity changes are enough or whether medication is needed.

4. Medication When Needed

Some women can manage gestational diabetes with diet and exercise alone. Others need medication. Needing medication does not mean you have failed. It means your body needs extra help to keep blood sugar safe for you and your baby.

CDC states that if healthy eating and being active are not enough to manage blood sugar, a doctor may prescribe insulin, metformin or other medication. [6]

Your doctor will explain:

• Why medication is recommended
• How to take it safely
• Possible side effects
• How often to monitor blood sugar
• What to do if readings are too high or too low

5. Closer Pregnancy Monitoring

If you have gestational diabetes, your doctor may monitor your pregnancy more closely. This may include:

• More frequent antenatal reviews
• Growth scans to check baby’s size
• Blood pressure monitoring
• Urine tests
• Discussion about timing and mode of delivery
• Baby’s blood sugar monitoring after birth

NHS notes that women with gestational diabetes are more closely monitored during pregnancy and birth to check for potential problems. [7]

Will I Need an Early Delivery or C-Section?

Not always. Many women with gestational diabetes have vaginal births. The delivery plan depends on blood sugar control, baby’s growth, mother’s health, pregnancy complications and hospital guidelines.

NHS states that if you have gestational diabetes, it is best to give birth before 41 weeks, and induction or caesarean may be recommended if labour does not start naturally by then. Earlier delivery may be recommended if there are concerns about the mother’s or baby’s health, or if blood sugar levels are not well controlled. [7]

Your gynae will discuss the safest plan based on your individual situation.

What Happens After Baby Is Born?

Gestational diabetes often improves after delivery because the placenta is delivered and pregnancy hormone levels change. However, both mother and baby may need monitoring.

For baby

The baby’s blood sugar may be checked after birth, especially if the mother needed medication or if the baby is large or has symptoms. Early feeding may help stabilise baby’s blood sugar.

For mother

Your doctor may arrange follow-up blood sugar testing after birth to make sure diabetes has resolved. You may also be advised to test again regularly in future because gestational diabetes increases the risk of type 2 diabetes.

ACOG states that women with gestational diabetes should be tested after delivery and that those who had gestational diabetes have a higher risk of developing diabetes later in life. [1]

Can Gestational Diabetes Be Prevented?

Gestational diabetes cannot always be prevented. Some risk factors, such as family history and age, cannot be changed. However, healthy habits before and during pregnancy may reduce risk or help with management.

Helpful steps include:

• Entering pregnancy at a healthy weight where possible
• Eating balanced meals
• Reducing sweet drinks and high-sugar foods
• Staying active if medically safe
• Attending antenatal appointments
• Following screening and testing advice

Emotional Support: It Is Not Your Fault

Some mothers feel guilty or ashamed after being diagnosed with gestational diabetes. It is important to know that gestational diabetes is strongly linked with pregnancy hormones and insulin resistance. It is not simply caused by eating one dessert or having cravings.

Instead of blame, focus on practical steps. With the right support, many women manage gestational diabetes well.

When Should You Seek Medical Advice?

Contact your doctor or diabetes care team if:

• Your blood sugar readings are repeatedly above target
• You feel dizzy, shaky, sweaty or faint
• You are vomiting and cannot eat or drink normally
• You are unsure what to eat
• You are losing weight unintentionally
• You are taking medication and have concerns
• Your baby’s movements are reduced in later pregnancy
• You feel overwhelmed and unable to cope

Seek Urgent Medical Help If You Have These Symptoms

• Reduced baby movements
• Severe abdominal pain
• Vaginal bleeding
• Severe vomiting or dehydration
• Severe headache or blurred vision
• Sudden swelling of face or hands
• Chest pain or shortness of breath
• Fainting or confusion

These symptoms may not be caused by gestational diabetes directly, but they can signal pregnancy complications that need urgent assessment.

FAQ: Gestational Diabetes

What is gestational diabetes?

Gestational diabetes is diabetes first diagnosed during pregnancy. It happens when the body cannot make enough insulin or use insulin effectively, causing blood sugar to become too high.

Does gestational diabetes have symptoms?

Many women have no symptoms. Some may have increased thirst, frequent urination, dry mouth, tiredness or blurred vision if blood sugar is very high, but testing is needed for diagnosis.

When is gestational diabetes tested?

Screening is commonly done between 24 and 28 weeks of pregnancy, although some women with higher risk may be tested earlier. The exact timing depends on the clinic or hospital.

How is gestational diabetes diagnosed?

It is diagnosed with glucose testing, often using a glucose challenge test or oral glucose tolerance test. These tests check how the body handles sugar after drinking a glucose drink.

Can gestational diabetes be managed without medication?

Some women can manage it with food choices, physical activity and blood sugar monitoring. Others need insulin, metformin or other medication. Needing medication does not mean the mother has failed.

Can I still eat rice or noodles with gestational diabetes?

Many women can still eat carbohydrates such as rice or noodles, but portion size, type and pairing with protein and vegetables matter. A dietitian can help create a practical meal plan.

Will gestational diabetes affect my baby?

If not well managed, gestational diabetes may increase the risk of a large baby, birth complications, preterm birth and low blood sugar in the baby after delivery. Good blood sugar control reduces these risks.

Will gestational diabetes go away after birth?

It often improves after delivery, but follow-up testing is important. Women who had gestational diabetes have a higher future risk of type 2 diabetes.

Key Takeaway

Gestational diabetes is common and often has no obvious symptoms, which is why pregnancy glucose testing is important. It usually develops because pregnancy hormones make the body more resistant to insulin.

Management may include balanced meals, controlled carbohydrate portions, physical activity, blood sugar monitoring and medication when needed. With good care, many women with gestational diabetes have healthy pregnancies. After delivery, follow-up testing remains important because of the higher future risk of type 2 diabetes.

References

• [1] American College of Obstetricians and Gynecologists, Gestational Diabetes.
• [2] CDC, Symptoms of Diabetes.
• [3] HealthHub Singapore, Gestational Diabetes.
• [4] HealthXchange Singapore, Pregnancy Week 24: Gestational Diabetes Testing.
• [5] CDC, Diabetes During Pregnancy.
• [6] CDC, Gestational Diabetes.
• [7] NHS, Gestational Diabetes.
• [8] NHS, Treatment: Gestational Diabetes.