Gestational diabetes is a condition that develops during pregnancy when blood sugar levels become too high, affecting between 5% and 10% of pregnant women in the United States each year. Managing this condition through healthy eating, physical activity, and sometimes medication can help ensure both mother and baby remain healthy throughout pregnancy and beyond.

How Treatment Helps Both Mother and Baby Stay Healthy

When a woman develops gestational diabetes, the main goal of treatment is to keep blood sugar levels within a safe range throughout the rest of the pregnancy. This approach helps prevent complications that can affect both the mother and the developing baby. The treatment focuses on three key areas: controlling blood sugar to protect the baby’s health, preventing delivery complications, and reducing the risk of long-term health problems for the mother after pregnancy ends.^[1]

The good news is that gestational diabetes can be managed effectively in most cases. Many women are able to control their blood sugar levels through changes to their diet and regular physical activity alone. When these lifestyle changes are not enough to keep blood sugar in the target range, medications such as pills or insulin injections may be added to the treatment plan. The specific treatment approach depends on several factors, including how high the blood sugar levels are, how far along the pregnancy is, and whether the baby is showing any signs of being affected by the mother’s blood sugar levels.^[2]

Treatment for gestational diabetes also includes more frequent check-ups with healthcare providers. These extra visits allow doctors and nurses to monitor how well the treatment is working, check on the baby’s growth and health, and make adjustments to the treatment plan if needed. Women with gestational diabetes typically see their healthcare team more often during the last three months of pregnancy, when blood sugar control becomes even more important.^[3]

Standard Treatment Approaches for Managing Blood Sugar

Blood Sugar Monitoring at Home

The foundation of gestational diabetes treatment is regular monitoring of blood sugar levels. Women diagnosed with this condition are given a testing kit that allows them to check their blood sugar at home several times each day. This kit includes a small device called a glucose meter, along with thin needles for pricking the finger and special strips that measure the amount of sugar in a drop of blood.^[9]

Healthcare providers give specific instructions about when and how often to test. Most women are advised to check their blood sugar before breakfast and one hour after each meal. The target levels are usually less than 95 milligrams per deciliter before eating, less than 140 milligrams per deciliter one hour after eating, or less than 120 milligrams per deciliter two hours after eating. These targets may vary slightly depending on individual circumstances and medical guidelines.^[10]

Some women who take insulin and experience problems with unstable blood sugar levels may be offered a continuous glucose monitor. This is a small sensor worn on the skin that automatically tracks blood sugar levels throughout the day and night. The sensor sends information wirelessly to a receiver or mobile phone, allowing the woman and her healthcare team to see patterns in blood sugar levels without needing to do finger pricks as often.^[11]

Nutrition and Dietary Changes

Making changes to what and when you eat is one of the most powerful tools for controlling blood sugar levels during pregnancy. All women with gestational diabetes should be referred to a dietitian, a healthcare professional who specializes in nutrition and can provide personalized advice about meal planning and food choices. The dietitian helps create an eating plan that provides enough nutrients for the baby to grow properly while keeping blood sugar levels stable.^[9]

The type of food eaten makes a big difference in blood sugar control. Carbohydrates are nutrients found in foods like bread, rice, pasta, potatoes, fruits, milk, and sweets. When digested, carbohydrates break down into glucose, which enters the bloodstream. Because carbohydrates have the biggest effect on blood sugar levels, nutritional counseling focuses heavily on choosing the right types of carbohydrates, eating appropriate portion sizes, and spreading carbohydrate intake throughout the day.^[12]

Women with gestational diabetes are typically advised to eat three meals and two to three snacks each day. Eating too much food at one time can cause blood sugar to spike too high, while going too long without eating can cause other problems. Spreading food intake across the day helps keep blood sugar levels more stable. Breakfast can be particularly challenging because pregnancy hormones are strongest in the morning, making blood sugar harder to control. For this reason, breakfast often requires special attention, and foods like dry cereals, fruit juice, and large amounts of fruit may need to be limited or avoided in the morning.^[15]

Choosing complex carbohydrates that contain fiber helps slow down how quickly sugar enters the bloodstream. Examples include whole grain bread instead of white bread, brown rice or basmati rice instead of white rice, and whole wheat pasta instead of regular pasta. These foods also contain more vitamins, minerals, and fiber, which are beneficial during pregnancy. Foods high in fiber include beans, lentils, split peas, and vegetables.^[18]

Portion control is essential. A reasonable serving of starchy food is about one cup of cooked rice, pasta, or potatoes, or two slices of bread per meal. Fruit should be limited to one small piece at a time because even though fruit is nutritious, it contains natural sugars that can raise blood sugar levels. Fruit juice should be avoided entirely because it takes several pieces of fruit to make one glass of juice, and the liquid form causes blood sugar to rise very quickly.^[15]

Foods and drinks that should be strictly limited or avoided include cakes, cookies, candies, pastries, regular sodas, and other sugary items. These provide little nutrition and can cause blood sugar levels to become too high. Women can use artificial sweeteners such as aspartame, sucralose, or stevia, which are considered safe during pregnancy and do not affect blood sugar levels.^[15]

Protein foods such as lean meat, fish, eggs, and cheese do not raise blood sugar levels as much as carbohydrates and can be included in meals and snacks. Combining protein with carbohydrates helps slow down the absorption of sugar. Healthy fats from sources like nuts, seeds, avocados, and olive oil are also important for the baby’s development and do not directly raise blood sugar.^[20]

Physical Activity and Exercise

Regular physical activity is an effective way to help control blood sugar levels during pregnancy. Exercise helps the body use insulin more efficiently and can lower blood sugar both during and after activity. Women with gestational diabetes are typically advised to aim for at least 150 minutes of moderate-intensity activity per week, which equals about 30 minutes on most days. This can be spread throughout the week in smaller amounts, such as 15 minutes twice a day.^[11]

Safe forms of exercise during pregnancy include walking, swimming, prenatal yoga, and stationary cycling. These activities are gentle on the joints and can be adapted as pregnancy progresses. Women should always check with their healthcare provider about which activities are safe for their specific situation, as some pregnancy complications may limit what types of exercise are recommended.^[9]

It is important to avoid exercising too intensely or in ways that could cause falls or injuries. Activities like contact sports, exercises that involve lying flat on the back after the first trimester, and exercises with a high risk of falling should be avoided. Staying hydrated and not exercising in hot weather are also important safety measures.^[6]

Medication When Lifestyle Changes Are Not Enough

If blood sugar levels remain too high after one to two weeks of following a healthy diet and exercising regularly, or if blood sugar levels are very high when gestational diabetes is first diagnosed, medication may be necessary. The decision to add medication depends on blood sugar readings, how well lifestyle changes are working, and whether there are any signs that the baby is growing too large or other pregnancy complications are developing.^[11]

Metformin is the most commonly prescribed oral medication for gestational diabetes. It is a tablet taken up to three times per day, usually with or after meals. Metformin works by helping the body use its own insulin more effectively and by reducing the amount of glucose produced by the liver. This medication has been used safely in pregnancy for many years, though it is not officially approved by all regulatory agencies specifically for use during pregnancy. Side effects can include feeling sick to the stomach, vomiting, stomach cramps, diarrhea, and loss of appetite. These side effects often improve after the first few days of taking the medication.^[11]

Occasionally, a different tablet called glibenclamide (also known as glyburide in some countries) may be prescribed instead of or in addition to metformin. This medication works by stimulating the pancreas to produce more insulin. However, metformin is more commonly used as the first choice.^[11]

Insulin injections may be recommended if oral medications do not lower blood sugar levels enough, if a woman cannot take metformin or experiences severe side effects, if blood sugar levels are very high, or if the baby is showing signs of growing too large or if there is too much amniotic fluid around the baby. Insulin is a hormone that the body naturally produces, and taking extra insulin by injection helps move glucose from the blood into the cells where it can be used for energy.^[11]

Insulin is injected under the skin using a device called an insulin pen, which looks similar to a large pen and contains a cartridge of insulin. The needles used are very small and thin, so the injections usually do not hurt much. Healthcare providers teach women exactly how to use the insulin pen, where on the body to inject (usually the abdomen, thighs, or upper arms), and how to store insulin properly. Depending on the type of insulin prescribed, injections may be needed before meals, at bedtime, or upon waking.^[11]

The amount of insulin needed often increases as pregnancy progresses because pregnancy hormones continue to cause more insulin resistance. Healthcare providers adjust insulin doses based on blood sugar readings and other factors. Women taking insulin need to be aware of the risk of blood sugar dropping too low, a condition called hypoglycemia. Signs of low blood sugar include shakiness, sweating, confusion, rapid heartbeat, and hunger. Women are taught how to recognize and treat low blood sugar quickly by consuming fast-acting carbohydrates like glucose tablets or juice.^[11]

All medications for gestational diabetes can usually be stopped immediately after the baby is born, as blood sugar levels typically return to normal once the placenta is delivered. However, women need to have their blood sugar tested shortly after delivery and again six to twelve weeks after giving birth to make sure levels have returned to normal and to screen for type 2 diabetes.^[9]

Duration of Treatment

Treatment for gestational diabetes continues for the remainder of the pregnancy, typically from the time of diagnosis (usually between 24 and 28 weeks) until delivery. The intensity of treatment and frequency of monitoring increase as the due date approaches. Women with gestational diabetes have more frequent prenatal visits, often weekly or every two weeks during the final trimester, to monitor blood sugar control, check on the baby’s growth with ultrasound examinations, and watch for signs of complications.^[3]

Possible Side Effects of Standard Treatment

The dietary changes required for gestational diabetes are generally safe and healthy, though some women may find the restrictions challenging or feel hungry between meals if portion sizes need to be reduced. It is important to work closely with a dietitian to ensure adequate nutrition for both mother and baby while maintaining blood sugar control.^[12]

Metformin can cause digestive side effects such as nausea, vomiting, diarrhea, stomach cramps, and loss of appetite, particularly when first starting the medication. These symptoms often improve within a few days to a week as the body adjusts. Taking metformin with food can help reduce these side effects.^[11]

The main risk associated with insulin treatment is hypoglycemia, when blood sugar drops too low. This can happen if too much insulin is given, if a meal is skipped or delayed, or if physical activity is more intense than usual. Mild hypoglycemia can usually be treated quickly by consuming 15 grams of fast-acting carbohydrate, such as four ounces of fruit juice, three to four glucose tablets, or a tablespoon of honey. Severe hypoglycemia is rare but requires immediate medical attention.^[9]

Insulin injections can sometimes cause minor bruising, redness, or discomfort at the injection site. Rotating injection sites and using proper injection technique can minimize these issues. Weight gain is possible with insulin use, though maintaining a healthy diet and staying active help manage this.^[11]

Research Into New Treatment Approaches

While the sources provided do not contain detailed information about specific experimental drugs or clinical trials for gestational diabetes, it is important to note that research continues to explore better ways to prevent, diagnose, and treat this condition. Standard treatment approaches using diet, exercise, metformin, and insulin remain the backbone of gestational diabetes management because they have been studied extensively and proven effective and safe during pregnancy.^[8]

Researchers are working to better understand the underlying causes of gestational diabetes, which could lead to new prevention strategies. Studies are also examining whether screening women earlier in pregnancy or even before conception could identify those at highest risk and allow for earlier interventions. Additionally, research is ongoing into whether newer diabetes medications used for type 2 diabetes outside of pregnancy might be safe and effective for use during pregnancy, though currently these medications are not recommended for gestational diabetes due to limited safety data.^[12]

Clinical trials may be available for women with gestational diabetes who meet specific criteria and are interested in participating in research. These studies help advance medical knowledge and may provide access to new monitoring technologies or treatment approaches before they become widely available. Women interested in clinical trials should discuss this option with their healthcare providers.^[2]

Most Common Treatment Methods

• Blood Sugar Monitoring
  • Home glucose testing using finger-prick devices and test strips, typically before breakfast and one hour after each meal
  • Continuous glucose monitors for women with unstable blood sugar levels or those taking insulin
  • Target blood sugar levels: less than 95 mg/dL before meals, less than 140 mg/dL one hour after meals, or less than 120 mg/dL two hours after meals
• Medical Nutrition Therapy
  • Personalized meal planning with a registered dietitian
  • Eating three meals and two to three snacks daily to distribute carbohydrate intake throughout the day
  • Choosing complex carbohydrates high in fiber such as whole grains, brown rice, and whole wheat products
  • Controlling portion sizes of starchy foods to about one cup of cooked grains or two slices of bread per meal
  • Limiting fruit to one small piece at a time and avoiding fruit juice
  • Avoiding sugary foods, desserts, and sweetened beverages
  • Including lean protein sources and healthy fats in meals
• Physical Activity
  • At least 150 minutes of moderate-intensity exercise per week
  • Safe activities including walking, swimming, prenatal yoga, and stationary cycling
  • Exercise helps improve insulin sensitivity and lower blood sugar levels
• Oral Medication
  • Metformin as the first-line oral medication, taken up to three times daily with meals
  • Glibenclamide as an alternative oral medication in some cases
  • Used when diet and exercise alone do not adequately control blood sugar levels
• Insulin Therapy
  • Insulin injections using insulin pens with small needles
  • Prescribed when oral medications are insufficient or contraindicated
  • Timing of injections varies based on insulin type: before meals, at bedtime, or upon waking
  • Doses adjusted throughout pregnancy based on blood sugar readings
• Enhanced Prenatal Care
  • More frequent prenatal visits, especially during the third trimester
  • Regular ultrasound examinations to monitor fetal growth
  • Monitoring for pregnancy complications such as preeclampsia and polyhydramnios
  • Planning for delivery, which may involve inducing labor or cesarean section if complications arise