If I ever write a book about pregnancy, it will be called, "Who the hell knows why?"
Because here's the thing about gestational diabetes: your body literally works against itself while trying to grow a baby. And if you're reading this, you're probably either dreading that orange glucose drink, just failed your one-hour test, or got diagnosed and want to know what happens next.
The quick answer: Gestational diabetes is when your blood sugar gets too high during pregnancy because your pancreas can't keep up with the extra demands. It affects about 8-9% of pregnancies in the US, and while it's definitely a detour in your pregnancy journey, it's manageable with monitoring, diet adjustments, and sometimes medication.
Let me walk you through everything I learned (the hard way).
Table of Contents
- What Is Gestational Diabetes?
- The Glucose Challenge Test
- The Three-Hour Glucose Test
- Who's at Risk?
- Symptoms to Watch For
- Risks to Baby and Mom
- Treatment and Management
- Can You Prevent It?
- Life After Diagnosis
What Is Gestational Diabetes?
Simply put: high blood sugar during pregnancy because your body doesn't produce enough insulin.
Here's what's actually happening: Your pancreas normally does a decent job balancing glucose by producing insulin. But when you're pregnant, your placenta is basically a hormone factory that makes your body resist insulin. Your pancreas tries to compensate by working overtime, but sometimes it just can't keep up.
Your pancreas tried, it really did. But pregnancy is a bitch sometimes.
The Glucose Challenge Test: What to Expect (24-28 Weeks)
Every pregnant woman gets tested for gestational diabetes between 24-28 weeks. If you have major risk factors, you might get tested earlier for a baseline.
What happens:
- You drink a syrupy glucose beverage (often called "Glucola") within a specific timeframe
- Wait one hour (prepare for orange-flavored burps)
- Get your blood drawn to see how your body handled the sugar spike
About that drink: You know those people who sail through pregnancy without a hint of nausea? And maybe you fantasized you'd be one of them? Some lucky souls even claim the glucose drink "isn't that bad."
Spoiler: It tastes like flat, concentrated orange soda mixed with melted candy corn.
Results: In a day or two, you'll find out if you passed or failed. Here's the critical part: failing just means higher-than-average risk – it's NOT a diagnosis. Different clinics even use different thresholds for "failing."
True story: I actually avoided the three-hour test in my second pregnancy by switching providers and ending up at the high-risk clinic, where the threshold was different. I don't really recommend this as a solid plan, though.
The Three-Hour Glucose Test: When You "Fail" the First One
Failed the one-hour? Welcome to more orange-flavored sadness syrup.
The Glucose Tolerance Test means:
- Fasting beforehand (yes, while pregnant)
- Drinking twice as much glucose drink
- Blood draws at four points: before drinking, then every hour for three hours
- No food or drink during those three hours
- Being a hangry pregnant woman (rarely fun for anyone)
I wish I could say it wasn't so bad. In the grand scheme of things, it wasn't traumatic, but it definitely wasn't fun.
Alternative option: Some people hate the idea of the three-hour test so much they'd rather just proceed as though they have gestational diabetes – meaning regular blood sugar checks and dietary changes. You can discuss this with your provider.
If you fail the three-hour test, you'll be diagnosed with gestational diabetes.
Who's at Risk? (Spoiler: Lots of Us)
Age: Women over 25 are more likely to develop it. That really narrows it down for a lot of us, I know.
Health history: You're at higher risk if you have:
- Prediabetes
- A close family member with type 2 diabetes
- Previous gestational diabetes
- A previous baby who weighed over 9 pounds (4.1 kg)
- History of unexplained stillbirth
Weight: BMI over 30 increases risk
Race: Black, Hispanic, American Indian, and Asian women face increased risk
Symptoms to Watch For (Though Many Women Have None)
Here's the frustrating part: many women have zero noticeable symptoms, which is exactly why we're all tested. The symptoms that do appear often masquerade as normal pregnancy stuff:
- Unusual thirst
- Frequent urination (more than usual, which is saying something)
- Fatigue
- Nausea
- Frequent vaginal, bladder, or skin infections
- Blurred vision
- Sugar in urine (your doctor catches this one – don't drink your pee)
Risks to Baby and Mom (The Scary Part)
I'm not going to sugarcoat this because you deserve to know what you're monitoring for.
Potential risks to baby:
- Macrosomia: Medical speak for "a really freaking big baby," which can lead to shoulder dystocia (baby's shoulders getting stuck) and increased C-section risk
- Preterm birth
- Respiratory distress syndrome
- Low blood sugar after birth, with seizure risk
- Increased risk of type 2 diabetes later in life
Risks to you:
- High blood pressure
- Preeclampsia
- Increased risk of developing type 2 diabetes later (you'll want to remember this for postpartum)
According to the Mayo Clinic, proper management significantly reduces these risks, which is why all the monitoring matters.
Treatment and Management: What Actually Works
Blood sugar monitoring: You'll check your levels regularly (your doctor will show you how)
Diet and exercise: Yes, the universal answer to everything, but it genuinely helps. This gives you an idea of what type of eating plan you'd follow – think balanced meals, controlled carbs, and strategic snacks.
Insulin: Between 10-20% of women with gestational diabetes need supplemental insulin. If diet and exercise alone don't control your blood sugar, medication isn't a failure – it's a tool.
Postpartum testing: You'll likely get your blood sugar tested right after delivery and again at your six-week postpartum visit.
Can You Prevent It? (The Annoying Truth)
Diet and exercise is the answer to pretty much everything, right? Need to lose a few pounds? Diet and exercise. Need to lower your blood pressure? Diet and exercise. Depressed? Anxious? Got a wicked hangnail? Diet and exercise.
Here's the frustrating reality: even though healthy habits are constantly recommended as preventative measures, gestational diabetes is a bit of a wild card that can affect anyone – including incredibly healthy, active women.
Does a healthy lifestyle better your odds? Maybe. Does it guarantee prevention? Nope.
Life After Diagnosis: Your Next Steps
Being diagnosed with gestational diabetes isn't the end of your pregnancy journey; it's just a detour requiring extra attention. You're definitely not alone: around 9% of pregnant women face this challenge every year (hard to say if that's comforting or not).
What successful management looks like:
- Regular blood sugar monitoring and tracking patterns
- Working with your healthcare team (possibly including a nutritionist or diabetes educator)
- Thoughtful food choices without feeling deprived
- Regular movement that feels good for your pregnant body
- Medication if needed (no shame in that)
The good news? This condition typically resolves after delivery. Those orange drink memories may linger, unfortunately, but the actual diabetes usually doesn't.
The important postpartum reminder: Having gestational diabetes increases your future risk of type 2 diabetes. Maintaining healthy habits after birth isn't just good practice – it's preventative medicine for your future self.
Additional Resources
Related reading: The Perks of Gestational Diabetes (and There Aren't Many)
About the Author
Rhiannon is a single mom and writer whose work has appeared in The New York Times, The Washington Post, Parents, Huffington Post, and TODAY.com. She writes about the messy, honest parts of parenting and pregnancy with humor that reassures you're not alone in this chaos.
Last updated: January 2026
Medical disclaimer: This content is for informational purposes based on personal experience and research. Always consult your healthcare provider for medical advice specific to your situation. You're smart. You get it.
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