After the initial shock of hearing you’ve been diagnosed with gestational diabetes wears off,  you might be wondering what comes next. How will this diagnosis change the care you receive during your pregnancy? Will you have to change providers? Will you still get to have the birth you are hoping for? 

Gestational Diabetes: a brief overview

We still don’t know why some people get gestational diabetes while others don’t; and despite the fact that there are certain identifiable factors that may place you at a higher risk for gestational diabetes, the fact is that they test everyone because anyone can get it. 

Gestational diabetes is a type of diabetes that only occurs during pregnancy. The leading theory is that the placenta (that super cool organ your body grows as a life source for your baby while they grow and develop) produces hormones that block the mother’s ability to use naturally occurring insulin effectively. 

Our bodies rely on insulin, which is a hormone, to convert sugar (or glucose) into energy for our cells. As the placenta grows larger to provide for your growing baby, more hormones are released; and in some people, this increase in hormones can lead to the glucose building up in the blood, instead of it being used by the cells of the parent and the growing baby. 

Providers & Gestational Diabetes

While most providers feel comfortable supporting clients with gestational diabetes, it is possible that you might be referred out to a provider or clinic who specializes in this field. Depending on what other risk factors are identified, it may be suggested that you work with an OBGYN or Maternal Fetal Specialist to ensure that you and your baby get the individualized care that you need. 

How Gestational Diabetes Impacts Appointments

At your first visit following your diagnosis, your provider will likely schedule time to show you how to use a glucose monitor, how to track your numbers, and discuss the impact of diet and exercise for management of sugar levels. They will likely also refer you to a nutritionist or dietician, who will cover diet recommendations in more detail. 

As your pregnancy progresses, you may also find that you have more appointments to fit into your busy schedule. Starting at about 32-34 weeks, your provider might ask that you start coming in to see them for an NST (Non-Stress Test) and a BPP (Biophysical Profile) weekly, in addition to your normally scheduled prenatal appointments. These two additional appointments allow the provider to monitor you and baby more closely, giving them detailed information that supports decisions on what care looks like for the last few weeks of your pregnancy. 

How Gestational Diabetes Impacts Birth

A diagnosis of gestational diabetes doesn’t always mean that you can’t have the birth that you are hoping for. Last year (2023), ACOG (The American College of Obstetrics and Gynecology) updated their recommendations about delivery to be more specific surrounding how well gestational diabetes is managed by diet only or by diet and insulin. Previously the recommendation was for delivery around 39 weeks of pregnancy, but the new guidelines allow for more flexibility dependent on how well the individual is responding to their treatment plan. 

If spontaneous labor is important to you, this is something that you can discuss with your provider. They will be able to make an educated recommendation based on how well you and baby are doing (all those NSTs and BPPs), your log of glucose readings, and whether or not you’re using insulin to help manage your numbers. 

After delivery, your medical team will likely continue to test both your glucose levels and your baby’s glucose levels for a period of time. If the levels are within normal range, usually this testing does not continue for long. If, however, there are high or low readings, your provider may want to continue testing glucose levels until they feel satisfied that things are returning to normal. 

Final Thoughts

A diagnosis of gestational diabetes does not mean that you’ve done something wrong or that there is something wrong with you or your baby. While it may take a while to come to terms with what this means for you, and space to process any emotions it brings up, this diagnosis doesn’t have to define your pregnancy journey. If you’re interested in learning more about how a birth doula can help support you, click HERE.