Supporting people with gestational diabetes

A diagnosis of gestational diabetes mellitus (GDM) can be overwhelming. Many people experience anxiety, guilt, or self-blame following diagnosis, making the support provided by health professionals critical. By combining evidence-based education, emotional support, and coordinated care, you can help people achieve healthy pregnancy outcomes while reducing future health risks for both mother and baby.

Understanding why treatment matters

Explaining the reasons for treatment can help motivate self-management and reduce anxiety. Elevated maternal blood glucose levels increase the transfer of glucose across the placenta, which can lead to excessive foetal growth, birth complications, induction of labour, caesarean birth, and neonatal hypoglycaemia. Women with gestational diabetes are also at increased risk of hypertension and pre-eclampsia during pregnancy.

The reassuring message for clients is that careful management significantly reduces these risks, and most people with well-managed gestational diabetes will go on to have a healthy pregnancy and healthy baby.

Gestational diabetes in Australia

Gestational diabetes affects around one in seven pregnancies in Australia and is one of the most common pregnancy-related complications encountered in practice. It occurs when hormones produced by the placenta increase insulin resistance during pregnancy. If the pancreas cannot produce enough additional insulin to overcome this resistance, blood glucose levels rise and gestational diabetes develops.

While gestational diabetes can occur in any pregnancy, risk is increased in people with previous gestational diabetes, overweight or obesity, a family history of type 2 diabetes, polyendocrine metabolic ovarian syndrome, or come from Aboriginal and Torres Strait Islander, African, Asian, Pacific Islander, Middle Eastern, Hispanic, or South American backgrounds. All pregnant people should be screened between 24 and 28 weeks’ gestation using an oral glucose tolerance test, with earlier testing recommended for those at higher risk.

Building a multidisciplinary approach

Gestational diabetes management is most effective when delivered through a multidisciplinary model of care. Depending on individual circumstances, this team may include a GP, obstetrician, endocrinologist, credentialled diabetes educator or diabetes nurse practitioner, accredited practising dietitian, midwife, exercise physiologist, or physiotherapist. Early referral to diabetes educators and dietitians can help ensure people receive tailored support as soon as possible.

Supporting healthy lifestyle behaviours

Healthy eating remains the foundation of gestational diabetes management. Rather than focusing on restriction, encourage sustainable eating patterns that support blood glucose targets while meeting the nutritional demands of pregnancy. Key messages include spreading carbohydrate intake throughout the day, choosing lower GI and high-fibre carbohydrate foods, limiting foods high in added sugars, and including a wide variety of nutritious foods to support increased requirements for nutrients such as iron and folate. Importantly, carbohydrates should not be eliminated and should be tailored to individual needs with dietetic guidance.

Physical activity also plays an important role in managing blood glucose levels, supporting healthy pregnancy weight gain, and improving overall wellbeing. Encourage people without contraindications to be active most days, with activities such as walking, swimming, pregnancy yoga, Pilates, aqua fitness, or other prenatal exercise programs. Even short periods of activity after meals may assist with post-meal glucose management.

Blood glucose monitoring and medication

Self-monitoring of blood glucose levels allows people to understand how food, activity, and medication affect their glucose levels and enables treatment plans to be adjusted when required.

While many people can achieve target glucose levels through healthy eating and physical activity, some will require medication. Insulin is commonly prescribed and is safe during pregnancy because it does not cross the placenta. Metformin may also be appropriate for some individuals. You can help normalise the need for medication by explaining that it a normal and effective response to increasing insulin resistance during pregnancy rather than a sign of failure.

After pregnancy

Although gestational diabetes often resolves after birth, ongoing follow-up remains important. Encourage people to complete an oral glucose tolerance test 6 to 12 weeks postpartum and continue diabetes screening every one to three years, depending on their level of risk.

Having gestational diabetes increases the likelihood of recurrence in future pregnancies and the risk of developing type 2 diabetes later in life. Healthy eating, regular physical activity, weight management, and breastfeeding where possible can help reduce this risk. Health professionals can also encourage registration with the National Gestational Diabetes Register, which provides ongoing reminders and support after pregnancy.

Effective gestational diabetes care extends beyond blood glucose management. By supporting emotional wellbeing, providing practical education, encouraging healthy lifestyle behaviours, and promoting appropriate postpartum follow-up, health professionals can help people navigate gestational diabetes with confidence and achieve the best possible outcomes for themselves and their babies.