Published: 26 August, 2026 Gestational diabetes mellitus (GDM) affects around one in seven pregnancies in Australia, making it one of the most common pregnancy complications encountered by health professionals. While gestational diabetes often resolves after birth, it requires careful management during pregnancy and ongoing follow-up to reduce short and long-term health risks for both mother and baby. Health professionals play a critical role in supporting women from diagnosis through to the postnatal period. Providing evidence-based education, emotional support, and coordinated multidisciplinary care can help people achieve healthy pregnancy outcomes while reducing their future risk of type 2 diabetes. Understanding gestational diabetes Gestational diabetes occurs when hormones produced by the placenta increase insulin resistance during pregnancy. To maintain normal blood glucose levels, the pancreas must produce additional insulin. When it cannot meet this increased demand, blood glucose levels rise and gestational diabetes develops. Although gestational diabetes can occur in any pregnancy, risk is increased among those who: have previously experienced gestational diabetes are aged 40 years or older have polyendocrine metabolic ovarian syndrome (previously known as polycystic ovary syndrome) have overweight or obesity have a family history of type 2 diabetes have previously delivered a baby weighing more than 4.5kg are 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 (OGTT), with earlier testing recommended for those with identified risk factors. Helping people understand why management matters Receiving a diagnosis of gestational diabetes can be distressing. Many people experience anxiety, guilt or self-blame. Reassurance is important, as gestational diabetes develops largely due to pregnancy-related hormonal changes rather than anything the person has done wrong. Health professionals can help motivate self-management by explaining the reasons treatment is important. Elevated maternal blood glucose levels increase glucose transfer across the placenta, prompting increased foetal insulin production. This can contribute to: excessive foetal growth birth complications induction of labour caesarean birth neonatal hypoglycaemia. Women with gestational diabetes also have a greater risk of developing hypertension and pre-eclampsia during pregnancy. The good news is that careful management significantly reduces these risks, and most people with well-managed gestational diabetes will have a healthy pregnancy and healthy baby. Building a multidisciplinary care team Gestational diabetes management is most effective when delivered by a multidisciplinary team. Depending on the individual’s needs and location, this may include: 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 is particularly valuable, ensuring people receive individualised advice on blood glucose monitoring, healthy eating and lifestyle management. Supporting healthy eating Healthy eating remains the cornerstone of gestational diabetes management. Rather than restricting foods unnecessarily, health professionals should focus on helping establish sustainable eating patterns that support blood glucose targets while meeting pregnancy nutrition requirements. Key dietary messages include: spreading carbohydrate intake across three meals and two to three snacks per day choosing high-fibre, lower GI carbohydrate foods avoiding large carbohydrate loads at any single meal limiting foods and drinks high in added sugars choosing healthy fats and reducing saturated fat intake eating a wide variety of nutritious foods to meet increased pregnancy needs, including iron and folate. Importantly, carbohydrates should not be eliminated. They are an essential energy source during pregnancy and should be tailored to individual needs with dietetic guidance. Encouraging regular physical activity Physical activity supports blood glucose management, healthy pregnancy weight gain and overall wellbeing. It may also help reduce common pregnancy symptoms such as constipation, heartburn and back pain. People without contraindications should be encouraged to be active most days. Suitable activities include: brisk walking swimming pregnancy yoga or Pilates aqua fitness prenatal exercise programs. Even short periods of activity after meals can assist with post-meal glucose management. Monitoring blood glucose levels Self-monitoring of blood glucose levels is a key part of gestational diabetes care. It helps women understand how food, activity and medications affect their glucose levels and enables timely treatment adjustments. Monitoring often includes fasting and post-meal readings, with targets tailored to individual needs. Diabetes educators play an important role in providing training and support in blood glucose monitoring techniques. When medication is required While many people achieve target blood glucose levels through healthy eating and physical activity, some require medication. Insulin is commonly prescribed and is safe during pregnancy because it does not cross the placenta. Metformin may also be appropriate in some cases. Some people view the need for medication as a sign they have failed. Health professionals can help reframe treatment as a normal and effective response to increasing insulin resistance during pregnancy. Looking beyond pregnancy Postpartum care is a critical but sometimes overlooked component of gestational diabetes management. People should be encouraged to undertake an OGTT 6-12 weeks after birth to confirm that glucose levels have returned to the normal range. Ongoing type 2 diabetes screening is recommended every one to three years, depending on individual risk. Having gestational diabetes increases the risk of recurrence in future pregnancies and of developing type 2 diabetes later in life. Approximately half will develop pre-diabetes or type 2 diabetes within 10 to 20 years. Healthy eating, regular physical activity, weight management and breastfeeding where possible can help reduce this risk. Health professionals should also promote registration with the NDSS and awareness of the National Gestational Diabetes Register, which provides reminders and ongoing support after pregnancy. Key message For health professionals, effective gestational diabetes care extends beyond blood glucose management alone. Supporting emotional wellbeing, providing practical education, promoting healthy lifestyle behaviours and ensuring appropriate postpartum follow-up all contribute to better outcomes. With coordinated care, most people with gestational diabetes can expect a healthy pregnancy and a healthy baby.
