Yes, gestational diabetes classifies your pregnancy as high risk. This designation means your care team will monitor you more closely, you’ll have additional appointments and tests, and your delivery plan may be adjusted. The good news is that with proper blood sugar management, most women with gestational diabetes have healthy pregnancies and deliveries.
Why It’s Considered High Risk
Gestational diabetes raises the likelihood of several complications for both you and your baby. Elevated blood sugar during pregnancy is associated with preeclampsia (a dangerous spike in blood pressure), difficult deliveries, and babies that grow larger than expected. Women with gestational diabetes develop preeclampsia at roughly twice the rate of those without it: about 6% compared to 3%. That increased risk holds even after accounting for body weight.
The “high risk” label doesn’t mean something will go wrong. It means your pregnancy needs closer attention than one without any complicating factors. In practice, this translates to more frequent monitoring, possible medication, and a more structured delivery timeline.
Risks to Your Baby
The primary concern is that extra glucose crossing the placenta causes your baby to grow larger than normal, a condition called macrosomia (birth weight over about 8 pounds 13 ounces). Babies of mothers with diabetes are roughly twice as likely to be macrosomic compared to babies of non-diabetic mothers. A larger baby increases the chance of a difficult delivery, particularly shoulder dystocia, where the baby’s shoulder gets stuck behind the pelvic bone during birth. Shoulder dystocia occurs in about 13% of macrosomic deliveries, compared to 1% when birth weight is in the normal range.
After delivery, babies born to mothers with gestational diabetes are also more likely to experience low blood sugar in the first hours of life. In one large study, about 12.5% of newborns from gestational diabetes pregnancies needed time in the neonatal intensive care unit. Among those admitted, nearly half had low blood sugar episodes. These are typically caught quickly with routine newborn monitoring and treated with early feeding or, when needed, an IV glucose solution.
How Your Prenatal Care Changes
Once you’re diagnosed, expect your appointment schedule to expand. You’ll track your blood sugar at home multiple times a day, typically after meals and first thing in the morning. Your care team will review these numbers regularly to decide whether diet and exercise are keeping things under control or whether medication is needed.
You’ll also get extra ultrasounds. Most guidelines recommend growth scans starting around 28 weeks, with follow-ups every two to four weeks until delivery. These check whether your baby is measuring large and whether amniotic fluid levels look normal. Starting around 36 weeks, many providers add a weekly non-stress test, a simple monitoring session where sensors track your baby’s heart rate and movement patterns for about 20 to 30 minutes.
Diet, Medication, and Blood Sugar Control
Most women start with dietary changes: balancing carbohydrates across meals, pairing them with protein and fat, and eating at consistent times. Regular physical activity, even a 15-minute walk after meals, can meaningfully lower post-meal blood sugar. For many women, these steps are enough.
When diet and exercise don’t bring blood sugar into target range, medication becomes necessary. Insulin is the most common option, and some providers prescribe metformin as an alternative. Research shows that about 46% of women who start on metformin eventually need insulin added to their regimen as well, so your treatment plan may evolve as your pregnancy progresses. The placenta produces increasing amounts of hormones that interfere with insulin as you get further along, which is why blood sugar can become harder to manage in the third trimester even if your habits haven’t changed.
What Delivery Looks Like
Gestational diabetes typically changes your delivery timeline. Rather than waiting for labor to start on its own, most guidelines recommend scheduling delivery somewhere between 38 and 41 weeks, depending on how well your blood sugar has been controlled and whether you’ve needed medication. Women managing with diet alone generally have more flexibility to wait closer to their due date. Those on insulin are often induced a bit earlier, sometimes around 39 weeks, to reduce the risk of complications that rise with longer pregnancies.
If ultrasounds show your baby is measuring very large, your provider may discuss the possibility of a cesarean delivery to avoid shoulder dystocia. This is a conversation, not an automatic decision, and the estimated weight on ultrasound has a margin of error.
After Delivery: What Happens Next
For most women, blood sugar returns to normal almost immediately after the placenta is delivered. You’ll stop monitoring and stop any diabetes medication. But the story doesn’t end there. Having gestational diabetes carries a lifetime risk of developing type 2 diabetes of up to 60%. The highest rate of progression happens in the first five years after pregnancy, then levels off around 10 years.
Professional guidelines recommend a glucose tolerance test between 6 and 12 weeks postpartum. This involves drinking a sugary solution and having your blood drawn two hours later to check how your body processes glucose without pregnancy hormones in the picture. If results are normal, periodic screening every one to three years is standard going forward.
The factors that lower your long-term risk are the same ones you’d expect: maintaining a healthy weight, staying physically active, and eating a balanced diet. Women who had gestational diabetes and take these steps can significantly reduce their chances of progressing to type 2. Breastfeeding also appears to improve insulin sensitivity in the postpartum period.
Does It Affect Your Child Long Term?
Research on whether children born to mothers with gestational diabetes face higher rates of obesity has produced mixed results. Some studies found that these children were nearly twice as likely to be above the 85th percentile for weight by age 5 to 7, but other studies found the link largely disappeared once the mother’s pre-pregnancy weight was accounted for. In other words, maternal weight before pregnancy may matter as much as or more than the gestational diabetes itself. Good blood sugar control during pregnancy is thought to reduce any excess risk to the child, which is one more reason the extra monitoring and management effort pays off.