By Dr. Isabel Herrera (Licensed Physician No. 030310741).
Gestational diabetes mellitus (GDM) is a condition that affects approximately 1 in 10 pregnant women worldwide. It is a type of diabetes that is first diagnosed during pregnancy and is associated with risk factors such as being overweight or having a family history of diabetes.
In 2022, approximately 16,100 cases of gestational diabetes were recorded in Spain.
Often, gestational diabetes is asymptomatic, but when symptoms do appear, affected women may experience excessive thirst, blurred vision, frequent urination, weight loss, or urinary infections.
Therefore, if you are pregnant, even if you have never had diabetes problems before, you should consult a healthcare provider if you have any of these symptoms.
There are two strategies for diagnosis:
Screening/diagnosis will be carried out:
Gestational diabetes can pose risks for both the mother and the baby. For the mother, there is an increased risk of preeclampsia and a higher likelihood of developing type 2 diabetes in the future.
For the baby, severe gestational diabetes can cause structural malformations in the fetus (nervous, muscular, digestive system abnormalities, fetal cardiomyopathy) or more commonly, fetal macrosomia (larger size at birth, which can complicate delivery). After birth, the baby may experience hypoglycemia (low blood sugar levels) or respiratory problems.

When a pregnant woman is diagnosed with gestational diabetes, it is essential to carry out metabolic control (monitoring blood glucose levels several times a day to ensure they remain within the appropriate range), nutritional control (following a healthy eating plan, low in sugars and rich in fruits, vegetables, and proteins), and daily physical exercise with moderate physical activity. If this is not sufficient, the use of insulin may be necessary.
In most cases, this condition disappears once the woman has given birth. However, it is important to note that women who have had gestational diabetes may develop type 2 diabetes in the future.
For this reason, it is recommended to perform periodic blood glucose tests after pregnancy to detect any early signs of diabetes.
The most important thing is to follow a balanced diet that helps keep blood glucose levels within a healthy range. Your doctor will provide you with a diet plan and guidelines to follow (such as dividing your intake into 5 meals a day instead of 3 and engaging in daily physical exercise), as well as pre- and postprandial glucose monitoring. Pregnant women with GDM who have poor glycemic control, macrosomia, obesity, or other comorbidities are at risk of worse perinatal outcomes.

Obstetric control will be similar to that of a normal pregnancy, with some specific considerations. Follow-up in patients with GDM will include the recommendation to perform an additional ultrasound at 28-30 weeks to evaluate polyhydramnios (increased amniotic fluid) and fetal macrosomia (increased baby size).
An ultrasound around 36-38 weeks can provide useful information for planning the end of the pregnancy. The conclusion of the pregnancy in well-controlled GDM patients will be similar to the general population. In cases with risk factors, such as those requiring insulin or having very large fetuses, the decision will be individualized, although generally, it is not advised to prolong the pregnancy beyond 39-40 weeks.
Breastfeeding is recommended due to its beneficial effects on both the mother and the baby. Recommendations regarding contraception after childbirth are similar to those for the general population.
Rut Gómez de Segura, gynecologist and expert in reproductive medicine at IVF-Life Madrid.