Gestational Diabetes on the Rise in the U.S.

Close-up of a pregnant woman having her blood sugar glucose checked.
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A large new study of gestational diabetes shows that rates of the health condition in the U.S. have significantly increased across all race and ethnicity groups over an eight-year period.

Gestational diabetes is the emergence of diabetes in a pregnant person who did not previously have diabetes. Pregnancy causes many hormonal changes, some of which can lead to insulin resistance. Insulin is the hormone that regulates blood sugar, and when the body does not respond to insulin, too much blood sugar remains in the bloodstream. Some pregnant people can overcome this insulin resistance by making more insulin, but those that can’t, develop gestational diabetes.

Left untreated, gestational diabetes can result in serious consequences for both the pregnant person and child. Gestational diabetes increases the child bearer’s risk for hypertension disorders (e.g. preeclampsia) and preterm delivery. They have a greatly increased risk for later developing type 2 diabetes.

Gestational diabetes can cause the fetus to grow excessively. Once born, the baby is at greater risk for low blood sugar as a newborn (neonatal hypoglycemia), as well as obesity during childhood and teenage years. They are also more likely to develop type 2 diabetes.

The study reviewed gestational diabetes data of over 1.2 million U.S. individuals from the Center for National Health Statistics. These individuals delivered a single child (no twins or other multiples) first live births. Ages of the individuals ranged between 15 and 44 years.

The findings reveal that between 2011 and 2019, the rate of gestational diabetes in the U.S. increased from 47.6 to 63.5 per 1000 live births, or an average annual percent change of 3.7% per year. These rates increased across all age and race and ethnicity groups.

Participant data was sorted into the following race and ethnicity groups and subgroups: Hispanic/Latina (including Central and South American, Cuban, Mexican, and Puerto Rican), non-Hispanic Asian/Pacific Islander (including Asian Indian, Chinese, Filipina, Japanese, Korean, and Vietnamese), non-Hispanic Black, and non-Hispanic White.

While all racial and ethnic group rates of gestational diabetes increased, Asian Indian individuals saw the highest rates overall. The 2019 gestational diabetes rate for the Asian Indian group was 129.1 per 1000 live births. Puerto Rican individuals had the highest gestational diabetes rate in the Hispanic/Latina group at 75.8 per 1000 live births.

Gestational diabetes can be a “silent disease,” often with no noticeable signs or symptoms. Health organizations, such as the American College of Obstetricians and Gynecologists and the American Diabetes Association, recommend that pregnant people be screened for gestational diabetes during the second trimester, between 24 and 28 weeks of pregnancy. The U.S. Preventive Services Task Force (USPSTF) recently affirmed their recommendation for screening at week 24 of gestation or after.

Risk factors for gestational diabetes include:

  • Personal history of gestational diabetes
  • Family history of diabetes
  • Older age
  • Obesity

If diagnosed with gestational diabetes, pregnant persons are first recommended to:

  • Perform moderate exercises that are safe during pregnancy
  • Modify their diets to include healthy foods
  • Monitor glucose levels
  • Seek support from nutritionists and diabetes educators

If they’re unable to control their glucose through these steps, some people with gestational diabetes may need medication that helps lower blood glucose levels. These patients are recommended to have close monitoring throughout the remainder of the pregnancy. They may also require some changes in the management of their delivery.

Pregnant people can reduce their risk for gestational diabetes by gaining a healthy amount of weight during pregnancy. This year, the USPSTF released for the first time its recommendations on healthy weight gain during pregnancy.

Prepregnancy Weight Gestational Weight Gain (GWG) Recommendation
Underweight (body mass index [BMI] <18.5) 28 to 40 lb
Healthy weight (BMI 18.5-24.9) 25 to 35 lb
Overweight (BMI 25-29.9) 15 to 25 lb
Obese (BMI ≥30) 11 to 20 lb

Even before becoming pregnant, there are steps one can take to reduce the risk of gestational diabetes. Overweight individuals can lose weight and increase physical activity prior to becoming pregnant.

Before and during pregnancy, people can also modify their diets. Research shows a healthy diet is high in fruits, vegetables, legumes, whole grains, fish, and nuts, and it is lower in fried and processed foods and red meats. Additionally, individuals can consult their healthcare providers for more preventive and risk-reduction strategies.

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