Jaime Herndon is a freelance health/medical writer with over a decade of experience writing for the public.
Lyndsey Garbi, MD, is a pediatrician who is double board-certified in pediatrics and neonatology.
Most people with gestational diabetes have uncomplicated, full-term births. However, the condition does put a person at risk for preterm birth (delivering your baby before 37 weeks versus a full-term pregnancy of 40 weeks). Gestational diabetes is high blood sugar during pregnancy in a person who did not have diabetes before pregnancy.
You may go into labor early, or your healthcare provider may induce labor or schedule a cesarean section (surgical delivery) early due to complications from gestational diabetes.
This article explores gestational diabetes and the possible complications it can cause in a pregnancy that might lead to early delivery.
It’s also important to remember many pregnant people with gestational diabetes can control their blood sugar levels. They may not experience complications—everyone is different. If you have questions or concerns about potential risks or complications, talk with your maternity healthcare provider.
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To monitor or treat gestational diabetes, it has to be diagnosed. Everyone who is pregnant is screened for gestational diabetes because the symptoms aren’t always apparent.
Many times, gestational diabetes won’t have obvious symptoms. You may be a little thirstier than usual or urinate more often—but these are also pregnancy symptoms, so they may go unnoticed. This is why every pregnant person is screened for gestational diabetes between 24 and 28 weeks of pregnancy. This way, diabetes can be properly diagnosed and a treatment or management plan can be put in place.
Although screening usually takes place between weeks 24 and 28 of pregnancy, you may be tested earlier if you’re at higher risk.
The glucose screening test is a blood draw taken after you drink a glucose drink. It's a non-fasting test (you don't have to refrain from food or drink before the test). If your blood sugar is 140 milligrams per deciliter (mg/dL) or higher, you'll need an oral glucose tolerance test (OGTT).
The OGTT is a fasting test. Follow instructions about when to pause eating or drinking before the test. After drinking a glucose drink, your blood will be drawn at one, two, and three hours post-drink. Your healthcare provider will discuss your results and any treatment plan.
If your blood sugar is not controlled during pregnancy, this can significantly increase the risk of stillbirth (pregnancy loss at or after 20 weeks). Because blood sugar levels are often a modifiable risk factor, healthcare providers will work with pregnant people to control their blood sugar.
However, if blood sugar levels remain high, your healthcare provider might discuss early induction with you to prevent complications or stillbirth.
Babies with macrosomia, or weighing more than 8 pounds, 13 ounces at birth, are at risk for injuries during birth, and the person giving birth is also at risk for complications.
An early delivery may be induced, but it may not, especially if there are no other complications. However, an increased risk of spontaneous preterm birth starting at 25 weeks has been noted in those with macrosomic babies.
This association has been consistent over time; an older study from 2003 also found that the risk of preterm birth increased with higher blood sugar levels. This is one reason you will be monitored more closely if you have gestational diabetes.
Induction of labor is when your provider gives you medication to start your labor artificially. This is often done if your health or that of your fetus is at risk.
It’s not typically done if everything is progressing normally and you and your fetus are healthy, with no risk factors. If at all possible, most people try to wait until at least 39 weeks gestation so the fetus can develop as much as possible.
Induction of labor at 38 or 39 weeks for people with gestational diabetes may be associated with a lower risk of cesarean birth. But induction of labor at less than 39 weeks may increase the risk of admission to the neonatal intensive care unit (NICU). Your maternity healthcare provider will discuss all of the risks and benefits with you if this is presented as a possible option.
For pregnant people with gestational diabetes, the cesarean section (or C-section) rate is about 35%. In addition to the typical recovery concerns, diabetes also carries additional risk factors for wound infection, so this is especially concerning.
If gestational diabetes is not well controlled, a cesarean section may be necessary to deliver the baby due to emergency reasons or because the baby is too big to safely deliver vaginally.
Fetuses keep developing throughout all 40 weeks of pregnancy. If they are born early, they lose valuable development time. Babies born before 32 weeks of gestation have a higher rate of death and disability. Risks of premature delivery can include:
Giving birth prematurely can cause significant stress and emotional changes for parents, including anxiety, postpartum depression, and financial stress due to hospital and NICU stays.
Birthing parents are also at higher risk of negative feelings toward their babies. They use support services less than those who had full-term pregnancies, yet they are the ones who may need it the most.
The best way to reduce the risk of early delivery with gestational diabetes is to keep your diabetes controlled and blood sugar levels down and within the target range. This usually consists of:
Medication might be necessary if this isn’t enough to control your blood sugar levels. This typically consists of insulin shots to help manage your blood sugar. Your healthcare provider will show you how to give yourself the shots, and insulin will not harm you or your fetus.
Although gestational diabetes carries the risk of giving birth early, typically this is avoided, or delivery is delayed to allow the fetus to develop as much as possible. Early delivery might not always be avoidable due to complications with gestational diabetes. Early induction might be the safest option for the birthing parent and baby.
To help reduce the risk of early delivery, the best prevention is to manage blood sugar levels and ensure that gestational diabetes is well controlled.
Giving birth early can be an emotional experience. If your baby has to stay in the hospital for any reason, it can be especially challenging. You do not have to handle the stressors of early delivery alone. Ask your healthcare provider for resources.
Hospitals often have support groups for parents of babies in the NICU or premature babies, and your healthcare provider may know of local mental health counselors who specialize in helping parents of preemies. This is tough stuff, but there are supports out there.
Not all people with gestational diabetes are induced early. In fact, the American College of Obstetricians and Gynecologists (ACOG) does not recommend inducing early if gestational diabetes is controlled.
If gestational diabetes is not well controlled and other risk factors put the parent or the baby at risk, early induction is recommended. This is because uncontrolled gestational diabetes can lead to complications of pregnancy and birth, including stillbirth.
Induction is typically not recommended if your gestational diabetes is well controlled. If it is not well controlled, your healthcare provider will determine the best time to induce, based on your specific situation. In general, induction for medical reasons is a safe procedure.
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National Institute of Diabetes and Digestive and Kidney Diseases. Tests & diagnosis for gestational diabetes.
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National Institute of Diabetes and Digestive and Kidney Diseases. Managing & treating gestational diabetes.
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