Diabetes And Fertility: Why Rising Blood Sugar Disorders Are Affecting Pregnancy Outcomes

Gestational diabetes mellitus (GDM) is different from type 1 or type 2 diabetes. It usually occurs around the 24th week of pregnancy, when hormonal changes from the placenta begin to disrupt the function of insulin.

23 May 2026, 09:45 · www.ndtv.com

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Gestational diabetes affects about 8% of pregnant women in the U.S. and 22% in India
GDM occurs around week 24 due to hormonal changes causing insulin resistance during pregnancy
Babies of mothers with GDM risk macrosomia, hypoglycemia, breathing issues, and future diabetes

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Diabetes is commonly considered to be a lifelong health condition caused by lifestyle or genetic factors. But there is another side to this epidemic that goes under the radar and is quietly affecting a very specific group of people, pregnant women. In 2021, approximately 8% of women in the U.S. developed gestational diabetes (GDM), which is a temporary rise in blood sugar during pregnancy. More importantly, the prevalence of gestational diabetes is the highest among Asian women. In India, nearly 22% of pregnant women suffer from gestational diabetes, while the average for the rest of the world is about 15%.

Why Does Pregnancy Alter The Rules

Gestational diabetes mellitus (GDM) is different from type 1 or type 2 diabetes. It usually occurs around the 24th week of pregnancy, when hormonal changes from the placenta begin to disrupt the function of insulin. The body continues to produce insulin, but the body's insulin is not as effective due to the hormones of pregnancy. The result of this is insulin resistance.

The pancreas usually overproduces insulin to compensate for the increased demand, which is not a problem for most women. However, if it is not sustained, blood sugar levels increase, and GDM is diagnosed.

What This Means For The Baby

Gestational diabetes does not typically lead to birth defects, as it is not present in the mother's body in the first trimester, the time when the baby's internal organs are developing. Although that does not mean it is harmless.

Extra glucose will cross the placenta when a mother's blood sugar is constantly elevated. The baby's pancreas begins to produce more insulin to make up for it, and all the extra energy is saved. The baby may have macrosomia (heavier than 4 kgs). This can make it more likely that the shoulder will be hurt during labour, or that the baby will have certain complications while they are in the womb, and/or that they will, in all likelihood, need a caesarean section (C-section).

Other risks to the baby are low blood sugar (hypoglycaemia) immediately after birth, trouble breathing, and an increased risk of obesity or developing Type 2 Diabetes later in life.

The Hidden Long-Term Danger For Mothers

According to an ICMR-INDIAB study, one of the most comprehensive metabolic surveys ever conducted in India, nearly one in four pregnant women in the country has gestational diabetes, with no significant difference between urban and rural areas. What makes this even more concerning is that 19.2% of women already show elevated blood sugar levels before 20 weeks of pregnancy, what experts call Early GDM. The study also found that central India has the highest prevalence at nearly 33%, while western India reported the lowest at 16%. High systolic blood pressure and a family history of diabetes were independently associated with GDM risk, reinforcing the strong genetic and metabolic underpinnings of this condition.

Many women think that their problem is solved once they give birth. Yes, sometimes blood glucose goes back to normal right after the birth. However, for some women, it is the beginning of their lifetime metabolic risk. When gestational diabetes evolves into persistent diabetes postpartum, medications such as insulin and metformin may be required to achieve optimal glycaemic control.

Women with severe obesity have a higher risk of developing GDM, however, the increased future risk of diabetes has been observed across all body types.

What Can We Do Differently?

The good news is that GDM can be managed, and most of the risk can be prevented by taking the correct steps.

If you have risk factors, such as a family history, polyendocrine metabolic ovarian syndrome (PMOS), or being overweight, before planning a pregnancy, visit your doctor for a preconception checkup. If you have been diagnosed with GDM, the essential steps for your pregnancy remain the same. Keep your blood sugar in check every day, stick to a well-balanced diet (eat foods that contain fibre and are low in refined carbs), exercise regularly, and take insulin if prescribed.

Once the baby is born, do not miss follow-up check-ins with your doctor. You get a diabetes screening 4-12 weeks after your baby is born and then every 1-3 years if the test is normal. The increasing prevalence of diabetes and prediabetes among young women renders the topic of blood sugar and metabolic health a non-negotiable discussion.

Whether you are planning a pregnancy, already expecting, or have just had a baby, know this - your blood sugar story does not begin or end with pregnancy. But pregnancy can be the moment that makes it all change.

(By Dr Manika Khanna, Founder, CEO & Chairperson, Gaudium IVF)

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