Gestational Diabetes: The Longevity Alarm Bell We Shouldn’t Snooze

We treat it like a brief detour, a condition that flickers into existence midway through pregnancy, demanding a crash course in glucose management, and then quietly recedes after delivery. Yet, when you look closer, gestational diabetes (GD) isn’t just about six to nine months of elevated blood sugar. It’s a stress test for the body’s metabolic resilience—a warning sign with implications far beyond delivery.

And increasingly, it’s becoming a case study in how technology is reshaping even temporary conditions. Patients, many of them not classically “high risk,” are now wearing continuous glucose monitors (CGMs), devices once reserved for type 1 diabetes, because pricking their fingers feels archaic. Even though CGMs aren’t standard of care for gestational diabetes, they’re finding their way into the conversation, whether clinicians are ready for it or not.

The Physiology Beneath the Label

Gestational diabetes is, by definition, glucose intolerance leading to hyperinsulinemia hyperglycemia and hyperinsulinemia, first recognized during pregnancy—usually in the second or third trimester—in women without overt pre-pregnancy diabetes. The culprit isn’t mysterious. Pregnancy itself is diabetogenic: placental hormones like human placental lactogen, progesterone, and cortisol ramp up insulin resistance, while pancreatic β-cells attempt to compensate by boosting insulin secretion. For some women, that compensation isn’t enough, and glucose climbs.

Diagnosis isn’t one-size-fits-all. The American Diabetes Association (ADA) and the American College of Obstetricians and Gynecologists (ACOG) both endorse two main screening strategies: the one-step 75-gram oral glucose tolerance test (OGTT) or the two-step protocol, 50-gram glucose challenge, followed by a 100-gram OGTT if the first is abnormal. Testing typically happens between 24 and 28 weeks.

But here’s the tension: by the time a woman “fails” one of these tests, her metabolic system has often been struggling for months. Elevated insulin levels—hyperinsulinemia—usually precede the abnormal glucose we’re measuring. Fasting insulin, or even a hemoglobin A1C early in pregnancy, could flag women on the path toward glucose intolerance long before the 24-week mark. Yet neither test is part of standard prenatal care, and ACOG doesn’t recommend routine A1C screening in healthy pregnancies. We’re left identifying gestational diabetes only after the glucose rises, rather than spotting the quieter, earlier metabolic shifts that set the stage.

Who’s Most at Risk?

Even if we didn’t test everyone, what if we only tested those most at risk with fasting insulin levels and a routine magic. The risk profile for GD is, frustratingly, both predictable and widening. Obesity and higher BMI remain the strongest risk factors; risk climbs almost linearly with BMI. Advanced maternal age, a family history of diabetes, and prior gestational diabetes all make the list. So does polycystic ovary syndrome (PCOS), even after adjusting for weight and other confounders, PCOS independently elevates risk, as confirmed by multiple cohort studies and meta-analyses, and many women fit the bill.

Then there’s the role of race and ethnicity. Women of Hispanic, Native American, South or East Asian, or Pacific Islander descent face higher rates of GD, reflecting a complex mix of genetic susceptibility, social determinants, and metabolic factors. Add in less common but notable risks—previous stillbirth, macrosomic infants, pregestational smoking, hypertension, and even hypothyroidism, and it’s clear why some clinicians advocate for more individualized screening strategies, even before 24 weeks and why earlier screening and even preconception screening may be warranted.

Beyond Birth: The Unspoken Horizon

Most women with GD return to normoglycemia postpartum. But “most” doesn’t mean “done.” These women carry a substantially increased risk of developing type 2 diabetes later in life and chronic inflammation due to rising and often undiagnosed insulin levels. Their children, too, face higher odds of obesity and metabolic disease. It raises an uncomfortable but important question: are we underutilizing gestational diabetes as an early warning system—not just for the pregnancy, but for the decades that follow?

Enter the Technology Curve

This is where the conversation gets interesting. CGMs, real-time (rtCGM) like Dexcom G7, intermittently scanned like FreeStyle Libre 3, and now even over-the-counter models like Stelo, were never designed with gestational diabetes in mind. They emerged to make type 1 diabetes management safer and more dynamic, offering continuous glucose data, customizable alerts, and the ability to ditch confirmatory fingersticks.

Yet, many pregnant women with GD and even those without are adopting them, sometimes outside formal recommendations. Why? Ease, empowerment, and frankly, modernity. Watching your glucose trends on a smartphone, seeing the arrows, getting a buzz before a spike, it feels intuitive compared to the ritual of lancets and logbooks.

Around the same time clinicians began questioning why we wait until glucose is frankly abnormal to act, a new paradigm quietly emerged. Dr. Casey Means, a Stanford-trained physician and co‑founder of Levels Health, launched a company offering continuous glucose monitors (CGMs) to euglycemic individuals as a tool for metabolic optimization, not just diabetes management. Means argues that even when hemoglobin A1c levels are below the conventional threshold of 6.0%—well within what clinicians consider “normal”—early insulin dysregulation and glucose excursions may already signal emerging metabolic dysfunction. By enabling users to track their real-time glucose responses to meals, sleep, stress, and movement, Levels offers a feedback loop that turns passive labs into active learning, and it’s no surprise that some pregnant women with gestational diabetes are now using CGMs off-label to monitor subtle metabolic shifts before glucose rises. While ACOG does not endorse routine CGM use for gestational diabetes in women not on insulin, the move toward proactive monitoring reflects a broader shift: glucose levels may be the tip of the iceberg, but CGMs offer a way to detect the deeper metabolic currents we’ve historically ignored.

The ADA and the American Association of Clinical Endocrinology currently recommend CGM for type 1 diabetes and insulin-treated type 2. For gestational diabetes, the evidence is emerging, not definitive. Early studies suggest CGMs could improve time-in-range and neonatal outcomes, but they’re not yet standard of care, in part due to cost, insurance barriers, and the absence of long-term outcome data.

The Tension We’re Sitting In

So here we are: a condition often treated as a fleeting inconvenience, affecting roughly 6–9% of U.S. pregnancies, quietly forecasting long-term health risks—and intersecting with a wave of consumer-driven technology that’s leaping ahead of guidelines.

For clinicians, the challenge isn’t just managing glucose for a few months. It’s deciding how much to treat GD as a one-off versus a metabolic red flag. It’s whether to embrace tools like CGMs before the evidence fully matures. And it’s acknowledging that, for many patients, the appeal of these devices isn’t purely clinical—it’s psychological, practical, and, increasingly, cultural.

Maybe the real question is this: if gestational diabetes is both a glimpse into the mother’s future and a proving ground for new tech, what does it say about where prenatal care is heading?

At Materna Healthcare, we believe gestational diabetes is more than a short-term condition, it’s a window into a woman’s long-term metabolic future. We’re here to help you understand your risks earlier, support you through real-time monitoring, and guide you toward lasting health for you and your baby.