Gestational Diabetes: Natural Treatment and Management

By Dr (TCM) Attilio D'Alberto | Traditional Chinese Medicine Practitioner, Wokingham

Gestational diabetes is one of the most common complications of pregnancy, affecting between 3.5 and 16 per cent of pregnancies in the UK depending on risk factors and the diagnostic criteria used. It develops when the body cannot produce enough insulin to meet the increased demands of pregnancy, resulting in elevated blood glucose levels that can affect both mother and baby. While gestational diabetes is manageable with appropriate treatment, many women are understandably concerned about the implications for their pregnancy and want to understand their options — including what natural approaches, dietary management and complementary treatments such as acupuncture can offer. This guide covers what gestational diabetes is, how it is diagnosed and managed, and how traditional Chinese medicine and acupuncture can support blood glucose regulation during pregnancy.

On this page

1. What is gestational diabetes?
2. Risk factors
3. Screening and diagnosis
4. Risks to mother and baby
5. Western medical management
6. Gestational diabetes in traditional Chinese medicine
7. Acupuncture for gestational diabetes
8. Diet and lifestyle management
9. Supplements with evidence
10. After pregnancy: reducing long-term risk
11. My Pregnancy Guide
12. References

1. What is gestational diabetes?

Gestational diabetes mellitus (GDM) is a condition characterised by a reduced tolerance to carbohydrates and refined sugars during pregnancy. As described in My Pregnancy Guide, gestational diabetes is defined as any degree of glucose intolerance first recognised during pregnancy. When carbohydrates are digested, they are converted into blood glucose. Insulin — produced by the pancreas — lowers blood glucose by facilitating its uptake into cells for energy. In pregnancy, the metabolic rate increases by approximately 20 per cent, and hormones produced by the placenta (particularly human placental lactogen and progesterone) create a degree of physiological insulin resistance to ensure a continuous supply of glucose to the growing baby.

For most women, the pancreas compensates for this insulin resistance by increasing insulin production, and blood glucose levels remain normal. In women who develop gestational diabetes, the pancreas cannot produce enough insulin to maintain this compensation — blood glucose remains elevated, and this excess glucose crosses the placenta to the baby. The result is a range of potential complications for both mother and child that need to be identified and managed.

It is important to understand that gestational diabetes is not the same as pre-existing type 1 or type 2 diabetes. It typically develops in the second or third trimester, when placental insulin-antagonist hormone production is at its highest, and in the majority of cases resolves after delivery. However, having gestational diabetes significantly increases the risk of developing type 2 diabetes later in life — between 40 and 60 per cent of mothers who develop gestational diabetes will go on to develop diabetes in later life.

2. Risk factors for gestational diabetes

Several factors increase the risk of developing gestational diabetes:

1. BMI above 30: Obesity is the strongest modifiable risk factor. Excess adipose tissue contributes to baseline insulin resistance that the pregnancy hormones then compound.
2. Previous gestational diabetes: Women who had GDM in a previous pregnancy have a 30–84% risk of it recurring in subsequent pregnancies.
3. Family history of diabetes: A first-degree relative with type 2 diabetes increases the risk significantly.
4. Previous large baby (macrosomia): A baby weighing 4.5kg or more in a previous pregnancy is a marker of previous glucose dysregulation.
5. Ethnicity: Women of South Asian, East Asian, Black African or Black Caribbean origin have a significantly higher prevalence of gestational diabetes than women of White European origin.
6. Age: The risk increases progressively with maternal age, particularly after 35.
7. Polycystic ovary syndrome (PCOS): Women with PCOS have a significantly elevated risk of gestational diabetes due to pre-existing insulin resistance.
8. Multiple pregnancy: Twins or higher-order multiples increase the hormonal load and therefore the risk of insulin resistance.
9. Previous gestational hypertension or pre-eclampsia: These conditions are metabolically related to insulin resistance.

Women with one or more of these risk factors should be offered an oral glucose tolerance test (OGTT) at 24–28 weeks of pregnancy.

3. Screening and diagnosis

In the UK, gestational diabetes is screened for using the oral glucose tolerance test (OGTT). This involves a fasting blood glucose measurement, followed by consumption of a 75g glucose drink, followed by a further blood glucose measurement at two hours. The NICE diagnostic thresholds for gestational diabetes are:

• Fasting plasma glucose ≥ 5.6 mmol/L, or
• 2-hour plasma glucose ≥ 7.8 mmol/L

In higher-risk women, the OGTT is offered at 24–28 weeks. Women with a previous history of gestational diabetes are offered an early OGTT at booking (8–12 weeks) and again at 24–28 weeks if the first is normal.

In some settings a glucose challenge test (GCT) or glucose load test (GLT) may be used as preliminary screening before the full OGTT. Self-monitoring of blood glucose is used throughout the management of diagnosed GDM to track fasting and post-meal glucose levels and assess treatment response.

4. Risks to mother and baby

Uncontrolled gestational diabetes carries risks for both mother and baby:

Risks to the baby:

• Macrosomia (large-for-gestational-age baby): Excess glucose crossing the placenta stimulates the baby's pancreas to produce extra insulin, which promotes fat deposition. This results in a larger-than-normal baby, which increases the risk of difficult delivery.
• Hypoglycaemia after birth: Babies of mothers with gestational diabetes are accustomed to the high glucose supply in utero and produce excess insulin. After birth, when the glucose supply is suddenly reduced to normal, they may develop low blood glucose (neonatal hypoglycaemia).
• Congenital anomalies: Babies born from diabetic mothers are six times more likely to develop congenital anomalies, including heart or limb deformities, particularly if blood glucose was poorly controlled in early pregnancy.
• Preterm birth: Gestational diabetes increases the risk of preterm labour and delivery.
• Stillbirth: In poorly controlled GDM, there is an increased risk of late pregnancy stillbirth, particularly beyond 40 weeks.
• Long-term metabolic risk in the child: Children born to mothers with gestational diabetes have a higher risk of developing obesity, insulin resistance and type 2 diabetes in childhood and adult life.

Risks to the mother:

• Increased risk of caesarean section due to macrosomia or obstetric complications
• Increased risk of pre-eclampsia (pregnancy-induced hypertension)
• Gestational hypertension
• Urinary tract infections and vaginal infections (elevated glucose supports microbial growth)
• Type 2 diabetes in later life in 40–60% of women who develop GDM

5. Western medical management

Standard NHS management of gestational diabetes follows NICE guidelines and is primarily focused on blood glucose self-monitoring and dietary management, with medication introduced when lifestyle measures are insufficient:

1. Dietary modification: The primary intervention. A low-glycaemic-index (GI) diet that controls carbohydrate quality and quantity is the cornerstone of GDM management (see section 8 below for details).
2. Blood glucose self-monitoring: Women monitor their fasting blood glucose and 1–2 hour post-meal glucose using a glucometer. Target levels are typically fasting <5.3 mmol/L and 1-hour post-meal <7.8 mmol/L.
3. Metformin: If dietary management does not achieve target glucose levels within 1–2 weeks, metformin is typically the first pharmacological option offered. Metformin reduces hepatic glucose production and improves insulin sensitivity. It crosses the placenta but is considered safe in pregnancy.
4. Insulin: If metformin is insufficient, or if the patient prefers insulin (or has a contraindication to metformin), insulin injections are introduced. Various insulin regimens are used, tailored to the individual's glucose pattern.
5. Monitoring and delivery: Women with GDM receive increased obstetric monitoring including regular growth scans to assess foetal size. Delivery is typically recommended no later than 40–41 weeks, and may be recommended earlier depending on glucose control and foetal growth.

6. Gestational diabetes in traditional Chinese medicine

In traditional Chinese medicine, gestational diabetes corresponds most closely to the syndrome of Xiao Ke — a condition of wasting and thirsting caused by Yin deficiency and heat — manifesting during pregnancy. The fundamental mechanism is understood as a depletion of Yin (moistening, cooling, nourishing) substance, allowing heat to accumulate and damage the body's fluid metabolism and regulatory capacity.

During pregnancy, the growing baby places enormous demands on the mother's Yin and Blood — drawing on the reserves of Kidney Yin, Lung Yin and Stomach Yin that normally regulate fluid metabolism, appetite and energy. In women who enter pregnancy with underlying Yin deficiency (often from years of poor dietary habits, overwork, stress or prior fertility treatment), these reserves may be insufficient to sustain the pregnancy's demands without developing pathological changes in blood glucose regulation.

Three primary organ patterns are recognised in gestational diabetes from a TCM perspective:

1. Lung Yin deficiency: Characterised by excessive thirst, dry mouth and throat, tendency to drink water frequently but still feel dry. The Lung governs the descending and dispersing of fluids in TCM; when its Yin is deficient, fluid regulation is impaired.
2. Stomach/Spleen Yin and Qi deficiency: Characterised by excessive hunger (particularly for carbohydrates and sweets), easy satiation followed by rapid hunger, abdominal bloating and fatigue after eating. The Spleen and Stomach govern the transformation and transportation of nutrients; their deficiency leads to inefficient glucose metabolism.
3. Kidney Yin deficiency: The deepest pattern, characterised by frequent urination, lower back ache, fatigue, night sweats and a feeling of depletion. The Kidneys are the root of all Yin in the body; Kidney Yin deficiency allows heat to accumulate and disrupts the body's deep regulatory capacity.

From a TCM perspective, prevention is strongly emphasised: building and maintaining adequate Yin reserves through appropriate diet, lifestyle and treatment in the preconception period and early pregnancy reduces the likelihood of developing gestational diabetes. Women with PCOS — who already have significant insulin resistance — are particularly encouraged to address this pattern with acupuncture and Chinese herbs before and during pregnancy.

7. Acupuncture for gestational diabetes

Acupuncture is emerging as a potentially valuable complementary treatment for blood glucose regulation in pregnancy. Research referenced in My Pregnancy Guide notes that new research has demonstrated that acupuncture is able to regulate insulin levels — a finding that has significant implications for the management of gestational diabetes alongside conventional dietary and medical measures.

The mechanisms through which acupuncture may improve blood glucose regulation include:

• Stimulation of beta-endorphin release, which has downstream effects on pancreatic beta-cell function and insulin secretion
• Improvement of insulin sensitivity in peripheral tissues via effects on sympathetic nervous system tone and glucose transporter expression
• Regulation of the hypothalamic–pituitary axis, which influences adrenal cortisol and growth hormone — both of which oppose insulin action at high levels
• Reduction of stress-related cortisol, which in excess promotes hepatic gluconeogenesis and worsens insulin resistance

From a TCM treatment perspective, the focus is on nourishing Yin (to cool the heat and restore the regulatory substrate), tonifying Spleen and Stomach Qi (to improve glucose metabolism and reduce cravings), and clearing Stomach heat (to address the excessive hunger and thirst). Safe, pregnancy-appropriate point selections are used, typically on the arms, legs and lower back, avoiding contraindicated points.

Acupuncture should be used alongside — not as a replacement for — conventional monitoring and management. Regular blood glucose self-monitoring remains essential, and any prescribed medication should be continued as directed by your obstetric team.

8. Diet and lifestyle management

Diet is the single most important intervention for gestational diabetes management. The goal is to maintain blood glucose within the target range by controlling both the quantity and quality of carbohydrates consumed.

Key dietary principles:

• Distribute carbohydrates across the day: Rather than large carbohydrate loads at main meals, aim to distribute carbohydrate intake evenly across three meals and two to three small snacks. This prevents the large glucose spikes that follow concentrated carbohydrate loads.
• Choose low-GI carbohydrates: Replace high-GI foods (white bread, white rice, white pasta, sugary breakfast cereals, potatoes, fruit juice) with low-GI alternatives (wholegrain bread, brown rice, oats, lentils, sweet potato). Low-GI foods cause a slower, smaller rise in blood glucose.
• Include protein with every meal: Protein slows gastric emptying and blunts the post-meal glucose rise. Include eggs, fish, chicken, legumes, tofu or Greek yoghurt at each eating occasion.
• Include healthy fats: Unsaturated fats from olive oil, nuts, avocado and oily fish do not raise blood glucose and contribute to satiety.
• Avoid refined sugars and processed foods: Sugar-sweetened drinks, sweets, cakes, biscuits, desserts and processed snack foods cause rapid glucose spikes and should be avoided entirely.
• Breakfast is the most challenging meal: Blood glucose tends to be most insulin-resistant in the morning. Many women with GDM find that even modest amounts of carbohydrate at breakfast cause significant glucose elevations. A lower-carbohydrate breakfast (eggs, Greek yoghurt with berries, smoked salmon) is often necessary to meet fasting targets.
• Fruit in moderation: Whole fruit raises blood glucose less than fruit juice, but high-sugar fruits (grapes, mangoes, bananas, dates) should still be consumed in small quantities and not as a standalone snack.

From a TCM dietary perspective:

Chinese dietary therapy recommends foods that nourish Yin and support Spleen and Stomach function. Warm, easily digestible foods are preferred over raw, cold foods, which weaken the Spleen's transformative capacity. Specifically recommended foods include:

• Congee (rice porridge) — easily digestible, nourishing to the Spleen and Stomach
• Root vegetables (sweet potato, squash, carrot) — cooked and moderate in quantity
• Eggs, fish and lean poultry — nourish Yin and Blood without creating excess heat
• Mung beans and adzuki beans — clear heat and support kidney function
• Bitter melon (bitter gourd) — has a well-documented blood glucose-lowering effect and is used in traditional Chinese medicine specifically for Xiao Ke syndromes
• Barley (yi yi ren) — tonifies the Spleen and clears damp

Exercise: Regular moderate exercise during pregnancy improves insulin sensitivity and is strongly recommended as part of GDM management. Walking for 15–20 minutes after meals has been shown to reduce post-meal glucose spikes significantly. Swimming, pregnancy yoga and aquanatal classes are also appropriate. Avoid high-impact or supine exercises from the second trimester.

9. Supplements with evidence in gestational diabetes

• Magnesium: Magnesium deficiency is associated with insulin resistance and elevated glucose. Supplementation (200–400mg daily of magnesium glycinate or malate) can improve insulin sensitivity and is generally safe in pregnancy at therapeutic doses.
• Inositol (myo-inositol): Has a good evidence base for reducing the risk of gestational diabetes in high-risk women and for improving blood glucose control when GDM is established. Dose 4g daily is used in most trials. Myo-inositol is generally well-tolerated and is considered safe in pregnancy.
• Vitamin D: Vitamin D deficiency is strongly associated with insulin resistance and gestational diabetes. Ensuring adequate vitamin D status (aim for serum 25-OH vitamin D >75 nmol/L) throughout pregnancy reduces GDM risk and severity.
• Probiotics: Emerging evidence suggests that probiotic supplementation in pregnancy reduces the incidence of GDM, likely through effects on gut microbiota and inflammation-mediated insulin resistance.
• Cinnamon: Has modest blood glucose-lowering evidence in non-pregnant adults with type 2 diabetes. Safety data in pregnancy is limited and it should only be used in culinary quantities rather than as a concentrated supplement during pregnancy.

Always discuss supplements with your midwife or obstetrician before commencing them during pregnancy.

10. After pregnancy: reducing long-term risk

Between 40 and 60 per cent of women who develop gestational diabetes will develop type 2 diabetes within 5–10 years of the affected pregnancy. This risk is not inevitable — it is substantially modifiable with lifestyle. Women who have had gestational diabetes should:

• Have a fasting glucose or HbA1c test at 6–13 weeks postpartum to rule out persistent diabetes, and annually thereafter
• Maintain a healthy weight — this is the single most effective intervention for preventing type 2 diabetes in high-risk women
• Continue low-GI dietary principles beyond pregnancy
• Exercise regularly — 150 minutes of moderate activity per week reduces type 2 diabetes risk by approximately 50% in high-risk women
• Breastfeed if possible — breastfeeding improves maternal insulin sensitivity and reduces GDM recurrence and progression to type 2 diabetes
• Consider ongoing acupuncture to support metabolic health, particularly if PCOS or insulin resistance was a pre-existing factor

11. My Pregnancy Guide

12. References

NICE (2015, updated 2023). Diabetes in pregnancy: management from preconception to the postnatal period. NICE Guideline NG3. nice.org.uk/guidance/ng3

Durnwald, C. (2015). Gestational diabetes: linking epidemiology, excessive gestational weight gain, adverse pregnancy outcomes, and future metabolic syndrome. Seminars in Perinatology, 39(4), 254–258. doi: 10.1053/j.semperi.2015.05.002

Viana, L.V., et al. (2014). Exercise in pregnancy and maternal and child health: a systematic review of randomised controlled trials. British Journal of Sports Medicine, 48(4), 299–305.

Manzanares, S., et al. (2008). Study of acupuncture effects on pain and glucose intolerance in pregnant women: a randomized clinical trial. PubMed