By the time most women realize they have gestational diabetes, metabolic disorders have been accumulating for years and often without a single symptom. Diagnosis is made during pregnancy, but the roots extend much further back. This is a warning that the system responsible for managing blood sugar levels is already under stress.
If left unaddressed, the consequences will continue beyond the 9th month of pregnancy. While the risk for serious complications during childbirth and long-term metabolic disease later in life increases, children are more likely to continue to bear that burden. This pattern makes gestational diabetes more likely to be influenced by what happens metabolically in the years leading up to pregnancy rather than just a single nine-month period.
Current US data shows that this problem has gone far beyond its limits. A study published in JAMA Internal Medicine by Northwestern Medicine researchers analyzed millions of U.S. births and documented a steady increase in gestational diabetes over nearly a decade.1
Steady increases without interruption or reversal indicate widespread changes in baseline health rather than isolated failures in prenatal care. This is no longer a rare complication. It has become a routine metabolic stress test that is causing more and more pregnancies to fail.
Moreover, the burden does not fall evenly. Some racial and ethnic groups face even higher rates, highlighting how environment, access to health care, and long-standing health patterns shape risk long before pregnancy begins. This context reframes the conversation away from short-term solutions and toward a metabolic foundation that sets the stage for pregnancy outcome.
A national trend that refuses to slow down
The study used data from the National Center for Health Statistics to analyze more than 12 million U.S. birth records to track trends in gestational diabetes from 2016 to 2024.2 This type of research captures what happens in real life, not in a tightly controlled laboratory. These results reflect routine pregnancies across the United States, not a narrow or idealized group.
By restricting their analysis to first singleton births, the researchers reduced the confounding of previous pregnancy history, which often distorts diabetes risk. This shows how often gestational diabetes occurs in uncomplicated pregnancies. It also highlights that this diagnosis increasingly affects people without a long medical history.
• Interest rates have risen every year without pause or reversal. Gestational diabetes increased from 58 cases per 1,000 live births in 2016 to 79 cases per 1,000 live births in 2024, a 36% increase over nine years. Even during the period of increased health awareness, there was no stagnation. This means that the risk environment has steadily worsened rather than fluctuated in response to short-term events.
• The increase continued even during the COVID-19 pandemic. This upward trend continued during and after the pandemic, confirming that temporary changes in lifestyle have not led to a decline in gestational diabetes. Many people assume that disruption caused by the pandemic explains recent health changes. Instead, the data shows deeper, longer-term metabolic problems that continue before the year in question.
• Significant differences were seen across racial and ethnic groups, as well as overall averages. In 2024, birth rates will reach 137 per 1,000 for American Indian and Alaska Native women, 131 per 1,000 for Asian women, and 126 per 1,000 for Native Hawaiian and Pacific Islander women. Hispanic women had 85 births per 1,000 live births, compared to 71 for white women and 67 for black women.
These communities often have greater exposure to environmental toxins, larger food deserts with limited access to whole foods, chronic stress from systemic inequities, and health care systems that fail to meet their specific needs, all factors that add to their metabolic burden over the years. Understanding this pattern will help everyone know that prevention should begin long before a positive pregnancy test result.
Senior author Dr. Nilay Shah also pointed out that the population groups with the highest rates are often underrepresented in health research, limiting our understanding of why their risks remain elevated. This explains why one-size-fits-all advice fails. Rather than pretending that all groups respond in the same way, we benefit when data reveals where knowledge gaps exist.
• Researchers have linked this trend to worsening metabolic health before pregnancy begins. Shah explained that “unhealthy eating habits, lack of exercise, and increasing obesity” among young adults are likely contributing to the higher rates of diabetes during pregnancy.
This framing shifts responsibility upstream and away from pregnancy. This highlights that gestational diabetes is not a sudden pregnancy-specific problem, but rather reflects years of metabolic strain (accumulated stress on the body’s systems that process food into energy).
• Current prevention strategies do not work as intended. Gestational diabetes has been increasing for more than a decade, indicating that existing approaches have failed to reverse this trend. This is a call to re-evaluate how metabolic health is addressed prior to pregnancy. By documenting nearly 15 years of uninterrupted growth, combined with previous data, this study positions gestational diabetes as an indicator of population-level metabolic decline.
How to Address the Real Causes of Gestational Diabetes
The good news is that gestational diabetes responds to upstream intervention. This condition does not begin during pregnancy. It forms quietly over many years as metabolic stress accumulates, insulin signaling weakens, and environmental exposures disrupt normal blood sugar regulation. Insulin is a hormone that unlocks cells so that glucose can enter and be used for energy.
When cells do not respond properly to insulin signals (a problem called insulin resistance), glucose builds up in the bloodstream instead of fueling the body. This is the key analysis of gestational diabetes. Addressing the cause early makes your blood sugar control more resilient, makes pregnancy less taxing on your body, and dramatically reduces long-term risks to you and your child. Ideally, start making these changes at least 6 to 12 months before becoming pregnant.
1. Restores cellular energy and keeps blood sugar stable — Mitochondria, the energy-producing structures inside each cell, need adequate fuel to function. When starved or damaged, cells cannot process glucose efficiently, so the body must pump more insulin to compensate. Cells process glucose best when they have enough fuel to produce energy efficiently.
For most adults, this means moderate carbohydrate intake rather than restriction. Aiming for approximately 250 grams of carbohydrates daily can support glucose processing and lower stress hormones. If you’ve heard that carbohydrates raise blood sugar, this may seem counterintuitive.
However, chronically restricting carbohydrates increases stress hormones like cortisol, which actually impairs insulin sensitivity over time. Adequate carbohydrate intake supports thyroid function and metabolic rate, both of which help your cells process glucose efficiently.
Stable energy reduces the metabolic pressures that cause insulin resistance before pregnancy even begins. I recommend starting with whole fruit and white rice. It is easier to digest, especially if your intestines are damaged. If your gut is healthy, gradually add root vegetables, followed by legumes and well-tolerated whole grains.
2. Eliminate seed oils and processed foods that interfere with insulin signaling — Linoleic acid (LA) in seed oil interferes with mitochondrial energy production and worsens glucose regulation. When LA accumulates in cell membranes, mitochondria become less efficient at burning fuel, impairing the cells’ ability to absorb glucose normally. Reduce this burden by eliminating packaged foods and avoiding restaurants that use most seed oils to cook their food.
The main seed oils to avoid are soybean oil, corn oil, canola oil, cottonseed oil, sunflower oil, safflower oil, and grapeseed oil. Check the ingredient label. It appears on most packaged foods, salad dressings, and take-out foods. Instead, use traditional fats like grass-fed butter, ghee, and tallow. These changes reduce inflammatory byproducts that cause the body to overproduce insulin.
3. Reduces toxic exposures that disrupt hormone and glucose metabolism. Chemicals used daily disrupt hormonal balance, increasing the risk of gestational diabetes.3 You can help protect your glucose control by avoiding plastic food containers, choosing phthalate-free personal care products, and minimizing packaged foods.
Lead exposure, even at low levels, impairs blood sugar tolerance (the body’s ability to process incoming sugar without causing a spike in blood levels). Purifying your drinking water, using a high-quality air purifier, and avoiding old paint and contaminated dust can help lower hidden metabolic stress that has built up long before pregnancy.
4. Harness sunlight to optimize vitamin D and metabolic resilience — Vitamin D plays a direct role in blood sugar control and pregnancy outcome. Sun exposure is the most effective way to increase levels, but timing is important. Because LA stored in the skin increases the risk of sun damage, it is recommended to avoid mid-day high-intensity sunlight exposure until you have stopped eating seed oils for at least 6 months.
During the transition period, aim for sunlight exposure every morning or late afternoon when UV intensity is lower. After discontinuing seed oil use for 6 months, midday exposure can be gradually increased as tolerated. Over time, getting adequate sunlight each day improves your vitamin D status, cellular energy production, and insulin sensitivity. If sunlight is still limited, vitamin D3 supplements are most effective when balanced with magnesium and vitamin K2.
These supplemental nutrients help your body absorb and induce vitamin D properly while reducing the dosage needed to maintain healthy levels.4 Instead of guessing, check your vitamin D levels with a simple blood test at least twice a year. Aim for 60 to 80 ng/mL (150 to 200 nmol/L).
5. Move daily to improve insulin sensitivity and weight control — Regular movement trains your cells to respond to insulin instead of resisting it. Walking, swimming, and light strength training improve your ability to process glucose without exhausting your system. Moderate activity, such as walking for an hour daily, lowers insulin resistance and supports healthy body composition.
Even a small amount of weight loss before pregnancy dramatically reduces the likelihood of loss of blood sugar control later in life. These steps will help you make an impact where it matters most. The metabolic foundation you’ve built in the years before pregnancy will determine whether pregnancy puts a strain on your system or elevates it enough to meet it.
Frequently Asked Questions About Gestational Diabetes
cue: What is gestational diabetes and why is it important after pregnancy?
no way: Gestational diabetes is an increase in blood sugar first identified during pregnancy. This is important because it reflects underlying metabolic dysfunction that often begins years ago and increases a child’s long-term risk for type 2 diabetes, cardiovascular disease, and metabolic problems.
cue: Why is the incidence of gestational diabetes increasing each year in the United States?
no way: National data shows a continued increase from 2016 to 2024, which researchers link to declining metabolic health in young adults. A nutrient-poor diet, reduced physical activity, increased obesity, and environmental exposures can all contribute to worsening insulin resistance before pregnancy begins.
cue: Who is at highest risk for gestational diabetes?
no way: Incidence rates are highest among American Indian, Alaska Native, Asian, Native Hawaiian, or Pacific Islander women. These disparities highlight how environment, access to care, and long-standing health patterns, not just individual behavior, shape risk before pregnancy.
cue: How does diet affect the risk of gestational diabetes?
no way: Adequate, healthy carbohydrates support stable cellular energy and reduce insulin stress, while seed oils and ultra-processed foods disrupt glucose regulation. A diet centered on whole foods, traditional fats, and easily digestible carbohydrate sources improves insulin sensitivity before pregnancy.
cue: What are the most effective steps to lower your risk before pregnancy?
no way: Addressing the root cause is most important. Restoring cellular energy, eliminating seed oils, reducing toxic exposures, optimizing vitamin D through sunlight, and moving daily all strengthen insulin sensitivity and lower the metabolic burden that leads to gestational diabetes.
