Self-Managing Gestational Diabetes: Study Identifies Key Barriers and Enablers - Video

Managing gestational diabetes is not just about monitoring numbers-it often requires rapid, life-changing adjustments during an already demanding phase of life. A new study published in the journal Pregnancy sheds light on why self-management of gestational diabetes mellitus (GDM), especially insulin use, can be so challenging, and what helps women successfully stick to their treatment plans.

Gestational diabetes affects nearly 14% of pregnancies worldwide, impacting around 18 million babies. Its prevalence has steadily increased over the past three decades. GDM raises the risk of complications such as pre-eclampsia and Caesarean delivery for mothers, while babies face higher chances of low blood sugar and other health problems at birth. Over time, mothers with GDM are also more likely to develop type 2 diabetes and cardiovascular disease. Because of these risks, strict self-management—often including insulin therapy-is crucial.

To better understand real-world challenges, researchers conducted a qualitative study alongside the Gestational Diabetes and Pharmacotherapy (GAP) randomized controlled trial. They interviewed 20 pregnant participants after 34 weeks of gestation, ensuring diversity in background and treatment experience. About half were using insulin, while others were preparing to start. All had received standard education on diet, exercise, glucose monitoring, and medication.

Using in-depth interviews and thematic analysis, the researchers identified several key barriers. Fear was the most common—fear of injections, of hypoglycemia, and of harming the baby. Many women also struggled with the mental load of learning complex routines in a short time, alongside feelings of shock, guilt, or self-blame following diagnosis. Practical challenges, especially in workplaces, made it difficult to test blood sugar or inject insulin at prescribed times.

At the same time, clear promoters of success emerged. Hands-on education from healthcare teams—such as practicing with insulin pens—significantly reduced anxiety and built confidence. Support from family and friends helped women stay on track, while concern for the baby was the strongest motivator of all, driving rapid and sustained behavior change. The study highlights that supporting GDM self-management requires more than prescriptions.

REFERENCE: Akinola, I., Flynn, K. E., Yee, L. M., et al. (2025). Barriers and facilitators to insulin management in pregnant people with gestational diabetes mellitus: A qualitative study. Obstetrics & Gynecology. DOI: https://doi.org/10.1002/pmf2.70232. https://obgyn.onlinelibrary.wiley.com/doi/10.1002/pmf2.70232