Gestational diabetes (GD) is a type of diabetes that develops during pregnancy. As carrying two fetuses results in higher levels of pregnancy hormones, gestational diabetes with twins has an increased risk.

GD is when a person has difficulty managing their blood sugar levels during pregnancy. It typically occurs due to the body developing resistance to insulin. This is the hormone responsible for regulating blood sugar levels.

During pregnancy, the body makes additional hormones that can block the effect of insulin. It also undergoes other changes, such as weight gain, which can lead to insulin resistance. Because the body produces more of these hormones when carrying twins, a person is more likely to develop GD with a twin pregnancy.

This article will discuss how GD may impact twin pregnancies and how to manage and prevent the condition.

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The risk of developing gestational diabetes is generally higher in people carrying twins or multiples than those carrying a single fetus. This is because carrying multiple babies places additional stress on the body and increases the demand for insulin.

The risk may also be higher due to increased placental hormones. When carrying twins, the placenta produces a higher amount of these hormones, which can interfere with insulin action and lead to resistance.

Gestational diabetes can have several effects on twin pregnancies. These can include:

  • Increased risk of premature birth: This can lead to potential complications and health concerns.
  • Greater likelihood of cesarean delivery: This can be due to various factors, such as fetus size, difficulties in labor progression, or concerns about the well-being of the fetuses.
  • Neonatal hypoglycemia: Twins born to people with gestational diabetes may have an increased risk of experiencing low blood sugar levels after birth.

Although there is an increased risk of potential complications in those with gestational diabetes and carrying twins, evidence suggests that a person can mitigate these risks by managing the condition.

Several factors can increase the risk of developing gestational diabetes, including:

  • being overweight or having obesity
  • performing low levels of physical activity before pregnancy
  • having a close family member, such as a parent or sibling, with diabetes
  • becoming pregnant at an older age
  • belonging to certain racial and ethnic groups

It is important to note that having one or more risk factors does not necessarily mean a person will develop gestational diabetes. Additionally, people without any risk factors can still develop the condition.

Typically, a person experiencing gestational diabetes will have no symptoms. In cases where a person has symptoms, these are often mild, such as increases in thirst and the need to urinate.

If a person suspects they may have gestational diabetes or is experiencing any concerning symptoms, it is crucial to consult a healthcare professional for a proper evaluation and diagnosis.

Learn more about the symptoms of gestational diabetes.

While it is not possible to guarantee the prevention of gestational diabetes, people can take steps to reduce their risk. The National Institute of Diabetes and Digestive and Kidney Diseases suggests the following strategies:

  • Maintaining a moderate weight before pregnancy: If the person planning to conceive is already at a moderate weight, it is best to try to maintain this.
  • Losing weight before pregnancy: People who are overweight or live with obesity may consider losing weight before conceiving. This may help improve how their body uses insulin.
  • Increasing physical activity: People can also reduce their risk of gestational diabetes and improve how their body uses insulin through increased exercise.

It is important that a pregnant person gains some weight for the fetus to be healthy. However, gaining a lot of weight quickly can increase the risk of developing gestational diabetes. People can consult their healthcare team to discuss weight gain and physical activity during pregnancy.

Learn more about preventing gestational diabetes.

Managing gestational diabetes involves a combination of lifestyle modifications and, in some cases, medication. Some ways to help manage gestational diabetes include:

Healthy eating

People can work with healthcare professionals to create a personalized meal plan that focuses on healthy, balanced eating. The plan will likely explain which foods it may be best to eat, when to eat, and how much.

Learn more about suitable diets for gestational diabetes.

Regular physical activity

A healthcare professional will likely recommend regular exercise. Physical activity helps lower blood sugar levels by improving insulin sensitivity. Activities that are safe during pregnancy include brisk walking, swimming, prenatal yoga, and stationary cycling. Unless advised differently, it is best to aim for at least 30 minutes of activity most days of the week.

Regular monitoring of blood sugar levels

Sometimes, a healthcare professional may ask someone to monitor their glucose levels with a glucose meter. This is to check if glucose levels are in the target range the healthcare professional recommends.


In some cases, lifestyle modifications alone may not be sufficient to control blood sugar levels, and a person may require medication. This may involve insulin injections that help regulate blood sugar levels.

Regular prenatal checkups

It is best for people to attend all scheduled prenatal appointments to monitor the progress of their pregnancy, their health, and the fetus’s health. During pregnancy with gestational diabetes, the person’s healthcare team will monitor their blood sugar levels, check for complications, and provide necessary guidance and support.

If a person suspects they may have gestational diabetes or is experiencing any concerning symptoms, it is important to contact a healthcare professional. They can provide a proper evaluation and diagnosis.

Gestational diabetes is a type of diabetes that occurs during pregnancy due to hormonal and bodily changes that can result in insulin resistance. Carrying twins increases the risk of developing the condition.

It can carry potential risks for the person and their pregnancy. However, people can reduce these risks with appropriate management strategies, such as following a healthy eating plan, exercising, and attending regular prenatal checkups.