A surrogate pregnancy involves the same fundamental medical considerations as any other
pregnancy, but it also requires careful coordination between the gestational carrier, intended
parents, fertility specialists, and the obstetric team. One condition that deserves particular attention is
gestational diabetes mellitus (GDM).
Gestational diabetes develops when blood glucose levels become elevated during pregnancy. It is
common and treatable, but inadequate control can increase pregnancy-related risks for both the
gestational carrier and baby.
The encouraging message for intended parents and surrogate mothers is that a diagnosis of
gestational diabetes does not automatically mean an unsuccessful surrogacy journey. With timely
screening, appropriate treatment, and close obstetric monitoring, many women with GDM have
healthy pregnancies and babies.
What Is Gestational Diabetes?
Gestational diabetes is diabetes first recognized during pregnancy. Pregnancy naturally changes
insulin sensitivity, and some women are unable to produce enough insulin to maintain normal
blood glucose levels.
It is important to distinguish GDM from pre-existing type 1 or type 2 diabetes, because the
evaluation and management can differ.
The World Health Organization's 2025 recommendations emphasize that diabetes during
pregnancy requires individualized treatment and closer monitoring to protect maternal and
newborn health.
Why Does Gestational Diabetes Matter in Surrogacy?
During a surrogacy journey, the health of the gestational carrier directly affects pregnancy
management and fetal well-being.
Poorly controlled hyperglycemia during pregnancy has been associated with complications such
as:
- Excessive fetal growth or macrosomia
- Hypertensive disorders, including preeclampsia
- Shoulder dystocia during delivery
- Caesarean delivery
- Neonatal hypoglycemia
- Other newborn complications
WHO notes that appropriate treatment of hyperglycemia during pregnancy can reduce several
adverse maternal and neonatal outcomes.
This is why GDM should be viewed as a manageable medical condition rather than an automatic
threat to the surrogacy outcome.
Who May Have a Higher Risk?
GDM can occur even in women without obvious risk factors. However, certain characteristics
can increase risk, including:
- Previous gestational diabetes
- Overweight or obesity
- A family history of diabetes
- Previous delivery of a large baby
- Prediabetes or abnormal glucose levels
- Polycystic ovary syndrome in some patients
- Increasing maternal age
- A history of glucose intolerance
Importantly, risk assessment should not replace appropriate pregnancy screening. A woman
without known risk factors can still develop gestational diabetes.
When Is Gestational Diabetes Tested?
Glucose testing is commonly performed between 24 and 28 weeks of pregnancy. Women with
significant risk factors may be evaluated earlier.
WHO antenatal-care recommendations also identify blood-glucose testing for GDM around
24–28 weeks as part of routine pregnancy care. The precise test and diagnostic criteria may vary
according to the clinical protocol being followed.
Many settings use an oral glucose tolerance test (OGTT). WHO criteria for a 75-g OGTT
classify GDM when one or more specified glucose values meet the diagnostic threshold.
For a surrogate pregnancy, the treating obstetric team should determine the appropriate screening
schedule rather than relying on a generic online testing calendar.
How Is Gestational Diabetes Managed During Surrogacy?
Management depends on glucose levels, gestational age, maternal health, and fetal development.
- Nutrition planning
Diet is an important part of GDM management.
A dietitian or qualified healthcare professional may help the gestational carrier develop a meal
plan that supports adequate pregnancy nutrition while limiting large glucose fluctuations.
Practical principles may include:
- Eating regular meals
- Choosing high-fiber carbohydrate sources
- Including adequate protein
- Eating vegetables and nutrient-dense foods
- Limiting sugary drinks and highly refined foods
- Avoiding unnecessary restrictive diets during pregnancy
ACOG notes that regular meals and appropriately planned snacks can help women with GDM
maintain better glucose control.
The goal is not weight loss during pregnancy. Nutritional management should support both
maternal health and fetal growth.
- Appropriate physical activity
For women who have no obstetric contraindication, pregnancy-appropriate physical activity may form part of GDM management.
However, a gestational carrier should never begin a new exercise program without discussing it with her obstetric provider.
- Blood glucose monitoring
Some women with GDM are asked to monitor glucose at home using a blood glucose meter.
Keeping a record of readings allows the medical team to identify patterns and determine whether dietary and lifestyle measures are sufficient.
The WHO’s 2025 guideline emphasizes regular glucose monitoring and personalized care for diabetes during pregnancy.
- Medication when necessary
Lifestyle measures are not always enough.
If glucose remains above the treatment targets established by the treating team, medication may be required. Insulin is an established treatment option during pregnancy, while the choice of therapy has to be determined by the obstetric/endocrine team.
Medication should be taken with medical supervision.
Monitoring the Baby during a Surrogate Pregnancy
GDM management is not limited to measuring the surrogate’s blood glucose.
The obstetric team may also monitor:
- Fetal growth
- Amniotic fluid
- Maternal blood pressure
- Fetal movements
- Overall pregnancy progression
- Signs of hypertensive or other pregnancy complications
The intensity and timing of fetal surveillance should be individualised according to maternal glucose control, medication use, fetal growth and other clinical factors. ACOG specifically recommends individualizing antenatal fetal surveillance according to the pregnancy’s risk profile.
Can a Surrogate With Gestational Diabetes Still Have a Healthy Baby?
Yes. A GDM diagnosis should not immediately be interpreted as a failed or high-risk surrogacy outcome.
The more important question is:
Is the condition being detected early enough and managed effectively?
ACOG states that women with gestational diabetes can have healthy pregnancies when appropriate monitoring and treatment are provided.
For intended parents, this reinforces the importance of choosing a surrogacy program where medical coordination does not stop after embryo transfer.
The Importance of Coordinated Care in International Surrogacy
For international intended parents, pregnancy may take place in a country different from their home country. This makes communication particularly important.
A well-organized surrogacy program should facilitate appropriate coordination among:
- Fertility specialists
- Obstetricians
- Gestational carrier
- Endocrinologist or diabetologist when required
- Dietitian
- Nursing and laboratory teams
- Intended parents and their designated representatives
The objective is to ensure that important clinical information is communicated promptly and that pregnancy decisions remain medically guided.
For a program serving international intended parents in Georgia, continuity of medical documentation and communication can be particularly valuable when intended parents are travelling between countries.
What Can Help Reduce the Risk of GDM?
Not every case of gestational diabetes can be prevented. Pregnancy-related hormonal changes and individual biology play an important role.
However, before pregnancy and during pregnancy, appropriate care may help reduce modifiable risk factors.
Before embryo transfer
The medical team may review:
- Weight and metabolic health
- Previous diabetes or GDM
- Family history
- Blood glucose status
- Dietary habits
- Physical activity
- Existing medications
- Overall obstetric history
During pregnancy
The gestational carrier should:
- Attend scheduled antenatal appointments
- Complete recommended glucose testing
- Follow personalized nutritional advice
- Take prescribed medications correctly
- Monitor glucose when instructed
- Report concerning symptoms promptly
- Attend fetal-growth and obstetric assessments
What Happens After Delivery?
GDM usually improves after pregnancy because insulin sensitivity changes once the placenta is delivered.
However, having gestational diabetes is an important long-term health signal. Women who have had GDM have an increased future risk of developing type 2 diabetes.
Follow-up glucose testing after delivery and continued preventive healthcare are therefore important. ACOG recommends ongoing diabetes screening after GDM, with the frequency determined by the individual’s results and risk profile.
For the gestational carrier, postpartum healthcare should therefore remain part of responsible pregnancy care rather than ending at delivery.
A Healthy Surrogacy Journey Requires More Than Embryo Transfer
Successful surrogacy is not determined solely by embryo quality or implantation.
The health of the gestational carrier, quality of antenatal care, early identification of complications, and coordinated medical decision-making all contribute to a safer pregnancy.
Gestational diabetes is one example of a pregnancy complication that can be effectively managed when identified and treated appropriately.
For intended parents considering surrogacy in Georgia, asking about prenatal monitoring, metabolic screening, emergency medical arrangements, and communication protocols can be just as important as asking about the IVF procedure itself.
Final Takeaway
Gestational diabetes during surrogacy requires attention, but it does not have to overshadow the journey.
With appropriate screening, personalized nutrition, glucose monitoring, medication when indicated, and regular obstetric care, the gestational carrier can receive the support she needs while the pregnancy is carefully monitored for maternal and fetal well-being.
At Surrogacy Centre Georgia, prospective intended parents should discuss the medical-care pathway, pregnancy monitoring arrangements, and responsibilities of all parties with qualified fertility and obstetric professionals before proceeding.
Disclaimer: This article is intended for general educational purposes and does not constitute medical advice. Gestational diabetes screening, diagnosis, and treatment should always be determined by a qualified obstetrician/endocrinologist based on the individual pregnancy. Surrogacy outcomes cannot be guaranteed, and medical protocols may vary according to the patient’s condition and applicable local regulations.
References:
Ravi Sharma is a self-motivated, successful entrepreneur and has a solid experience in the fertility segment. and he is the director at ARTbaby Global (ARThealthcare). He is a pharmacy graduate with post-graduation in business administration and has 14 years of rich experience in the field of infertility segment. He loves to write about IVF, Surrogacy, and other ART (assisted reproductive technology) news, issues, and updates. He is a Pharmacy graduate (B. Pharm) and M.B.A (marketing).
His most recent success includes the successful launch of the medical tourism company, ARTbaby, which offers treatment options for infertility, egg donation, and surrogacy. He likes spending time with his family and writing about various aspects of IVF surrogacy and donating eggs.
Reviewed by Dr. Nita Sharma Das (Ph.D., ND., PHDHM., B.Pharm) - Master of Business Administration (MBA), B.pharma, Naturopathic Medicine/Naturopathy, PhD in Alternative Medicine,, HSPCResearcher and Innovator in Breakthrough Cosmeceuticals & Neutraceuticals | Patent Granted for Anti-Aging Formula | Author | Columnist | Advocate for Holistic Beauty | Former Asso.Prof. in Pharmaceutical Sciences