PCOS & Gestational Diabetes: Understanding the Risk

Most people know that polycystic ovary syndrome (PCOS) can affect your periods and fertility. But they don’t realize that its impact doesn’t stop once you conceive. It can follow you into pregnancy, increasing the risk of complications like gestational diabetes.

One of the main drivers behind a lot of PCOS symptoms is insulin resistance. It’s to blame for common struggles like fatigue, cravings, stubborn weight loss, brain fog, irregular cycles, hirsutism, fertility challenges, and more. If it goes unchecked, PCOS can even raise your risk for long-term health issues like heart disease and type 2 diabetes.

Since this condition already increases a Cyster’s risk of type 2 diabetes, it’s probably no surprise that women with PCOS are also more likely to develop gestational diabetes during pregnancy. I understand how this could cause anxiety in expecting Cysters out there, but don’t stress! There are ways to reduce your risk and have a healthy pregnancy. 

To help you fully understand what’s happening, the risk factors, and how to manage those blood sugar levels, I’ve put together this guide to PCOS and Gestational Diabetes.

Here’s what you need to know:

PCOS & Gestational Diabetes: Understanding the Risk

Gestational diabetes often pops up in the second or third trimester, and it can impact both you and your baby. When blood sugar runs high during pregnancy, it can raise your chances of high blood pressure, preeclampsia, and other complications. It can also cause your baby to grow bigger than average, which can sometimes make delivery a challenge.

Even after your little one arrives, gestational diabetes can have lasting effects. For example, you may have a higher risk of developing type 2 diabetes later in life. At the same time, your baby could be more likely to experience low blood sugar and breathing issues at birth. 

No one likes to talk about the potential of adverse pregnancy outcomes, making it a sensitive, anxiety-inducing topic. But knowing the details can help you take smart steps toward a healthier, happier pregnancy! 

Are Women With PCOS More Likely to Have Gestational Diabetes?

Yes! Let’s first look at the basics. Gestational diabetes mellitus (GDM) is a type of diabetes that only develops during pregnancy. It happens when hormones that support your baby’s growth make your body less responsive to insulin. Basically, instead of glucose turning into energy in your cells, that sugar stays in your bloodstream and can get stored as fat.

If you’ve been researching PCOS for a while, you’re probably thinking that sounds a lot like insulin resistance—and it is! Studies show up to 80% of women with polycystic ovarian syndrome (PCOS) have insulin resistance, and pregnancy can make it even trickier to manage. 

Essentially, Cysters are already starting at a disadvantage. Since insulin resistance is already a challenge for most of us before pregnancy, this increases the risk of gestational diabetes. PCOS itself is considered an independent risk factor for GDM, regardless of age, family history, or BMI. 

Previous studies have found that only 5% to 9% of women without PCOS develop gestational diabetes. Comparatively, between 14% and 28% of Cysters do develop it. In retrospect, this means that women with PCOS face a 56% to 460% higher risk of developing gestational diabetes. That’s a significantly increased risk.

How Does PCOS Cause Gestational Diabetes?

Insulin Resistance

As I mentioned, insulin resistance is the main thing to blame. It starts when a Cyster’s body struggles to process glucose. When your cells aren’t responding to insulin like they should, blood sugar levels rise, and your whole metabolic system becomes dysfunctional. 

When you’re pregnant, the hormonal changes make your body even less responsive to insulin, potentially triggering gestational diabetes. 

High Androgen Levels 

Hormonal imbalance is another root issue of PCOS. One of the most common out-of-balance hormones is androgens (AKA male sex hormones). When androgen levels are high, it actually prompts your ovaries to produce more insulin. This, of course, boosts your chances of developing insulin resistance and gestational diabetes! 

High androgen levels during pregnancy are a concern on their own, too. These irregular hormones can lead to difficulties with implantation, preterm birth, and issues with fetal development. That’s why it’s important for pregnant women with PCOS to be mindful of their androgen levels.

For a deeper dive into androgens, head over to my post “High Testosterone Symptoms and PCOS.”

Chronic Inflammation

The last major root issue of PCOS is inflammation. Inflammation is your immune system’s way of fighting off illness or toxins in the body. Normally, it’s a temporary “emergency mode” that helps get your body back on track. But when inflammation becomes persistent, it can lead to chronic symptoms and a host of problems.

When your body is stuck in this survival mode, it can interfere with insulin signaling. Essentially, your body thinks something is wrong and responds by storing fat and energy for the future. This can lead to insulin resistance and significantly increase the incidence of GDM in women with PCOS. 

How to Prevent Gestational Diabetes With PCOS

Be mindful of blood sugar balance before pregnancy, if possible. 

As I’ve discussed, insulin resistance in women with PCOS often starts long before pregnancy. The sooner you recognize the symptoms and take action, the better your chances of improving your health now and setting yourself up for a complication-free pregnancy later. Once you are pregnant, your options for managing symptoms are more limited. Things like curbing cravings and staying active can become much harder or impractical.

If you’re not sure whether you’re dealing with insulin resistance, here are some of the common symptoms Cysters experience:

• Fatigue or low energy
• Difficulty losing weight or unexplained weight gain
• Strong sugar or carb cravings
• Brain fog or trouble concentrating
• Irregular menstrual cycles
• Excess facial or body hair (hirsutism)
• Skin changes, like dark patches (acanthosis nigricans)
• High blood pressure or cholesterol issues
• Increased thirst or frequent urination

Sound familiar? If so, you probably have insulin-resistant PCOS. Below, we’ll get into exactly how to naturally manage blood sugar levels with PCOS. 

Eat a gluten- and dairy-free anti-inflammatory diet. 

The thing that has the biggest impact on your insulin sensitivity is the food you eat. Eating a lot of processed, sugary foods can make your body less responsive to insulin over time. So, if you’re a Cyster who already struggles with insulin resistance, a balanced and intentional diet can make all the difference. 

Changing eating habits can be hard, but as a PCOS dietitian, I don’t advocate for highly restrictive diets or even super low-carb diets. They put so much stress on you and your body, and the outcome? More frustrating symptoms. Stress can actually increase insulin resistance, meaning a strict diet can backfire and worsen exactly what you’re trying to heal. 

So, what should you do? Here are the core components of a PCOS-friendly diet:

Avoid inflammatory foods: 

Remember, inflammation is not a friend to insulin sensitivity. So, cutting out inflammatory foods can help you keep chronic inflammation in check. Sugary snacks, refined carbs (like white bread, white rice, pastries, etc.), fried foods, prepackaged snacks, and processed meats are all good to cut out. I also recommend Cysters try cutting out gluten and dairy, since it’s a common trigger for women with PCOS. 

Want more information? Check out “How to Start Gluten & Dairy Free for PCOS” and “How to Reverse PCOS with Diet.”

Includes more fiber and healthy fats: 

Fiber and healthy fats help balance blood sugar and improve insulin sensitivity in PCOS. Fiber slows sugar absorption, while healthy fats reduce inflammation and support stable energy. As a result, both of these nutrients make it easier for your body to manage insulin.

Some high-fiber foods include broccoli, spinach, Brussels sprouts, berries, apples, lentils, chickpeas, oats, and quinoa. For healthy fats, aim for avocado, nuts, chia seeds, and fatty fish. Plenty of tasty ingredients to add to your daily meals. 

This Mongolian beef recipe that I recently posted about is a great example of a PCOS-friendly meal. You can find plenty more like this both on the blog and in The Cysterhood app!

Up your protein intake:

Protein is a great way to keep blood sugar balanced with PCOS. It slows sugar absorption, helps you feel full longer, and curbs cravings. Including protein in every meal supports steady energy and healthier insulin levels.

Aiming for about 30 grams of protein per meal is a good rule of thumb, especially for breakfast. For a more precise daily target, multiply your body weight by 1–1.2 to get the total grams of protein you should eat each day.

You can get protein from lean meats like chicken, turkey, fatty fish (salmon, mackerel, sardines), and eggs. Plant-based options like lentils, chickpeas, black beans, quinoa, nuts, and seeds also work well. Additionally, you reach your daily goal with high-quality protein powders, too! It can be as simple as adding a few scoops to smoothies, yogurt, oatmeal, or muffins.

Here’s my list of the best protein options for PCOS. 

Limit caffeine and alcohol intake: 

If you’re trying to get pregnant, alcohol is already off the table, so no worries there. (It’s not ideal for a PCOS diet either, since it spikes carbs and strains the liver.) But you’re also advised to limit your caffeine intake. Too much caffeine has been linked to lower birth weight, preterm birth, and, yes, high blood sugar.

Even when you’re not pregnant, caffeine raises stress hormone levels, keeping your body in that “emergency mode” I mentioned earlier. When your body feels anxious and wired, it floods your bloodstream with sugar and stores it as fat. Which, as you probably guessed, worsens insulin resistance. During pregnancy, hormone changes make caffeine’s effects even stronger.

The general guideline is to keep caffeine under 200 mg per day. Personally, I recommend going as low as possible to support insulin sensitivity. You’ll likely notice that with less caffeine and more water or other healthy alternatives, you actually feel more energized and focused.

This is a topic I’ve discussed a handful of times, but you can start with “Should I Cut Out Caffeine With PCOS?” to learn more!

Incorporate herbal teas:

Remember when I explained how high androgen levels can lead to insulin resistance? Luckily, herbal teas can help lower testosterone and balance other hormones. I recommend considering a switch from your usual morning pick-me-up, whether that’s a caffeinated tea or sugary soda, to herbal teas. There are plenty of ways to dress them up to suit your taste, and the hormone-balancing benefits are undeniable.

When you start looking for the best herbal teas for PCOS, the options can feel overwhelming. A strategic tea blend, however, can be just what you need to support insulin sensitivity. Try my Testosterone Relief Tea, an organic blend of research-backed herbs like spearmint, lemon balm, orange peel, chamomile, rosehip, peppermint, cinnamon, nettle, lavender, and calendula. These ingredients have been shown to help balance androgens and provide relief from PCOS symptoms. With this, you know you’re drinking something made specifically for Cysters. 

Consider your carb tolerance: 

I don’t like low-carb diets because our bodies need carbohydrates. They’re not all bad! Plus, eating too few carbs can increase stress hormones and worsen insulin resistance. And actually, you don’t even have to cut carbs as much as possible—it’s not a one-size-fits-all kind of thing. Instead, it’s better to figure out your carb tolerance. That way, you know how many carbs your body can handle to fuel energy without spiking blood sugar or triggering unwanted symptoms.

Here’s how to find your carb tolerance:

• Start with around 15–30 grams of carbs per meal: That’s roughly ½ cup of cooked rice or quinoa, 1 slice of whole-grain bread, or ½ cup of oatmeal.
• Pair with protein or fat: Examples include eggs, Greek yogurt, nuts, or avocado. This helps slow digestion and prevent blood sugar spikes.
• Observe how you feel: Are you energized or crashing afterward? Optional: measure your blood sugar 1-2 hours after eating if you want more precise data.
• Adjust gradually: Increase or decrease carb portions based on your energy, cravings, and blood sugar response.

Eat 3-4 meals a day: 

When you’re trying to improve insulin resistance, eating only 3-4 meals per day helps keep insulin levels from staying persistently high. Every time you eat, your body releases insulin to move glucose into your cells. This means that grazing all day can actually make insulin resistance worse. On the other hand, spacing meals gives your body a chance to reset and respond better to insulin.

Fewer meals also give your body time to burn stored glucose and fat for energy. This can reduce cravings, lower inflammation, and improve hormonal balance, which are all important for increasing insulin sensitivity! If you’re wondering, intermittent fasting can be useful for PCOS, too. 

Find reliable resources for managing your diet: 

Finding PCOS-friendly dishes, meal planning, tracking protein, and measuring carbs can feel overwhelming—especially if you’re pregnant! Luckily, The Cysterhood app handles all of it for you. It offers hundreds of delicious PCOS-friendly meals, a meal plan builder, and helpful trackers to keep you on course.

Don’t believe there are tasty meals that actually fall in line with a gluten- and dairy-free anti-inflammatory diet? Here are some recipes you’ll find on the app:

• Chicken Pot Pie
• Chili Mac and Cheese 
• Chicken Alfredo 
• Pork & Bacon Meatballs
• BBQ Chicken Pizza
• Fish Taco Bowls 
• Ferrero Rocher Protein Smoothie 
• Chocolate Waffles 
• Hot Chocolate Cookies 
• Funfetti Cookies 
• Hibiscus Blackberry Virgin Margaritas 
• Strawberry Basil Slushie

Does that sound restrictive? Not at all. These meals are nutrient-dense, balanced, and delicious. Whether you’re trying to conceive or managing pregnancy cravings, The Cysterhood has something to satisfy your taste buds while supporting your healing journey.

Get moving every day with gentle, slow-weighted workouts. 

Exercise isn’t just about weight loss or muscle building (though those are important for pregnancy, too). It’s more about improving insulin sensitivity and balancing hormones—both of which exercise helps with.  Aim for at least 30 minutes a day of gentle, slow-weighted workouts. These exercises focus on lifting weights slowly, through controlled movements and longer muscle engagement. As a result, this maximizes muscle activation and helps your body use more glucose.

Unlike high-intensity or fast-paced workouts that can spike stress hormones like cortisol, slow-weighted training is gentler on the adrenal system. This matters for PCOS, since chronic stress hormone elevation can worsen insulin resistance and androgen imbalances. Plus, slow-strength training increases lean muscle mass, naturally boosting metabolism and supporting long-term blood sugar control.

Starting these exercises now also means your doctor is more likely to clear you to continue them throughout your pregnancy. You can find slow-weighted workout routines tailored for PCOS on The Cysterhood app!

Manage your stress levels with self-care. 

As I’ve mentioned throughout this post, stress is harmful to your metabolism and hormone balance. Keeping cortisol levels in check is essential if you want to improve insulin sensitivity and manage PCOS symptoms. Beyond that, chronic stress can impact fetal development and birth outcomes. So, the earlier you can develop good stress management techniques, the better. 

Here are some ways you can reduce stress with PCOS:

• Gentle movement: Slow-weighted workouts, walking, swimming, or yoga
• Mindfulness practices: Meditation, acupuncture, deep breathing, or journaling
• Social support: Connect with friends, family, or PCOS communities
• Relaxation rituals: Warm baths, calming music, or reading
• Set boundaries: Limit exposure to unnecessary stressors when possible

Prioritize 7-9 hours of great-quality sleep. 

Sleep is a powerful tool for managing insulin resistance and reducing the risk of gestational diabetes. Poor or insufficient sleep can increase cortisol levels, worsen insulin sensitivity, and disrupt hormone balance, making it harder for your body to regulate blood sugar. 

By aiming for 7-9 hours of restorative sleep each night, you give your body the chance to recover, stabilize glucose levels, and balance hormones. I know this probably sounds easier said than done, since Cysters are way more likely to experience sleep disturbance than women without PCOS. To help you get optimal rest, here’s how to sleep better with PCOS. 

Talk to your doctor about insulin-sensitizing supplements. 

Supplements are a great way to fill nutritional gaps and address common PCOS deficiencies. Many of these vitamins and minerals are essential for supporting insulin sensitivity, hormone balance, and overall metabolic health, so don’t skip them! Also, make sure to choose high-quality, NSF-certified, PCOS-friendly options like the ones offered by Ovafit.

Here are some of the best supplements for managing insulin resistance and lowering your risk of gestational diabetes:

• Ovasitol: Combines myo-inositol and D-chiro-inositol in a 40:1 ratio to improve insulin signaling, regulate menstrual cycles, and support ovarian health.
• Berberine: Natural GLP-1 booster that enhances insulin sensitivity and supports healthy blood sugar levels
• Omega-3 Fatty Acids: Reduce inflammation and support healthy insulin-producing cell function, aiding blood sugar control.
• Prenatals: Prenatal vitamins can provide essential nutrients like chromium and vitamin D, which support insulin action, secretion, and sensitivity. These nutrients, along with folate, iron, and iodine, help support fertility, hormone balance, and healthy fetal development.

Before starting new supplements, make sure to talk with your doctor to make sure they’re the right fit for you.

Consider continuous glucose monitoring. 

Continuous glucose monitoring, or CGM, can be a total game-changer for seeing how your body reacts to food, exercise, and even stress. It lets you track your blood sugar in real time, spot any spikes, and make small tweaks to your meals and daily routine. 

If you have PCOS or are at risk for gestational diabetes, CGM gives you practical insights to help keep your blood sugar steady and avoid potential complications. Is regular finger-pricking a pain? Yes, but it may be worthwhile if you want to really understand your progress managing insulin sensitivity. 

To help you decide, read this post: Is it a Good Idea to do Continuous Glucose Monitoring for PCOS?

PCOS means you’re more likely to have gestational diabetes, but you can naturally reduce your risk for a healthier pregnancy. 

Having PCOS doesn’t have to mean a stressful pregnancy. With the right tools, like mindful eating, gentle movement, good sleep, and a little self-care—you can support your body, your baby, and your peace of mind. 

Every small step you take adds up, helping you feel empowered, confident, and in control. Remember: you’re not just managing PCOS. You’re creating the healthiest, happiest start possible for you and your little one. You’ve got this!

For more guidance, dive into our Essential Guide to Natural PCOS Management and tune in weekly to A Cyster and Her Mister Podcast. We can’t wait to welcome you to the community and support you on your journey!