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How To Manage Gestational Diabetes in Twin, Triplet, & Quad Pregnancies

You’re pregnant with more than one baby and you’ve been inundated with advice and facts about what to expect. And, you’ve probably had many sleepless nights after learning about all the possible complications that can arise in a multiple pregnancy that simply don’t occur with singletons. The good news is that in the case of Gestational Diabetes (GDM), although more prevalent in multiples, the outcomes are extremely positive.

It’s a fact of life that pregnancy causes a diabetic state in every woman. About 90 per cent of pregnant women can cope with it, while 10 per cent can’t. It’s this latter group who get GDM.

So, what is Gestational Diabetes?

Diabetes Educator, Nurse Practitioner, and Midwife Marina Mickleson has spent more than twenty years explaining this to pregnant women. She says quite simply GDM is diabetes that is picked up for the first time in pregnancy.

“What this means is that the woman hasn’t had a prior diabetes diagnosis and the condition has been picked up during routine testing, which shows the woman has glucose intolerance in the pregnancy,” explains Marina.

What’s more, the percentage of women diagnosed with GDM varies depending on the population. On average, about 10 per cent of the Caucasian population will get GDM, but if you add in the Indian, Asian, Indigenous, and African population, it can be up to 20 per cent of the population who get GDM, according to Marina.

“These women are more at risk just because of mainly the food they’re eating,”

“Compared to what they’d be eating for three or four generations in their communities, it’s the Western diet their bodies aren’t able to cope with,” says Marina.

“On average, about 10 per cent of the Caucasian population will get GDM.”

~Marina Mickleson~

Unfortunately, as Marina explains women who are carrying multiples are also at a higher risk of developing GDM, due to the larger placenta, and GDM has a lot to do with placental hormones. So, the more babies you’re carrying, the more placental hormones you’ll be producing, which increases the chances of developing GDM.


There are two ways to be tested for GDM:

  1. A fasting blood glucose test, usually done in the first 12-weeks of pregnancy for women considered at high-risk of developing GDM. If this fasting level is elevated, then you will get a positive diagnosis and further testing isn’t required.
  2. The two-hour glucose tolerance test – this is where after an initial blood test you drink 75 grams of glucose syrup, which is followed by two more blood tests to see how your body reacts to the glucose load. This test is ideally given at 26-to-28-weeks’ gestation, however, if there has been a GDM diagnosis in a previous pregnancy or there is a family history of Type 1 or Type 2 diabetes, the test will be done at around 20-22-weeks’ gestation.

Taking the Test

Deb Howe admits she was worried that she had developed gestational diabetes because she was following a low carb, high fat diet when she fell pregnant with twins. When morning sickness set in, she craved carbs and gained a lot of weight in the first trimester.

She invited us along to her Glucose Tolerance Test (GTT) at 26-weeks gestation. You see, Deb was considered a high-risk because her twin sister has Type 1 diabetes.

After fasting for 10-hours, Deb had her first blood test and was given a 300ml bottle of liquid to drink, which contained the 75 grams of glucose syrup.

Everything was going well until about 20-minutes after Deb consumed the sweet liquid, she started to feel a bit lightheaded, the babies were kicking a lot, and she felt a tiny bit of nausea.

Another two blood tests later and Deb was given to all clear to go home and wait a few days for the results.

The good news is, that apart from having low iron Deb passed the GTT, which means she didn’t have gestational diabetes.


However, if a woman is diagnosed with GDM, the next step is to be referred to a diabetes educator who will explain the condition and give instructions about blood glucose level checks, diet, and exercise.

“For the majority of women Gestational Diabetes isn’t dangerous at all, it only becomes dangerous if women aren’t looking after themselves and are not controlling their blood glucose levels, and their levels are high,” Marina says.


There are no specific symptoms and most women have no idea they have GDM. The first indication is usually that on ultrasound the babies are bigger for gestation than what is expected, or you have a positive result on your GTT.

In fact, this is how Rachelle Lear found out she had GDM while pregnant with triplets. She was diagnosed with the condition at 26-weeks’ gestation, at the time she was still working full-time as a Treasury Analyst.

Rachelle says that apart from having to do regular blood glucose testing and keeping a food diary the condition didn’t bother her at all. She found the GDM was quite easy to manage, it was just that she had to eat a lot and quite regularly, which was difficult because she didn’t have any room left for food.

“I actually found Gestational Diabetes quite easy to manage, it was just the fact that you had to eat a lot and quite regularly, which I found difficult because I didn’t have any room.”

~Triplet mum – Rachelle Lear~

When Rachelle was admitted to the hospital, a few days before the boys were born, she realised just how much she was supposed to be eating.

“They come around with breakfast, and then drop off a snack for morning tea, and then your lunch, and then another snack, and then dinner, and another snack after that even. It was just too much,” she laughs.

All in all, Rachelle’s pregnancy was relatively uneventful and the boys arrived at 30-weeks’ gestation, and apart from the expected challenges that having babies in NICU presents, the boys continue to thrive.


When it comes to nutrition during pregnancy, Marina Mickleson recommends every woman, not just those who’ve been diagnosed with gestational diabetes, pay attention to what’s on their plate. And, for some, there might be a steep learning curve on the way.

“A quarter of your plate should be carbohydrates, another quarter of the plate should be protein, and the rest leafy green vegetables, salad, and vegetables,”

“Someone who has diabetes, Type 1, Type 2, or Gestational, the carbohydrates they’re having should be as low GI as possible,” explains Marina.

“Someone who has diabetes, Type 1, Type 2, or Gestational, the carbohydrates they’re having should be as low GI as possible.”

~Marina Mickleson~

According to Marina the simplest way to work out if something is low GI is to look for the least processed food. For example; a grainy piece of bread is going to be lower GI than a white piece of bread because your body is going to work a lot harder to break it down and it will break down more slowly.

Beyond delivery

As mentioned earlier, for 95 per cent of women diagnosed with GDM the condition resolves once the babies are born.

“In the cases where it doesn’t go, these women have come into the pregnancy with undiagnosed Type 2 Diabetes,”

“And, because it’s picked up in pregnancy it’s referred to as Gestational Diabetes,” says Marina.

Not only that, but if the mother’s blood glucose levels have been high during pregnancy, the baby or babies blood glucose levels will have also been higher in utero. What this means is that because the baby or babies are used to higher glucose levels when they are born their blood glucose levels can drop.

“These babies can have problems with low blood glucose levels or Hypos for the first day or so of life,”

“Because they’ve got low glucose levels, they may need some top ups with either breast milk or formula to bring those blood glucose levels up,”

“Within a couple of days most babies are able to self-regulate their insulin and it doesn’t seem to be a problem,” explains Marina.

All women who have had GDM, are encouraged to have a follow-up glucose tolerance test to ensure the condition has resolved. Marina suggests asking for a referral at your 6-week check-up and have the test done at around the 8-10-week post-partum mark.

GDM in future pregnancies

As a result of having GDM, there is a high likelihood of developing the condition in subsequent pregnancies. The main reason for this is age.

“As we have more children, we’re getting older, and unfortunately one of the risk factors of having Gestational Diabetes is being 30 or older,”

“Most of us are already 30 before we have our first pregnancy. Unfortunately, one of the risk factors for having gestational Diabetes is being 30 or older.”

~Marina Mickleson~

“So, if we’ve had Gestational Diabetes in one pregnancy, there is around a 40 per cent chance of getting it in subsequent pregnancies,” Marina says.

Educate yourself

If you’re like most people you want to be informed about likely scenarios with your pregnancy, that’s why it’s important to understand what’s happening to your body, and that of your babies’ if you’ve been diagnosed with GDM. But what questions should you be asking your specialist?

Marina suggests the following:

  1. Do I need to be monitored more closely?
  2. What can I do in terms of my diet to reduce the extra glucose going through to the babies?
  3. Who can I talk to about an appropriate exercise program?
  4. Who can show me how to test my blood glucose levels, and interpret what the readings mean?

If you have a diagnosis of GDM and your doctor says not to worry about it, seek further help. It’s your right!

Remember, if you’ve been diagnosed with GDM and you look after yourself by eating well, exercising moderately, and ensuring your blood glucose levels stay within the acceptable range, the condition isn’t dangerous.

Until next time…

I wish you Double Happiness … Multiplied.



  • Educate yourself about the condition.
  • Ask for a second opinion if your doctor says not to worry about a Gestational Diabetes diagnosis.
  • Ask questions. And, if you’re not satisfied with the answers, ask again.
  • Remember, for 95 per cent of women diagnosed with GDM the condition resolves once the babies are born.
  • As a result of having GDM, you will need to have a follow-up glucose tolerance test two-months post-partum.


Disclaimer: The content contained within this article is purely informative and educational in nature and should not be construed as medical advice. Please use the content only in consultation with an appropriately certified medical or healthcare professional.


Double Happiness Multiplied podcast

Double Happiness Multiplied – The Complete Guide to Enjoying Your Multiple Pregnancy and Building a Happy, Healthy Family Life.

S1 E4 – Gestational Diabetes

Gestational Diabetes Support Group

Gestational Diabetes UK

About the author, Sally

Sally Barker is a Hypnotherapist, Meditation Mentor, Pregnancy & Birth Trauma Coach, Podcaster, Author, and Educator on the topic of Multiple Births.

First and foremost, though, she is the proud Mamma of identical twin girls.

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