Surrogates & Gestational Diabetes: What You Need to Know

For many women exploring surrogacy, gestational diabetes is one of the first medical questions that comes up — and one of the most anxiety-inducing. If you’ve had it in a prior pregnancy, you may be wondering whether it disqualifies you. If you’ve never had it, you may wonder what your risk looks like carrying someone else’s baby.

According to the Centers for Disease Control and Prevention (CDC), gestational diabetes affects approximately 2–10% of pregnancies in the United States each year.

At Physician’s Surrogacy, our in-house OB/GYN team reviews every surrogate candidate’s full medical history — including any prior pregnancy complications — as part of our 47-point physician-designed screening process. The answers here are not one-size-fits-all, and that’s exactly why medical oversight matters.

This article explains what gestational diabetes is, how it affects a surrogate pregnancy, what risk factors to be aware of, and what our screening team evaluates when a prior diagnosis is part of a candidate’s history.

What Is Gestational Diabetes?

Gestational diabetes develops when hormonal changes during pregnancy cause the body to become less responsive to insulin — the hormone that regulates blood glucose. The pancreas may not produce enough extra insulin to compensate, resulting in elevated blood sugar levels.

According to the American College of Obstetricians and Gynecologists (ACOG), gestational diabetes mellitus (GDM) is one of the most common medical complications of pregnancy. In most cases, it can be managed through dietary changes, physical activity, and — when necessary — insulin therapy or oral medication.

Gestational diabetes typically resolves after delivery. However, the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) reports that women who have had it face a measurably elevated risk of developing Type 2 diabetes later in life — making ongoing monitoring important even after pregnancy ends.

How Gestational Diabetes Affects a Surrogate Pregnancy

Gestational diabetes affects a surrogate the same way it affects any pregnant woman — because physiologically, the pregnancy process is identical regardless of genetic parentage. The hormonal environment of pregnancy creates the same insulin resistance whether the embryo is genetically related to the carrier or not.

For surrogates, the stakes of an unmanaged complication extend beyond personal health. A surrogate pregnancy involves a legal agreement, a fertility clinic, and intended parents who are tracking every development. Managing gestational diabetes well — or preventing it altogether — matters on every level.

Complications associated with gestational diabetes that our medical team monitors include:

• Elevated blood pressure and preeclampsia. The ACOG guidelines on gestational diabetes link poorly controlled blood glucose to increased risk of hypertensive disorders in pregnancy, including preeclampsia.
• Increased likelihood of Cesarean delivery. When the baby grows larger than normal due to excess blood sugar, vaginal delivery becomes more difficult and surgical delivery more common.
• Future diabetes risk. Each episode of gestational diabetes raises a woman’s risk of Type 2 diabetes in subsequent years — a factor our OB/GYN team considers in evaluating long-term surrogate health.

How Gestational Diabetes Affects the Baby

Blood glucose crosses the placenta. When a surrogate’s blood sugar runs high, the baby’s pancreas responds by producing more insulin — which promotes excess fat storage and growth. The American Diabetes Association (ADA) outlines several complications that gestational diabetes can create for the baby.

The primary concerns our physicians watch for include the following.

Excessive Birth Weight (Macrosomia)

Elevated blood glucose in the surrogate causes the baby to receive more glucose than it needs, often resulting in a birth weight above nine pounds. Larger babies carry higher risk of birth injuries, shoulder dystocia, and surgical delivery.

According to research published through the National Library of Medicine (NLM), macrosomia occurs in approximately 15–45% of pregnancies affected by gestational diabetes.

Preterm Birth

Gestational diabetes is associated with a higher rate of preterm labor and delivery — either spontaneously or because the care team recommends early delivery due to the baby’s size or maternal health concerns. The CDC’s gestational diabetes data identifies preterm birth as one of the primary complications linked to the condition.

Preterm births carry their own cascade of complications, which is part of why our physician-designed screening process focuses so heavily on reducing preterm risk. Our preterm delivery rate is 50% below the national average.

Respiratory Distress Syndrome

Some infants born to mothers with gestational diabetes develop respiratory distress syndrome (RDS), a breathing condition more common in preterm babies or those whose lung development was affected by the hormonal environment of a diabetic pregnancy.

The National Heart, Lung, and Blood Institute (NHLBI) notes that RDS occurs when the lungs lack sufficient surfactant — a substance that keeps air sacs open.

Neonatal Hypoglycemia

After delivery, a baby who was accustomed to receiving excess glucose from the surrogate’s bloodstream may experience a sudden drop in blood sugar — known as neonatal hypoglycemia. The baby’s insulin levels, elevated in response to the mother’s blood sugar during pregnancy, continue producing at high levels immediately after birth.

According to clinical literature published through the National Library of Medicine (NLM), neonatal hypoglycemia is one of the most common metabolic complications in newborns of mothers with gestational diabetes. It typically resolves with early feeding and monitoring in the neonatal period.

Long-Term Risk of Type 2 Diabetes and Obesity

Children born in pregnancies complicated by gestational diabetes face a statistically elevated risk of developing obesity and Type 2 diabetes in adolescence and adulthood.

Research published in the journal of Diabetes Care via PubMed Central demonstrates that offspring of GDM pregnancies have higher rates of childhood obesity and impaired glucose tolerance compared to the general population — a risk shaped by both genetic factors and the metabolic environment of the pregnancy itself.

Risk Factors for Gestational Diabetes in Surrogacy

Certain factors raise a woman’s likelihood of developing gestational diabetes during a surrogate pregnancy. Many of these are modifiable — meaning healthy changes made before and during pregnancy can reduce risk meaningfully.

The most well-documented risk factors, per Mayo Clinic’s clinical guidance on gestational diabetes, include:

• Body weight. Carrying excess weight before pregnancy — particularly abdominal fat — is one of the strongest predictors of gestational diabetes risk.
• Prior diagnosis of gestational diabetes. Women who developed gestational diabetes in a previous pregnancy have a substantially higher chance of developing it again.
• Prediabetes. Elevated fasting blood glucose before pregnancy indicates compromised insulin sensitivity that pregnancy hormones can push further.
• Family history of diabetes. A close first-degree relative with Type 2 diabetes raises individual risk.
• Previous large baby. Having delivered a baby over eight pounds in a prior pregnancy is associated with gestational diabetes in subsequent pregnancies.
• Physical inactivity. Sedentary lifestyle reduces insulin sensitivity independent of weight, compounding metabolic risk during pregnancy.

How to Reduce Your Risk Before and During a Surrogate Pregnancy

There is no guaranteed method to prevent gestational diabetes entirely — but the research is consistent that women who enter pregnancy in better metabolic health carry meaningfully lower risk. The steps below are not specific to surrogacy; they reflect standard preventive guidance from the CDC, ACOG, and the ADA for any woman planning a pregnancy.

Prioritize Whole Foods and Reduce Refined Carbohydrates

Diet is the most direct lever for blood glucose management. The ADA recommends a diet built around vegetables, legumes, whole grains, lean proteins, and healthy fats — with attention to portion size and meal timing.

Reducing refined sugars and processed carbohydrates directly reduces postprandial (post-meal) blood glucose spikes, which are the primary driver of gestational diabetes risk.

Build a Consistent Exercise Routine

Regular physical activity improves insulin sensitivity independent of weight loss. ACOG recommends at least 150 minutes of moderate-intensity aerobic activity per week for pregnant women without contraindications — and the same guidance applies in the preparation period before pregnancy.

Walking, swimming, cycling, and prenatal yoga are all appropriate options. The benefits extend to mood, sleep quality, and cardiovascular health throughout a surrogate pregnancy.

Achieve and Maintain a Healthy Weight Before Applying

Body weight before pregnancy is one of the strongest modifiable predictors of gestational diabetes. Losing even a modest percentage of body weight before conception can substantially reduce risk in women who carry excess weight.

This is also relevant to surrogate eligibility — our screening team evaluates Body Mass Index (BMI) as part of the initial medical review.

Monitor Blood Glucose if You Have a Prior History

Women who have had gestational diabetes in a prior pregnancy should discuss baseline glucose testing with their physician before beginning a surrogate journey. Knowing your fasting glucose and hemoglobin A1c (HbA1c) values before screening gives our medical team better data to assess your candidacy — and gives you a clearer picture of your own health going in.

Gestational Diabetes and Surrogate Screening at Physician’s Surrogacy

Our surrogate screening process is designed by practicing OB/GYNs — not by administrative coordinators working from a standard checklist. That distinction matters when it comes to nuanced medical histories like gestational diabetes.

A prior diagnosis of gestational diabetes is not an automatic disqualifier at Physician’s Surrogacy. What our physicians evaluate is the full picture: the severity of the prior episode, whether it was managed effectively, current metabolic health indicators, BMI, and the overall pregnancy history.

A woman who had well-controlled gestational diabetes in a single prior pregnancy and has since maintained a healthy weight and normal glucose levels presents a very different risk profile than one with repeated uncontrolled episodes or current prediabetes.

Our published surrogate eligibility criteria include:

• Age: 20.5 to 40.5 years old.
• BMI: Up to 35. Candidates with a BMI between 35–37 who meet all other criteria are encouraged to reach out — our team can discuss your specific situation and options.
• Prior pregnancy: At least one successful prior pregnancy and delivery.
• Non-smoker: Living in a non-smoking environment.
• No active Type 1 or Type 2 diabetes diagnosis at the time of application.

For questions about prior gestational diabetes specifically, the best path is to apply and let our OB/GYN team review your full medical history. Our physician-designed pre-screening process is built to evaluate individual candidacy — not to apply blunt cutoffs that don’t account for context.

Managing Gestational Diabetes If It Develops During Your Surrogate Pregnancy

If gestational diabetes develops during a surrogate pregnancy, it does not necessarily mean the journey ends. It does mean that management becomes a clinical priority — and that close coordination between the surrogate’s OB/GYN, the fertility clinic, and our medical team becomes even more important.

Standard management approaches, per ACOG clinical guidance, include the following.

Blood Glucose Monitoring

Women with gestational diabetes check their blood glucose at regular intervals throughout the day — typically fasting and one to two hours after each meal. The goal is to keep readings within target ranges recommended by the care team. This requires a glucose meter, test strips, and consistent daily discipline.

Medical Nutrition Therapy

A registered dietitian typically designs a meal plan that distributes carbohydrate intake across the day to prevent spikes. The plan balances adequate nutrition for pregnancy with glucose control. Portion management, food timing, and carbohydrate counting are standard tools in this approach.

Physical Activity

Exercise improves insulin sensitivity and helps the body use glucose more efficiently. Moderate walking after meals, in particular, has strong evidence for lowering postprandial glucose in gestational diabetes. Activity should be cleared with the OB/GYN, particularly in surrogacy where the care team includes multiple parties.

Insulin Therapy or Oral Medication

When diet and exercise alone are insufficient to maintain target glucose ranges, insulin therapy is typically the first-line medical intervention — it does not cross the placenta and has a long safety record in pregnancy. Some oral medications such as metformin are used in certain cases, though ACOG notes that insulin remains the preferred agent for gestational diabetes management during pregnancy.

Foot Care and Neuropathy Prevention

Elevated blood glucose over time can affect nerve function — including in the feet. During pregnancy, daily moisturizing, comfortable footwear, and regular foot inspection help prevent circulation-related complications. While acute neuropathy from gestational diabetes is uncommon in otherwise healthy women, awareness of this risk is part of comprehensive diabetes management.

What to Know Before You Apply

If gestational diabetes is part of your medical history, the most productive step you can take is to gather your records and apply. Our OB/GYN-led screening team reviews individual history — not checkbox outcomes. The same physician oversight that produces our 50%-below-average preterm rate also means your candidacy gets a genuinely clinical evaluation, not a form rejection based on a keyword in your chart.

A prior history of gestational diabetes and surrogacy are not mutually exclusive for every candidate. Your current health, your pregnancy history, your glucose management record, and your overall medical profile all matter. Let our physicians review that picture before drawing any conclusions.

If you’re ready to find out where you stand, submit your surrogate application and our team will be in touch. If you have questions about your specific history before applying, visit our surrogate application help desk — our coordinators can walk you through what to expect from the medical review process.

Frequently Asked Questions About Gestational Diabetes and Surrogacy

Julianna Nikolic

Chief Strategy Officer Julianna Nikolic leads strategic initiatives, focusing on growth, innovation, and patient-centered solutions in the reproductive sciences sector. With 26+ years of management experience and a strong entrepreneurial background, she brings deep expertise to advancing reproductive healthcare.