An Open Letter to Gestational Diabetes, Written by a Perinatal Psychotherapist who had Gestational Diabetes twice

By Elle Murphy, MSW, LSW, PMH-C

As a perinatal psychotherapist and someone who has navigated two pregnancies with gestational diabetes myself, this is an open letter to the gaps I have personally experienced in care, and what I want more of.

Pregnancy comes with goalposts: the first positive test, the heartbeat, the anatomy scan, viability week. You celebrate each one while holding your breath for the next. The gestational diabetes test is another goalpost we all hope to pass. When the diagnosis lands, the appointments multiply, the instructions pile up, and something quieter happens too, something almost no one asks about.

The Diagnosis Lands Hard

Gestational diabetes affects roughly 6 to 9% of pregnancies in the United States, with rates considerably higher among Black, Latina, Indigenous, and South and East Asian birthing people. (1) For many, it arrives without warning in the second trimester, during a time when pregnancy is supposed to finally feel manageable.

"I thought I did something wrong. I thought I hurt my baby. I kept Googling and couldn't stop."

The emotional response to a GD diagnosis is not trivial. Research consistently documents elevated rates of anxiety, depression, and pregnancy-specific stress in people with gestational diabetes, and yet the standard of care rarely includes a warm handoff to mental health support. (2) Nutrition counseling? Yes. Endocrinology referrals? Often. A therapist or social worker? Almost never. This is a significant gap.

The Psychological Burden Is Real

Managing gestational diabetes is an around-the-clock cognitive and emotional task. Every carbohydrate is tracked. Dietary advice conflicts. Well-meaning family members weigh in. Every appointment is entered braced for bad news. The mental load is enormous, and it happens inside a body that is also growing a human, also sleep-deprived, also hormonally in flux.

For people who already carried guilt or self-blame into the pregnancy, especially those experience health struggles feeling like as personal failure, the diagnosis can feel like confirmation of their worst fears about themselves. For those with health anxiety, continuous glucose monitoring can become a compulsive loop. None of this is typically screened for. No one asks.

GD Management and Disordered Eating

This deserves its own conversation, because it comes up more than people realize and is almost never addressed in standard GD care.

Gestational diabetes management is, at its core, a set of instructions about food: what to eat, how much, when, in what combination, and with what measurable outcome. For someone with a history of disordered eating, whether restriction, bingeing, orthorexia, or chronic dieting, the GD dietary protocol can land like a detonator.

Carbohydrate counting, portioning, logging, and monitoring the body's response to every meal mirror, almost precisely, the cognitive patterns that drive restrictive eating disorders. When a dietitian hands someone a carb limit and a tracking sheet, they are providing medically necessary tools. But for a person who has spent years in a rule-based relationship with food, those same tools can reactivate thought patterns they may have worked hard to move beyond.

People may restrict beyond what their care team recommended because the permission to limit food felt like relief. Post-meal glucose numbers become verdicts. Others respond to the rigidity with cycles of resistance and rebellion that are exhausting and can entrench disordered patterns that outlast the pregnancy. Providers celebrate low numbers, but no one is checking whether the path to those numbers is healthy.

For people in recovery from eating disorders who receive a GD diagnosis: your care team needs to know your history. GD management without that context can put your recovery at serious risk, and there are providers who know how to hold both realities at once. You deserve that level of care.

The Screening Problem

Perinatal mood and anxiety disorders affect up to 1 in 7 birthing people, and medical complexity during pregnancy substantially raises that risk. The evidence linking GD to heightened rates of depression and anxiety is robust and has been for years. And yet the Edinburgh Postnatal Depression Scale and PHQ-9 are not systematically integrated into the visits where GD is managed. When screening does happen, it is often a checkbox on an intake form, not a conversation.

We are very good, as a healthcare system, at monitoring hemoglobin A1C. We are far less good at asking: How are you actually doing with all of this?

What Better Care Could Look Like

Routine mental health screening at GD diagnosis: not just at the six-week postpartum visit, but at the point of highest acute stress, when there is still time to intervene during the pregnancy itself.

Warm referrals to perinatal mental health specialists: A printed list of resources is not a referral; it is a barrier. A brief personal introduction to a social worker or counselor meaningfully changes the likelihood that someone will actually reach out.

Psychoeducation about emotional responses: Even a few minutes from a provider normalizing the anxiety, grief, and overwhelm that often accompany a GD diagnosis can shift a person's experience. It tells them: this is a normal response to a hard situation. You have not failed.

Training for endocrinologists, dietitians, and MFM specialists: PMAD literacy, brief screening competency, and clear referral pathways will all provide a more holistic form of care for patients. 

Your Feelings Are Valid 

The way you feel right now makes complete sense. Feeling scared does not mean you are incapable of managing this. Feeling angry does not mean you are ungrateful for your pregnancy. Feeling overwhelmed does not mean you are failing your baby. It means you are a human being dealing with something genuinely hard, in a body and a system that is asking a great deal of you.

You deserve more than blood sugar targets and dietary restrictions. You deserve someone asking how you are.

If you are struggling emotionally, with anxiety, sadness, intrusive thoughts, or a heaviness you cannot shake, please reach out to a perinatal mental health provider. You do not have to wait until things feel unbearable. You can ask for support now.

Colle, L., Hilviu, D., Boggio, M., Toso, A., Longo, P., Abbate-Daga, G., Garbarini, F., & Fossataro, C. (2023). Abnormal sense of agency in eating disorders. Scientific reports, 13(1), 14176. https://doi.org/10.1038/s41598-023-41345-5

2: Fischer, S., & Morales-Suárez-Varela, M. (2023). The Bidirectional Relationship between Gestational Diabetes and Depression in Pregnant Women: A Systematic Search and Review. Healthcare (Basel, Switzerland), 11(3), 404. https://doi.org/10.3390/healthcare11030404

1: Hedderson, M. M., Darbinian, J. A., & Ferrara, A. (2010). Disparities in the risk of gestational diabetes by race-ethnicity and country of birth. Pediatric and perinatal epidemiology, 24(5), 441–448. https://doi.org/10.1111/j.1365-3016.2010.01140.x

Majeed, N. G., Mohammed, P. A., Abdullah, S. H., Ahmad, S. M., Khdir, R. H., Abdul Aziz, J. M., & Abdullah, L. (2025). Prevalence of gestational diabetes and associated risk factors among pregnant women. Annals of medicine and surgery (2012), 87(10), 6340–6345. https://doi.org/10.1097/MS9.0000000000003837