Gestational diabetes mellitus (GDM) affects approximately 5% of pregnancies in the UK, according to NICE, though prevalence is rising — driven in part by increasing maternal age and obesity rates. The condition, defined as glucose intolerance first recognised during pregnancy, carries risks for both mother and baby if poorly controlled, yet most cases can be managed effectively with lifestyle measures, blood glucose monitoring, and, where necessary, medication.

Community pharmacists play a practical supporting role throughout the gestational diabetes journey — from supplying and explaining blood glucose monitoring equipment, to counselling on metformin and insulin, to providing the dietary and lifestyle guidance that forms the foundation of management. The renewed Women's Health Strategy prioritises better support for women's health during pregnancy, making this a timely area for pharmacy engagement.

Who is at risk?

The NHS Diabetic Eye Screening Programme and NICE guideline NG3 identify several risk factors for GDM:

Women with risk factors are offered an oral glucose tolerance test (OGTT) at 24–28 weeks of pregnancy. Those with previous GDM may be offered testing earlier and/or self-monitoring from booking.

Blood glucose monitoring: the pharmacist's practical domain

Self-monitoring of blood glucose (SMBG) is central to GDM management. Pharmacists may be asked to supply or advise on monitoring equipment, and the consultation provides an opportunity to ensure women understand the practical details:

Target levels (NICE NG3):

• Fasting: below 5.3 mmol/L
• 1 hour post-meal: below 7.8 mmol/L
• 2 hours post-meal: below 6.4 mmol/L (if used instead of 1-hour)

Practical pharmacist advice:

• Test fasting (before breakfast) and 1 hour after each main meal — the diabetes team will confirm the specific schedule
• Wash and dry hands before testing — residual food sugars on fingers can give falsely high readings
• Rotate finger prick sites to avoid soreness
• Use the sides of the fingertips (less sensitive than the pads)
• Record all readings in a diary or app — the diabetes team reviews trends, not individual readings
• Ensure test strips are in date and stored correctly (sealed container, room temperature)

Equipment:

• Most NHS trusts provide a blood glucose meter and initial supply of strips and lancets on diagnosis. Pharmacists may dispense prescriptions for ongoing supplies
• Ensure the meter matches the prescribed strips — incompatible meters and strips is a surprisingly common dispensing issue
• CGM (continuous glucose monitoring) is not routinely offered for GDM in most NHS trusts, though this may evolve

Lifestyle management: what pharmacists can reinforce

Dietary and exercise advice is the first-line management for GDM, with medication added only if targets are not met within 1–2 weeks.

Dietary guidance:

• Eat regular meals — three meals and two to three snacks daily to avoid blood sugar peaks and troughs
• Choose low glycaemic index (GI) carbohydrates — wholegrain bread, basmati rice, oats, pulses — rather than white bread, white rice, or sugary cereals
• Portion control on carbohydrates at each meal (not elimination — carbohydrates are still needed for energy and foetal growth)
• Include protein and healthy fats with each meal to slow glucose absorption
• Limit sugary drinks, fruit juice and confectionery
• Breakfast is often the hardest meal to manage — many women find that porridge with nuts or eggs on wholegrain toast produces better readings than cereal with milk

Exercise:

• 30 minutes of moderate activity after meals (brisk walking is effective and practical) has been shown to reduce post-prandial glucose levels
• Swimming and pregnancy yoga are also appropriate
• Exercise is safe in uncomplicated GDM — reassure women who are nervous about exercising during pregnancy

Medication counselling

Metformin

If lifestyle measures alone do not achieve target glucose levels, metformin is typically the first medication offered (NICE NG3). Pharmacists should advise:

• Start at a low dose (500mg once daily) and increase gradually to reduce GI side effects (nausea, diarrhoea)
• Take with or after food
• Modified-release formulations may be better tolerated than standard-release
• Metformin crosses the placenta, but current evidence does not suggest harm to the baby — reassure patients who are anxious about taking medication during pregnancy

Insulin

If metformin alone is insufficient, or if fasting glucose is significantly elevated at diagnosis, insulin is added or used as first-line. Pharmacists dispensing insulin for GDM should:

• Ensure the woman has received injection technique training from her diabetes team
• Advise on insulin storage (refrigerate unopened, room temperature once in use, discard after 28 days)
• Explain hypoglycaemia recognition and treatment: shakiness, sweating, confusion — treat with fast-acting glucose (glucose tablets, sugary drink)
• Confirm she has been supplied with glucose for treating hypos

Glibenclamide

A second-line option when metformin is not tolerated and insulin is declined. NICE notes that glibenclamide carries a higher risk of macrosomia and neonatal hypoglycaemia compared to insulin.

After delivery

GDM usually resolves after birth, but women who have had GDM carry a significantly elevated lifetime risk of developing type 2 diabetes — estimated at 50% over 10–20 years. Pharmacists can play a role in long-term awareness:

• Women should have a fasting glucose test at 6–13 weeks postnatally (HbA1c is unreliable in the immediate postnatal period)
• Annual HbA1c screening is recommended thereafter
• Maintaining a healthy weight, regular exercise and a balanced diet reduce the risk of progression to type 2 diabetes
• Breastfeeding is associated with reduced risk — another reason to support breastfeeding where possible

Pharmacy as ongoing support

A diagnosis of gestational diabetes can feel overwhelming — particularly for women managing their first pregnancy alongside work, other children, or pre-existing anxiety. The pharmacy counter, visited regularly for monitoring supplies and prescriptions, offers a consistent touchpoint for reassurance and practical advice.

With over 13,000 community pharmacies across England and 1,742 active pharmacy vacancies, the pharmacy workforce supports pregnant women with GDM at every stage — from first blood glucose test to postnatal follow-up.

The Women's Health Strategy envisions a healthcare system that listens to women and supports them through pregnancy and beyond. For gestational diabetes, that support often begins with a pharmacist explaining how to use a blood glucose meter.

Sources

• NICE Guideline NG3: Diabetes in pregnancy — management from preconception to the postnatal period
• Diabetes UK: gestational diabetes patient information
• NICE Clinical Knowledge Summary: Gestational diabetes
• Department of Health and Social Care, Women's Health Strategy renewal (April 2026)
• PharmSee pharmacy and vacancy data, accessed April 2026

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