Addressing Stigma in Gestational Diabetes

touchENDOCRINOLOGY coverage of Diabetes UK 2026

Can you briefly outline your presentation at Diabetes UK and its focus on stigma in gestational diabetes?

The research that we’re doing has a two-fold focus. First, it involves mapping women’s experiences of stigma across a variety of contexts. Stigma can involve labelling, stereotyping and judgment, among other things. It not only manifests through external interactions, in other words, what people say to women that makes them feel stigmatized, but also through an internal dimension.
In the presentation we gave at Diabetes UK, we reported on that phase of the work. We highlighted a number of the different ways women are exposed to stigma and how these experiences can shape their perceptions and experiences of gestational diabetes.

This included experiences of internalized stigma, as well as interactions with health professionals, which may surprise people because assumptions about GDM are often made unintentionally. These assumptions, even when not deliberate, can leave women feeling judged or stigmatized.

We also explored the role of friends and family, where similar forms of stigma can occur.

Beyond this, we looked at the wider societal underpinnings of stigma. Much of this appears to stem from the perception of GDM, similar to type 2 diabetes, as a condition caused by an individual’s personal failings or a lack of self-control, when in reality that is not remotely true.

Some of the anti-stigma messaging we are trying to promote focuses on the fact that gestational diabetes is largely driven by natural hormonal changes in the body during pregnancy, which increase insulin resistance as the pregnancy progresses. There are also genetic and other biological factors that can contribute to the risk. As a result, a significant proportion of women who develop GDM are of normal body weight.

Another important message we are trying to emphasize is that around one in 10 women in the UK develop GDM, so it is a common condition. It is not an individual’s fault, but rather related to hormonal changes during pregnancy, alongside a range of other biological and risk factors that can increase the likelihood of developing GDM.

What are the key ways in which women with gestational diabetes experience stigma during pregnancy and postnatally?

Much of this centers around self-blame and guilt, with women often feeling as though the condition is somehow their fault. Many question whether they are harming their baby or whether they have brought the condition upon themselves. Others may feel they are failing if their glucose levels are not responding as expected during pregnancy. Altogether, this can create a significant amount of psychological pressure and distress for women.

This can have a major impact on women’s ability to fully enjoy and engage with their pregnancy. It can also lead to avoidance behaviours, with some women choosing not to share their GDM diagnosis with others for fear of being judged, or concealing aspects of their experience altogether. Over time, this may also create resistance towards important follow-up care, such as postpartum screening and diabetes prevention initiatives.

For example, some women report feeling singled out during screening because of their body weight or body type. They may also feel judged during blood glucose reviews, particularly if they are questioned about a specific reading. This can lead women to interpret those interactions as criticism, wondering whether they are being blamed for eating something they “shouldn’t” have eaten. As a result, these experiences can become internalized as feelings of failure and guilt.

Similar experiences can also come from friends and family, through comments such as, “Should you be eating that?” or suggestions that the individual has somehow brought the condition upon themselves.

How does stigma impact engagement with care, self-management, and maternal–fetal outcomes?

We have also been exploring the scale of the stigma. We initially began this work through research focused on preventing future type 2 diabetes in this population. However, what we realised was a big impediment was the psychosocial burden associated with these pregnancies. This includes issues such as anxiety and depression, but also a broader sense of trauma linked to the scrutiny and judgment that many women experience during pregnancy.

The big observation was the sheer scale of the stigma experienced by women with GDM. At the Diabetes UK conference, we also presented findings from another study involving a national survey of 1,800 women from across the country, with broad national representation. The survey showed that around 70% of women reported experiencing stigma, including feelings of judgment, shame and guilt, as a consequence of their GDM pregnancy.

We have gained some key insights showing that stigma is multifaceted and comes from lots of different interactions. Women with GDM typically encounter a large number of healthcare professionals during pregnancy, including midwives, diabetes nurses, diabetes specialists, obstetricians, sonographers and others.

One example is comments such as, “Oh my God, that’s a big baby.” From the woman’s perspective, this can prompt concerns about what is really being implied, leading them to question whether they are harming their baby or whether they are somehow responsible for the baby being larger than expected.

We have found that even casual language can cause a lot of damage. Another important observation is that GDM is often diagnosed relatively late in pregnancy, typically between 18 and 25 weeks, meaning women are already around halfway through their pregnancy when they receive the diagnosis. From that point, there’s a lot to be done within a short period of time.

Over the years, we have learned a lot over the years about how to improve pregnancy outcomes, and this often involves very intensive glucose management and monitoring. However, I think we have perhaps lost sight somewhat of the person at the center of all of this. The guidelines and clinical approaches are well considered in terms of improving maternal and infant outcomes, but they do not always fully address how to engage with and support women throughout their pregnancies.

Many women report feeling quite alienated during their pregnancy, as though they have lost control over the experience. GDM pregnancies can become highly medicalised, which can further reinforce the feeling that they have somehow brought themselves into this situation and are personally responsible for it.

Those feelings are often not alleviated during pregnancy, and that is something we need to change, hopefully through the findings and insights generated by this study.

What steps can clinicians and healthcare systems take to reduce stigma and improve the experience of women with gestational diabetes?

I think there are lots of things that clinicians can do to help turn this around. Primarily, it is important to listen to women and talk to them as individuals, rather than immediately focusing solely on blood glucose levels and questioning why certain readings may have occurred. Instead, clinicians should begin by asking women how they are feeling and how they are coping, paying greater attention to the emotional aspects of the experience.

This is a significant and often overwhelming experience for many women, and each person’s situation is unique.

The language used when explaining gestational diabetes and screening is also important. For example, when discussing why someone is being screened for GDM, clinicians should be mindful not to frame this purely in terms of body weight. Screening takes place for a range of different reasons, and the way these conversations are handled can have a meaningful impact on how women perceive themselves and their pregnancy experience.

We are looking at a number of known risk factors. For example, as body weight increases, the risk of developing GDM can also increase. However, it is about how these conversations are framed. Rephrasing the language can help soften the sense of judgment that women may otherwise feel.

Similarly, when discussing blood glucose levels and possible reasons for readings outside the target range, it is important we do not go down the inquisition route. Instead, clinicians can ask women how they feel their glucose management is going, whether there is anything they need support with, or whether there is anything they would like help understanding.
This allows the conversation to be driven more by the woman’s experience and less by the blood glucose results. Taking this approach can help reduce situations where women feel judged, blamed or disempowered.

A big no-no is telling women things such as, “If we don’t get your sugar levels down, you’ll need to move on to metformin or insulin.” Statements like this can be perceived as a threat and can make women feel as though medication is a punishment or a sign that they have somehow failed. Some women even describe themselves as being “one step off the naughty step” when insulin is discussed.

Instead, these conversations should be framed in a more supportive and reassuring way. For example, clinicians can explain that it is normal for some women to need medication during pregnancy because hormonal changes naturally increase insulin resistance as the pregnancy progresses. In this context, medication is simply an additional form of support to help manage glucose levels.
It is also important to normalize treatment escalation by explaining that around two-thirds of women with GDM will require an oral medication such as metformin during pregnancy, while around one-third will also need insulin. Women should be reassured that they are not alone if they need medication, rather than being told, “If things don’t improve, we’ll have to move you onto medication.” Simple changes in language and communication can make a significant difference from a clinical perspective.

Another important area is birth choices and engagement in decision-making. While pregnancies affected by GDM may be considered higher risk, and they certainly do bring certain risks in terms of if there are concerns about a large-for-gestational-age baby, it is essential that healthcare professionals clearly explain these risks and involve women in discussions about their birth options. Women should be given as much choice and control as possible over their pregnancy and delivery decisions.

Rather than simply telling women, “We’re going to induce you on this date,” or “We’re going to schedule an elective caesarean,” clinicians should ensure these decisions are discussed collaboratively and sensitively. Experiences where women feel excluded from decision-making can have a profound emotional impact, leaving some feeling traumatized or as though they have lost all sense of agency during their pregnancy.

I think it is really important that, however concerned clinicians may be about the safety of delivery, women are engaged in the decision-making process as much as possible and given as much control over their pregnancies as possible while obviously maintaining a safe pregnancy.

Postnatally, it is also important that we do allow space and time for women to process some of the emotional burden associated with a GDM pregnancy. If that emotional impact is not addressed, it can persist and potentially lead to disengagement from important follow-up care, including postpartum screening and diabetes prevention support. At present, uptake of programmes such as the National Diabetes Prevention Programme among women who have experienced GDM is incredibly small, with fewer than 10% participating.