We are continuing in our series on how Insulin Resistance impacts the different reproductive stages from fertility, through pregnancy and postpartum, and into perimenopause and menopause. This blog is focusing on pregnancy and postpartum, and how mild insulin resistance is a physiological process in pregnancy, as well as the negative effects when the body doesn’t adapt properly to this change, and how you can support your body with this information. If you are beginning your fertility and pregnancy journey, you can read our last blog which focuses on how insulin resistance impacts fertility.
Insulin Resistance – an Overview
I want to begin with a brief overview of what insulin resistance is, but a more in depth analysis can be found in our last blog. Insulin resistance is a state in which cells have become desensitized to insulin. The pancreas is overproducing insulin in response to the elevated glucose levels in the blood, but the cells become resistant and unresponsive. This means your cells aren’t registering it and the insulin can’t bind to the cells, causing an inability to maintain glucose and insulin balance and functioning in the body. Insulin resistance disrupts your metabolism in a few ways, inflammation, impaired glucose metabolism, disrupts ovulation, and blood sugar regulation and uptake. This excess glucose drives production of visceral abdominal tissue- a specific kind of tissue that operates around the organs and creates a large amount of inflammatory chemicals and confusion in hormonal cross talk and hormonal signaling.
Natural Insulin Resistance in the 2nd and 3rd Trimester
Metabolic changes are natural and physiologically normal with pregnancy, and even with the healthiest pregnancies, women will experience some level insulin resistance for baby’s growth and development. Pregnant women require more energy with an increase in metabolic demand, and a growing fetus requires more glucose, so insulin resistance is a “physiological adaptation of the mother to ensure adequate carbohydrate supply for the rapidly growing fetus (Journal of Clinical and Diagnostic Research, 2014.).”
Gestational Diabetes
Gestational Diabetes (GDM) affects 5-9% of all US pregnancies annually. During pregnancy, the body becomes more insulin resistant to send ample nutrients to the baby. The pancreas typically increases insulin output to compensate. With GDM, the body cannot keep up with this demand, leading to elevated blood sugar. As mentioned before, all women experience insulin resistance to some degree in the later part of their pregnancy. However, if you have insulin resistance before becoming pregnant, it can increase your chances of developing gestational diabetes. Other risk factors are PMOS or a history of insulin resistance, a history of stillbirth, a previous pregnancy with GDM, being over 25 years of age, a family history of type 2 diabetes, and beginning pregnancy at a higher weight. Gestational Diabetes typically develops around mid pregnancy, and testing is often done between weeks 25 and 28. While a GDM diagnosis can feel overwhelming, diet and lifestyle changes can often help manage blood sugar levels and improve maternal and neonatal outcomes. A few key strategies for supporting blood sugar levels include prioritizing protein, moderating carbohydrates and sugars, daily movement, nutritional support and adding supplements such as inositol, magnesium, Vitamin D, and electrolytes. Some women find that diet and lifestyle alone are not enough to bring fasting and post-prandial (after meal) numbers back in range and ultimately leading to the need for insulin in pregnancy. This is not a personal failure in any way to need insulin. Everyone’s body will respond differently and sometimes medication is necessary to keep blood sugar levels in the healthy range.
Insulin Resistance Postpartum
Tracking insulin resistance postpartum is also essential, especially for those with GDM. A few reasons insulin resistance can persist into the postpartum stage include hormonal changes after delivery (plummeting levels of estrogen and progesterone and stress hormones like cortisol), the stress of caring for a newborn, sleep deprivation, breastfeeding, anxiety and depression, adjustments in physical activity, and the other lifestyle factors that naturally change when a new baby enters your life.
Insulin resistance can show up as fatigue, mood disruptions, brain fog, weight retention, appetite changes, and low milk supply, but it can also persist without symptoms. These symptoms by no means indicate insulin resistance, because so many of the above symptoms are synonymous with new motherhood and the lack of sleep and time to care for yourself. Regularly monitoring your blood sugar is important for early intervention for your long-term health. If left unaddressed, insulin resistance in the postpartum period can increase the risk of type 2 diabetes, this is particularly true for those with a diagnosis of gestational diabetes. It also carries risks related to cardiovascular disease, fertility issues, fatty liver disease, and metabolic syndrome. It is essential your OBGYN or midwife follow up with an oral glucose tolerance test (OGTT) postpartum if you experienced GDM in pregnancy.
The good news is that insulin resistance is often corrected after baby is born in those unaffected by GDM. Continuing to focus on a blood-sugar friendly diet (whole foods, fiber, protein, healthy fats, complex carbohydrates, and reducing ultra processed foods), taking supplements if necessary (inositol, vitamin D, magnesium, electrolytes, and omega 3’s), stress management and gentle movement as your body is ready are all great strategies to address this physiological shift of insulin resistance in pregnancy and support your body in this beautiful and tender phase.
I hope this offers helpful information and tools for you. If you are beginning your fertility journey or are pregnant and seeking support, I would be happy to support you. As we discussed today, insulin resistance goes beyond pregnancy into the postpartum phase, but it also impacts perimenopause and menopause, which we will talk about next month. As I shared in last month’s blog, insulin resistance impacts all ages and reproductive stages, so if you are experiencing insulin resistance please know you are not alone and there is a lot of information and supportive tools to help you regardless of your stage of life. I look forward to sharing more with you next month when we focus on Insulin Resistance for Perimenopause and Menopause!
References:
Normal Pregnancy – A State of Insulin Resistance from the Journal of Clinical and Diagnostic Research, 2014.
Understanding Insulin Resistance in Postpartum Women: Causes, Symptoms & What You Can Do About It from Postpartum Care USA, 2025.
Expecting the Unexpected: The Impact of Insulin Resistance On Pregnancy from Rupa Health, 2025.
Nichols, L. Real Food for Pregnancy. 2018.
HAPO Study Cooperative Research Group. “The hyperglycemia and adverse pregnancy outcome (HAPO) study.” International Journal of Gynecology & Obstetrics 78.1 (2002): 69-77.
Zhang, Cuilin, Shristi Rawal, and Yap Seng Chong. “Risk factors for gestational diabetes: is prevention possible?.” Diabetologia 59.7 (2016): 1385-1390.
Chan, Kwan Yi, et al. “Dietary supplementation for gestational diabetes prevention and management: a meta-analysis of randomized controlled trials.” Archives of Gynecology and Obstetrics 303.6 (2021): 1381-1391.