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The primary risk factor associated with gestational diabetes is hormonal changes during pregnancy. During pregnancy, the body goes through significant hormonal shifts, including increases in hormones such as estrogen, progesterone, and human placental lactogen. These hormonal changes can lead to insulin resistance, making it more challenging for the body to regulate blood glucose levels effectively.

As a result, some women may experience higher blood sugar levels that can develop into gestational diabetes. This condition occurs typically in the second or third trimester when the placenta is fully formed and producing these hormones in larger quantities. While other risk factors like insufficient exercise, genetic predisposition, and age over 30 may contribute to an individual's overall risk, the hormonal changes specific to pregnancy are the most direct and significant factor leading to the onset of gestational diabetes.