Intended for healthcare professionals

Practice Rational Testing

Screening and diagnosis of gestational diabetes

BMJ 2023; 381 doi: (Published 02 May 2023) Cite this as: BMJ 2023;381:e071920
  1. S L White, clinician scientist12,
  2. G Ayman, JLA PSP diabetes and pregnancy co-lead3,
  3. C Bakhai, general practitioner45,
  4. T A Hillier, distinguished investigator67,
  5. L A Magee, professor of women’s health1
  1. 1Department of Women and Children’s Health, King’s College London, London SE1 7EH, UK
  2. 2Department of Diabetes and Endocrinology, Guy’s and St Thomas’ Hospitals NHS Foundation Trust, London, SE1 7EH, UK
  3. 3Nuffield Department of Population Health, University of Oxford, Headington, Oxford OX3 7LF, UK
  4. 4Larkside Practice, Luton LU2 9SB, UK
  5. 5Bedfordshire, Luton and Milton Keynes Integrated Care Board, Luton LU1 2LJ, UK
  6. 6Center for Health Research, Kaiser Permanente Northwest, Portland, OR 97227, USA
  7. 7Center for Integrated Health Care Research, Kaiser Permanente Hawaii, Honolulu, HI 96817, USA
  1. Correspondence to: S L White sara.white{at}

What you need to know

  • Gestational diabetes may affect up to 30% of pregnancies, depending on the population, screening strategy and diagnostic criteria

  • Screening and diagnosis, with subsequent treatment of gestational diabetes after 24 weeks’ gestation, reduces maternal, fetal, and newborn complications

  • In the absence of international consensus, offer screening and diagnosis using local hospital, national, or international guidelines, taking into account available resources

  • Women who have experienced gestational diabetes are at higher risk of developing type 2 diabetes and are therefore a key group for targeted diabetes prevention support

A 32 year old woman books with her midwife at 8 weeks’ gestation. It is her first pregnancy. She is living with obesity, has South Asian ethnicity, and her father developed type 2 diabetes in his 60s. Her sister in the US and her cousin in India have recently been diagnosed with gestational diabetes using different diagnostic approaches. She asks why testing differs and what she should expect regarding testing for gestational diabetes.

Gestational diabetes is hyperglycaemia that develops during pregnancy and usually resolves after birth.1 It is rising in prevalence, with current estimates ranging widely from 1% to 30% of pregnancies, depending on screening approach, diagnostic criteria, and the population concerned,2 and it now complicates more than 20 million livebirths globally.3 Antenatal management of gestational diabetes includes regular glucose monitoring, education about behavioural modification (including diet and physical activity), and, if necessary, glucose lowering medication.45

What is the next investigation?

Because of a lack of local, national, and international consensus, the next investigation depends on the individual care provider and the applicable guidelines, as shown in table 1. There are three “key tests” that may be used alone or in combination for the screening and diagnosis of gestational diabetes: risk factors by clinical history to determine need for testing, glucose challenge test, and …

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