Early Screening and Diagnosis of Gestational Diabetes Mellitus (GDM) and Its Impact on Perinatal Outcomes
Abstract
Aims To compare the maternal and neonatal outcomes following early diagnosis compared with routine diagnosis of gestational diabetes (GDM). Methods In this observational study, 3494 women were categorised by weeks of gestation at GDM diagnosis: early GDM (≤20 weeks) and routine GDM (>20 weeks). The early GDM group was further divided by treatment commencement as immediate (<12 weeks) and delayed (12-20 weeks) and by diagnostic fasting blood glucose as higher-FBG (5.3-6.0 mmol/L) and lower-FBG group (FBG 5.1-5.2 mmol/L). Primary outcomes were large for gestational age (LGA) and small for gestational age (SGA). Generalized linear models used to calculate risk ratios and adjusted for confounding. Results Risk ratios (RR) for LGA and SGA were similar for early versus routine diagnosis, and immediate versus delayed treatment. The higher-FBG immediate treatment group had a lower risk of newborn respiratory distress (RR 0.52, 95 %CI 0.34, 0.81) and emergency caesarean (RR 0.55, 95 %CI 0.34, 0.88) compared to the higher-FBG delayed treatment group. Among the lower-FBG group, no such benefits were seen. Conclusions Fasting glucose levels modified the effects of early treatment of GDM where a higher-FBG with immediate treatment appears to reduce perinatal complications, but treating women with lower-FBG early has no benefits.
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The temporal pattern of increasing insulin resistance provides the physiological rationale for screening for GDM at 24-28 weeks' gestation.
“The temporal pattern of increasing insulin resistance provides the physiological rationale for screening for GDM at 24–28 weeks’ gestation, when metabolic derangement is most pronounced and diagnostic sensitivity is optimized [31,37,38,39,40].”
From Maternal Overnutrition and Fetal Programming: Long-Term Metabolic, Cognitive, and Epigenetic Consequences (2026) · cites this paper as [40]
In late gestation, insulin sensitivity is reduced by 40-80% in gravidae with normal or elevated body mass index.
“Evidence from late-gestation studies demonstrates that insulin sensitivity is reduced by 40–80% in gravidae with normal or elevated body mass index.”
From Maternal Overnutrition and Fetal Programming: Long-Term Metabolic, Cognitive, and Epigenetic Consequences (2026) · cites this paper as [40]
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- Authors
- Bastian, B., Smithers, L. G., Pape, A., Davis, W., Fu, K., & Francois, M.
- Affiliations
- University of Wollongong (AU)
- Illawarra Shoalhaven Local Health District (AU)
- Corresponding author
- Bastian, Beenu
- Smithers, Lisa Gaye
- Pape, Alexia
- Davis, Warren
- Fu, K.
- Venue
- Diabetes Research and Clinical Practice
- Publisher
- Elsevier BV
- Published
- 2024-11
- Volume
- 217
- Pages
- 111890
- ISSN
- 0168-8227 (ISSN-L)
- OpenAlex
- W4403561132
- Cited by
- 18
- References
- 23
- Citations by year
- 2026: 10 · 2025: 8
- FWCI
- 8.72
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- Locations
- Diabetes Research and Clinical Practice (publishedVersion)
- PubMed (publishedVersion)
- Adelaide Research & Scholarship (AR&S) (University of Adelaide) (submittedVersion)
- Funders
- Illawarra Health and Medical Research Institute (R5761)
- National Health and Medical Research Council (APP1177234)
- Illawarra Shoalhaven Local Health District
- Topics
- Health Sciences › Medicine › Obstetrics and Gynecology › Gestational Diabetes Research and Management
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Health Professions › General Health Professions › Maternal and Neonatal Healthcare
- Keywords
- gestational diabetes mellitus, early diagnosis, fasting blood glucose, treatment timing, large for gestational age, small for gestational age, neonatal respiratory distress, emergency cesarean section, perinatal outcomes
- MeSH terms
- Adult, Blood Glucose, Female, Fetal Macrosomia, Gestational Age, Humans, Infant, Newborn, Infant, Small for Gestational Age, Pregnancy, Pregnancy Outcome, Prenatal Diagnosis, Diabetes, Gestational, Early Diagnosis
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