Epidemiology and management of gestational diabetes
Open accessAbstract
Gestational diabetes is defined as hyperglycaemia first detected during pregnancy at glucose concentrations that are less than those of overt diabetes. Around 14% of pregnancies globally are affected by gestational diabetes; its prevalence varies with differences in risk factors and approaches to screening and diagnosis; and it is increasing in parallel with obesity and type 2 diabetes. Gestational diabetes direct costs are US$1·6 billion in the USA alone, largely due to complications including hypertensive disorders, preterm delivery, and neonatal metabolic and respiratory consequences. Between 30% and 70% of gestational diabetes is diagnosed in early pregnancy (ie, early gestational diabetes defined by hyperglycaemia before 20 weeks of gestation). Early gestational diabetes is associated with worse pregnancy outcomes compared with women diagnosed with late gestational diabetes (hyperglycaemia from 24 weeks to 28 weeks of gestation). Randomised controlled trials show benefits of treating gestational diabetes from 24 weeks to 28 weeks of gestation. The WHO 2013 recommendations for diagnosing gestational diabetes (one-step 75 gm 2-h oral glucose tolerance test at 24-28 weeks of gestation) are largely based on the Hyperglycemia and Adverse Pregnancy Outcomes Study, which confirmed the linear association between pregnancy complications and late-pregnancy maternal glycaemia: a phenomenon that has now also been shown in early pregnancy. Recently, the Treatment of Booking Gestational Diabetes Mellitus (TOBOGM) trial showed benefit in diagnosis and treatment of early gestational diabetes for women with risk factors. Given the diabesity epidemic, evidence for gestational diabetes heterogeneity by timing and subtype, and advances in technology, a life course precision medicine approach is urgently needed, using evidence-based prevention, diagnostic, and treatment strategies.
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A range of socio-demographic, obstetric and metabolic factors have been identified as contributing to the risk of GDM, including age, body mass index (BMI) and ethnicity.
“A range of socio‐demographic, obstetric and metabolic factors have been identified as contributing to the risk of GDM, including age, body mass index (BMI) and ethnicity [3, 4].”
From Preconception Perceptions, Knowledge and Behaviours of Women With Gestational Diabetes Mellitus: A Qualitative Study (2026) · cites this paper as [4]
GDM risk is driven by multiple interacting factors, including age, prior GDM, family history, ethnicity and conditions such as polycystic ovary syndrome (PCOS), beyond adiposity.
“Beyond adiposity, GDM risk is influenced by age, prior GDM, family history, ethnicity [39] and conditions such as polycystic ovary syndrome (PCOS) [4, 40].”
From Preconception Perceptions, Knowledge and Behaviours of Women With Gestational Diabetes Mellitus: A Qualitative Study (2026) · cites this paper as [4]
The findings highlight the complexity of behaviour change in the preconception period.
“Although this study did not set out to assess the effectiveness of women's health behaviours in the preconception period, the findings highlight the complexity of behaviour change in the preconception period [4, 40].”
From Preconception Perceptions, Knowledge and Behaviours of Women With Gestational Diabetes Mellitus: A Qualitative Study (2026) · cites this paper as [4]
Hyperglycaemia in pregnancy increases the risk of adverse pregnancy outcomes (such as preeclampsia, higher infant birth weight and obstetric intervention) and neonatal complications (such as hypoglycaemia, respiratory distress and jaundice).
“Hyperglycaemia in pregnancy, including gestational diabetes mellitus, overt DIP and pre‐existing diabetes (detected before pregnancy), 1 increases the risk of adverse pregnancy outcomes (such as preeclampsia, higher infant birth weight and obstetric intervention) and neonatal complications (such as hypoglycaemia, respiratory distress and jaundice). 2 , 3”
Having consistent criteria across pregnancy was a key priority for stakeholders.
“having consistent criteria across pregnancy was a key priority for stakeholders. 20 , 21 , 22”
The recommended approach to screening and diagnosis of gestational diabetes mellitus is based on known associations between all POGTT glucose measures and adverse outcomes.
“known associations between all POGTT glucose measures and adverse outcomes, 2 , 3”
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Pukkila, J., Mustaniemi, S., Lingaiah, S., Lappalainen, O.-P., Kajantie, E., Pouta, A. M., Kaaja, R., Eriksson, J. G., Laivuori, H. M., Gissler, M., et al. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph191710711 · Cited by 5 · see citing works
Disease Perception and Mental Health in Pregnancies with Gestational Diabetes—PsychDiab Pilot Study
Rieß, C., Heimann, Y., Schleußner, E., et al. (2023) · Journal of Clinical Medicine · doi:10.3390/jcm12103358 · Cited by 5 · see citing works
Zhu, Y., Wang, H., Ma, R., Zhang, L., Wang, Y., Zhang, Y., Shao, Z., Zhu, D., & Zhu, P. (2023) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/clinem/dgad446 · Cited by 5 · see citing works
Koefoed, A. S., McIntyre, D. H., GIBBONS, K. S., et al. (2023) · Reproductive Medicine · doi:10.3390/reprodmed4030014 · Cited by 4 · see citing works
Ganie, M. A., Krishnamurthy, A., Salem, M., et al. (2020) · International Journal of Gynecology & Obstetrics · doi:10.1002/ijgo.13103 · Cited by 3 · see citing works
35: Early treatment of women with prediabetes in pregnancy: a randomized controlled trial
Osmundson, S. S., Norton, M. E., El-Sayed, Y. Y., Faig, J., Carter, S., & Kitzmiller, J. L. (2014) · American Journal of Obstetrics and Gynecology · doi:10.1016/j.ajog.2014.10.081 · Cited by 2 · see citing works
Flagged first, then by citations
Research works printed but not linked: 3
- Gupta Y, Simmons D. Can HbA1c have a crucial role in gestational diabetes? Lancet Diabetes Endocrinol (in press).
- Saravanan P, Deepa M, Ahmed Z, et al. Early pregnancy HbA1c as the first screening test for gestational diabetes: a prospective cohort study. Lancet Diabetes Endocrinol (in press).
- Burk J, Ross GP, Hernandez T, Colagiuri S, Sweeting A. Continuous glucose monitoring improves perinatal outcomes in women with diabetes in pregnancy: a systematic review. The 17th International Conference on Advanced Technologies & Treatments for Diabetes; March 6–9, 2024 (abstr).
Cited by
Sorted by citations
Pathophysiology from preconception, during pregnancy, and beyond.
Hivert, M.-F., Backman, H., Benhalima, K., Catalano, P., Desoye, G., Immanuel, J., McKinlay, C. J. D., Meek, C. L., Nolan, C. J., Ram, U., et al. (2024) · The Lancet · doi:10.1016/s0140-6736(24)00827-4 · Cited by 186 · see citing works
Self-citationSweeting, A., Hare, M. J., de Jersey, S. J., Shub, A. L., Zinga, J., Foged, C., Hall, R. M., Wong, T., & Simmons, D. (2025) · Medical Journal of Australia · doi:10.5694/mja2.52696 · Cited by 26 · see citing works
Self-citationPayne, E., Schoenaker, D., Turner, K., Murphy, H. R., Skouteris, H., Ismail, K., Silverio, S. A., & Benton, M. (2026) · Health Expectations · doi:10.1111/hex.70617 · Cited by 4 · see citing works
Diagnosis of gestational diabetes: Evidence and pitfalls
Wong, T., Immanuel, J., Wong, V. W., Barnes, R., & Simmons, D. (2025) · Best Practice & Research Clinical Endocrinology & Metabolism · doi:10.1016/j.beem.2025.102069 · Cited by 4 · see citing works
Self-citationRisk Factors and Prevention Strategies for Gestational Diabetes in Asian Populations
Pan, S.-Y., Huang, C.-J., & Cheng, H.-M. (2024) · JACC: Asia · doi:10.1016/j.jacasi.2024.08.013 · Cited by 2 · see citing works
- Authors
- Sweeting, A., Hannah, W., Backman, H., Catalano, P., Feghali, M., Herman, W. H., Hivert, M.-F., Immanuel, J., Meek, C., Oppermann, M. L., Nolan, C. J., Ram, U., Schmidt, M. I., Simmons, D., Chivese, T., & Benhalima, K.
- Affiliations
- The University of Sydney (AU)
- Madras Diabetes Research Foundation (IN)
- Tufts University (US)
- University of Pittsburgh (US)
- University of Michigan (US)
- Harvard University (US)
- Texas Woman's University (US)
- Leicester General Hospital (GB)
- Universidade Federal do Rio Grande do Sul (BR)
- Australian National University (AU)
- Seethapathy Clinic and Hospital (IN)
- Western Sydney University (AU)
- Qatar University (QA)
- KU Leuven (BE)
- Corresponding author
- Simmons, David
- ORCID
- Venue
- The Lancet
- Publisher
- Elsevier BV
- Published
- 2024-07
- Volume
- 404
- Issue
- 10448
- Pages
- 175-192
- ISSN
- 0099-5355 (ISSN-L)
- 0140-6736
- OpenAlex
- W4399840978
- Semantic Scholar
- 111ad670aac165a91f8d9e3d7b7823e0527738bc
- Cited by
- 431
- References
- 192
- Citations by year
- 2026: 192 · 2025: 205 · 2024: 34
- FWCI
- 203.51
- Type
- journal article
- Language
- en
- Open access
- green
- lirias.kuleuven.be
- Licence
- Locations
- The Lancet (publishedVersion)
- PubMed (publishedVersion)
- Lirias (acceptedVersion, other-oa)
- Figshare (submittedVersion, cc-by)
- ANU Open Research (Australian National University) (submittedVersion)
- Qatar University QSpace (Qatar University) (submittedVersion)
- 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 › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Keywords
- gestational diabetes mellitus, gestational diabetes screening, oral glucose tolerance test, pregnancy complications, hypertensive disorders of pregnancy, preterm birth, neonatal outcomes, treatment timing, diabesity, type 2 diabetes, precision medicine
- MeSH terms
- Female, Glucose Tolerance Test, Humans, Hypoglycemic Agents, Pregnancy, Pregnancy Outcome, Risk Factors, Prevalence, Diabetes, Gestational
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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