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Cited by 26Gestational Diabetes Research and ManagementDiabetes Management and ResearchDiabetes, Cardiovascular Risks, and Lipoproteins

Australasian Diabetes in Pregnancy Society ( ADIPS ) 2025 consensus recommendations for the screening, diagnosis and classification of gestational diabetes

Open access
Sweeting, Arianne, Hare, Matthew JL, de Jersey, Susan J, Shub, Alexis L, Zinga, Julia, Foged, Cecily, Hall, Rosemary M, Wong, Tang +1 more·2025·Medical Journal of Australia
DOI 10.5694/mja2.52696PMC PMC12318493
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Abstract

Introduction: In the context of a global obesity and diabetes epidemic, gestational diabetes mellitus and other forms of hyperglycaemia in pregnancy are increasingly common. Hyperglycaemia in pregnancy is associated with short and long term complications for both the woman and her baby. These 2025 consensus recommendations from the Australasian Diabetes in Pregnancy Society (ADIPS) update the guidance for the screening, diagnosis and classification of hyperglycaemia in pregnancy based on available evidence and stakeholder consultation. Main recommendations: Overt diabetes in pregnancy (overt DIP) should be diagnosed at any time in pregnancy if one or more of the following criteria are met: (i) fasting plasma glucose (FPG) ≥ 7.0 mmol/L; (ii) two‐hour plasma glucose (2hPG) ≥ 11.1 mmol/L following a 75 g two‐hour pregnancy oral glucose tolerance test (POGTT); and/or (iii) glycated haemoglobin (HbA 1c ) ≥ 6.5% (≥ 48 mmol/mol). Irrespective of gestation, gestational diabetes mellitus should be diagnosed using one or more of the following criteria during a 75 g two‐hour POGTT: (i) FPG ≥ 5.3–6.9 mmol/L; (ii) one‐hour plasma glucose (1hPG) ≥ 10.6 mmol/L; (iii) 2hPG ≥ 9.0–11.0 mmol/L. Women with risk factors for hyperglycaemia in pregnancy should be advised to have the HbA 1c measured in the first trimester. Women with HbA 1c ≥ 6.5% (≥ 48 mmol/mol) should be diagnosed and managed as having overt DIP. Before 20 weeks’ gestation, and ideally between ten and 14 weeks’ gestation, if tolerated, women with a previous history of gestational diabetes mellitus or early pregnancy HbA 1c ≥ 6.0‐6.4% (≥ 42–47 mmol/mol), but without diagnosed diabetes, should be advised to undergo a 75 g two‐hour POGTT. All women (without diabetes already detected in the current pregnancy) should be advised to undergo a 75 g two‐hour POGTT at 24–28 weeks’ gestation. Changes in management as a result from this consensus statement: These updated recommendations raise the diagnostic glucose thresholds for gestational diabetes mellitus and clarify approaches to early pregnancy screening for women with risk factors for hyperglycaemia in pregnancy.

AI snapshot

Written from the paper’s full text.

TL;DR

The 2025 ADIPS consensus recommendations update the screening, diagnosis and classification of hyperglycaemia in pregnancy, raising gestational diabetes mellitus diagnostic glucose thresholds and clarifying early pregnancy testing. They recommend first-trimester HbA1c for women with risk factors, early POGTT for previous gestational diabetes mellitus or HbA1c 6.0–6.4%, and universal 75 g two-hour POGTT at 24–28 weeks’ gestation.

Key findings

  • Overt diabetes in pregnancy should be diagnosed at any gestation if FPG ≥ 7.0 mmol/L, 2hPG ≥ 11.1 mmol/L after a 75 g two-hour POGTT, HbA1c ≥ 6.5% (≥ 48 mmol/mol), and/or random plasma glucose ≥ 11.1 mmol/L with symptoms of hyperglycaemia.
  • Gestational diabetes mellitus should be diagnosed at any gestation by one or more of: FPG ≥ 5.3–6.9 mmol/L, 1hPG ≥ 10.6 mmol/L, or 2hPG ≥ 9.0–11.0 mmol/L during a 75 g two-hour POGTT; these thresholds are higher than the 2014 ADIPS/IADPSG HAPO OR 1.75 criteria.
  • Women with risk factors should have HbA1c measured in the first trimester; those with previous gestational diabetes mellitus or early pregnancy HbA1c ≥ 6.0–6.4% (≥ 42–47 mmol/mol) should be offered a 75 g two-hour POGTT before 20 weeks, ideally at 10–14 weeks, and all women without diabetes already detected should be offered universal POGTT at 24–28 weeks.
  • In TOBOGM (802 women), immediate treatment of early gestational diabetes mellitus reduced the perinatal composite outcome, with benefit before 14 weeks’ gestation (aOR, 0.75; 95% CI, 0.57–0.98) but not at or after 14 weeks (aOR, 0.84; 95% CI, 0.64–1.09); in GEMS (4061 women), IADPSG criteria more than doubled gestational diabetes mellitus prevalence versus New Zealand criteria (15.3% v 6.1%) with no difference in large for gestational age, while treating lower-threshold cases reduced large for gestational age (aRR, 0.49; 95% CI, 0.29–0.83) and pre-eclampsia (aRR, 0.08; 95% CI, 0.002–0.60) but increased small for gestational age and health service use.

Methods

  • Consensus-based update by the ADIPS Board, informed by evidence reviews prepared for the 2024 SIGN diabetes in pregnancy guidelines and the draft New Zealand national clinical guideline on gestational diabetes mellitus, with stakeholder consultation including an IADPSG Summit in November 2022, an ADIPS workshop in August 2023, and an ADIPS conference in May 2024.
  • The manuscript was drafted by the multidisciplinary ADIPS Board, circulated to key stakeholders and ADIPS members, and revised after 60 written submissions; it is reported according to ACCORD and assessed against the Guidelines International Network checklist for modifying a disease definition.
  • Conflicts of interest were managed through standardised declarations, open discussion, and moderation by authors without relevant interests where necessary.

Limitations

  • The paper states there remains no single best evidence-based approach, substantial variation in practice exists locally and internationally, and the continuum of risk between glycaemia and adverse outcomes means there will always be arguments for and against any specific diagnostic thresholds.
  • The paper states that raising POGTT diagnostic thresholds at 24–28 weeks means women and offspring previously diagnosed at HAPO OR 1.75 thresholds will no longer be identified as having gestational diabetes mellitus; it also notes reliance on a single OGTT with limited reproducibility, pre-analytical glucose handling problems that can cause marked underdiagnosis, HbA1c limitations, and no established evidence for self-blood glucose monitoring or continuous glucose monitoring thresholds or metrics.
  • Evident from the text: the recommendations are consensus-based rather than derived from a formal systematic review or meta-analysis, and the competing interests statement reports industry financial relationships for several authors, although the paper states conflicts were managed.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.5694/mja2.52696

Cites

55 of 55 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

36 of 77 cited sources checked · 13 supported · 0 flagged · accuracy not yet measured

  • Premisecitation

    FPG < 4.7 mmol/L at 24-28 weeks' gestation was associated with low absolute risk of hyperglycaemia in pregnancy-related complications, including large for gestational age babies, respiratory distress, and neonatal higher acuity care admission.

    “FPG < 4.7 mmol/L at 24–28 weeks’ gestation was associated with low absolute risk of hyperglycaemia in pregnancy‐related complications, including large for gestational age babies, respiratory distress, and neonatal higher acuity care admission. 31 , 32”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites [31] Deitch JM, Lee IL, Yates CJ, et al. Simplified gestational diabetes screening with a triaging fasting plasma glucose reduces the burden of oral glucose tolerance tests during pregnancy — a large tertiary comparative cohort study. Diabetes Res Clin Pract 2024; 209: 111120. 38307138 source

      The Introduction describes FPG <4.7 mmol/L as the simplified protocol’s threshold for no GDM at 24–28 weeks. Table 2 reports LGA, respiratory distress, and SCN/NICU admissions, but compares entire screening groups; it does not give the absolute risks of those outcomes specifically among women with FPG <4.7 mmol/L. The claim therefore applies the group-level findings to a subgroup the paper did not separately assess. (LLM, conf=0.85)

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    • cites [32] Meloncelli NML, Barnett AG, Cameron CM, et al. Gestational diabetes mellitus screening and diagnosis criteria before and during the COVID‐19 pandemic: a retrospective pre–post study. Med J Aust 2019; 219: 467‐ 474. https://www.mja.com.au/journal/2023/219/10/gestational‐diabetes‐mellitus‐screening‐and‐diagnosis‐criteria‐and‐during‐covid 37846046 source
  • Premisecitation

    A reanalysis of HAPO data demonstrated that women with FPG < 4.7 mmol/L had similar perinatal outcomes to women without gestational diabetes mellitus regardless of post-load values.

    “A reanalysis of HAPO data demonstrated that women with FPG < 4.7 mmol/L had similar perinatal outcomes to women without gestational diabetes mellitus regardless of post‐load values. 33”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [33] McIntyre D, Gibbons KS, Ma RCW, et al. Testing for gestational diabetes during the COVID‐19 pandemic. An evaluation of proposed protocols for the United Kingdom, Canada and Australia. Diabetes Res Clin Pract 2020; 167: 108353. 32739381 PMC7391984 source

      The Methods describe a reanalysis of HAPO data, and the Discussion (page unavailable) says the Australian protocol would miss some GDM cases whose complication risks appear lower. It also identifies 4.7 mmol/L as a testing threshold. The passages do not establish that women below that threshold had outcomes similar to women without GDM regardless of post-load values. (LLM, conf=0.82)

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  • Premisecitation

    In utero exposure to hyperglycaemia is associated with long term cardiometabolic risks in the baby, including diabetes and obesity.

    “In utero exposure to hyperglycaemia is also associated with long term cardiometabolic risks in the baby, including diabetes and obesity. 8 , 9 , 10”
    Quote in the paperNot a substantial claim3 of 3 sources checked
    • cites [8] Lowe WL, Scholtens DM, Kuang A, et al. HAPO Follow‐up Study Cooperative Research Group. Hyperglycemia and Adverse Pregnancy Outcome Follow‐up Study (HAPO FUS): maternal gestational diabetes mellitus and childhood glucose metabolism. Diabetes Care 2019; 42: 372‐ 380. 30655380 PMC6385693 source

      The Conclusions (page not supplied) report an association between maternal gestational diabetes and offspring obesity and adiposity, as well as a higher risk of impaired glucose tolerance in childhood. The Results report type 2 diabetes in 0.3% of exposed children versus 0.2% of unexposed children; the paper does not establish an increased risk of diabetes itself. (LLM, conf=0.86)

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    • cites [9] Wicklow BA, Sellers EAC, Sharma AK, et al. Association of gestational diabetes and type 2 diabetes exposure in utero with the development of type 2 diabetes in First Nations and non‐First Nations offspring. JAMA Pediatr 2018; 172: 724‐ 731. 29889938 PMC6142931 source
    • cites [10] Lowe WL, Lowe LP, Kuang A, et al. Maternal glucose levels during pregnancy and childhood adiposity in the Hyperglycemia and Adverse Pregnancy Outcome Follow‐up Study. Diabetologia 2019; 62: 598‐ 610. 30648193 PMC6421132 source

      The Conclusions (page not provided) report an association between maternal gestational diabetes and offspring obesity, and this study finds a higher risk of impaired glucose tolerance in childhood. They do not establish a higher risk of diagnosed diabetes in the offspring; the paper describes progression from impaired glucose tolerance to type 2 diabetes as a risk. (LLM, conf=0.85)

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  • Premisecitation

    Early treatment for gestational diabetes mellitus was cost-effective among high risk women in the higher glycaemic band when diagnosed before 14 weeks' gestation.

    “Early treatment for gestational diabetes mellitus was cost‐effective among high risk women in the higher glycaemic band when diagnosed before 14 weeks’ gestation. 26”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [26] Haque MM, Tannous KW, Herman WH, et al. TOBOGM Consortium. Cost‐effectiveness of diagnosis and treatment of early gestational diabetes mellitus: economic evaluation of the TOBOGM study, an international multicenter randomized controlled trial. EClinicalMedicine 2024; 71: 102610 38813447 PMC11133791 source
  • Premisecitation

    Evidence from Aotearoa New Zealand suggests that routine HbA1c measurement reduces disparities in screening.

    “Evidence from Aotearoa New Zealand suggests that routine HbA1c measurement reduces disparities in screening. 55”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [55] Hughes RCE, Williman J, Gullam JE. Universal HbA1c measurement in early pregnancy to detect type 2 diabetes reduces ethnic disparities in antenatal diabetes screening: a population‐based observational study. PLoS ONE 2016; 11: e0156926. 27272760 PMC4896429 source
  • May combine two claims. 21
  • Classified as probably not a substantial claim. 9
  • The quote only partly states this claim. 1

  • May combine two claims.

    Premisecitation

    Women with gestational diabetes mellitus have increased risk of future type 2 diabetes, kidney disease and cardiovascular disease.

    “Women with gestational diabetes mellitus have increased risk of future type 2 diabetes, kidney disease and cardiovascular disease. 4 , 5 , 6 , 7”
    Quote in the paperNot a substantial claim3 of 4 sources checked
    • cites [4] Bardugo et al. Glucose intolerance in pregnancy and risk of early‐onset type 2 diabetes: a population‐based cohort study. Lancet Diabetes Endocrinol 2023; 11: 333‐ 344. 37011646 source
    • cites [5] Daly BM, Wu Z, Nirantharakumar K, et al. Increased risk of cardiovascular and renal disease, and diabetes for all women diagnosed with gestational diabetes mellitus in New Zealand — a national retrospective cohort study. J Diabetes 2024; 16: e13535. 38599878 PMC11006618 source
    • cites [6] Hare MJL, Maple‐Brown LJ, Shaw JE, et al. Risk of kidney disease following a pregnancy complicated by diabetes: a longitudinal, population‐based data‐linkage study among Aboriginal women in the Northern Territory, Australia. Diabetologia 2023; 66: 837‐ 846. 36651940 PMC10036460 source

      The Results report increased future CKD and ESKD risk after gestational diabetes among Aboriginal women in the Northern Territory. The Discussion describes subsequent type 2 diabetes in women who developed kidney disease and reports a prior cohort’s postpartum type 2 diabetes findings. Our copy does not report an increased risk of cardiovascular disease after gestational diabetes, and this study’s kidney findings concern a specific population rather than women generally. (LLM, conf=0.88)

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    • cites [7] Kramer CK, Campbell S, Retnakaran R. Gestational diabetes and the risk of cardiovascular disease in women: a systematic review and meta‐analysis. Diabetologia 2019; 62: 905‐ 914. 30843102 source

      The Introduction states that gestational diabetes predicts future type 2 diabetes, and the Abstract reports a higher risk of future cardiovascular events. The paper does not address future kidney disease; searches for kidney and renal disease found no supporting passage. (LLM, conf=0.90)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    Other relevant trials have not shown benefit from early testing and treatment of gestational diabetes mellitus, including among women with obesity in the United States and in Iran.

    “Other relevant trials have not shown benefit from early testing and treatment of gestational diabetes mellitus, including among women with obesity in the United States 29 and in Iran. 30”
    Quote in the paperSubstantial claim2 of 2 sources checked
    • cites [29] Harper LM, Jauk V, Longo S, et al. Early gestational diabetes screening in obese women: a randomized controlled trial. Am J Obstet Gynecol 2020; 222: 495. PMC7196002 31926951 source
    • cites [30] Tehrani FR, Behboudi‐Gandevani S, Farzadfar F, et al. A cluster randomized noninferiority field trial of gestational diabetes mellitus screening. J Clin Endocrinol Metab 2022; 107: e2906‐ e2920. 35325164 source

      The Discussion reports that stricter first-trimester GDM criteria in the Iranian trial did not improve pregnancy outcomes despite earlier diagnosis and care. But both comparison groups underwent first-trimester testing, so the trial does not establish that early testing and treatment offer no benefit compared with testing later. The U.S. obesity trial is attached to a different citation. (LLM, conf=0.86)

      Experimental — accuracy not yet measured

  • Classified as probably not a substantial claim.

    Premisecitation

    The IADPSG made a consensus recommendation to adopt diagnostic glucose thresholds corresponding to a HAPO OR of 1.75 (FPG 5.1-6.9 mmol/L, 1hPG ≥ 10.0 mmol/L, and/or 2hPG 8.5-11.0 mmol/L).

    “to adopt diagnostic glucose thresholds corresponding to a HAPO OR of 1.75 (fasting plasma glucose [FPG] 5.1–6.9 mmol/L, one‐hour plasma glucose [1hPG] ≥ 10.0 mmol/L, and/or two‐hour plasma glucose [2hPG] 8.5–11.0 mmol/L). 14”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [14] International Association of Diabetes and Pregnancy Study Groups Consensus Panel. International Association of Diabetes and Pregnancy Study Groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care 2010; 33: 676‐ 682. 20190296 PMC2827530 source

      The 'Translation of HAPO Study Results for Diagnosis of GDM' and 'Diagnostic recommendations' passages state that the IADPSG Consensus Panel recommended fasting, 1-hour and 2-hour thresholds based on an odds ratio of 1.75, with any one threshold sufficient for GDM diagnosis. 'Other considerations' explicitly gives 5.1 mmol/L as the fasting threshold. The passages available from our copy do not give the cited 10.0 and 8.5 mmol/L values or the upper limits of 6.9 and 11.0 mmol/L, so those numerical details cannot be verified. (LLM, conf=0.84)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    These thresholds are consistent with the accepted Australian definition of pre-diabetes outside of pregnancy.

    “These thresholds are consistent with the accepted Australian definition of pre‐diabetes outside of pregnancy. 47”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [47] Bell K, Shaw JE, Maple‐Brown L, et al. A position statement on screening and management of prediabetes in adults in primary care in Australia. Diabetes Res Clin Pract 2020; 164: 108188. 32360708 source

      Sections 4.2.2 and 4.2.3 give recommended HbA1c and glucose thresholds for prediabetes in an Australian position statement on adults. Section 3 discusses gestational diabetes separately. The citing sentence does not specify what “these thresholds” are, so their consistency with the paper’s thresholds cannot be checked. (LLM, conf=0.76)

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  • May combine two claims.

    Premisecitation

    Not all women with overt DIP will have persistent diabetes post partum, but the risk of future type 2 diabetes is high.

    “Not all women with overt DIP will have persistent diabetes post partum, but the risk of future type 2 diabetes is high. 40 , 41”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites [40] Wood AJ, Boyle JA, Barr ELM, et al. Type 2 diabetes after a pregnancy with gestational diabetes among first nations women in Australia: the PANDORA study. Diabetes Res Clin Pract 2021; 181: 109092. 34653565 source
    • cites [41] Wong T, Ross GP, Jalaludin BB, Flack JR. The clinical significance of overt diabetes in pregnancy. Diabet Med 2013; 30: 468‐ 474. Erratum in: Diabet Med 2013; 30: 887. 23278460 source

  • May combine two claims.

    Premisecitation

    Early pregnancy HbA1c at thresholds of 6.0-6.4% (42-47 mmol/mol) is highly specific for gestational diabetes mellitus diagnosed on POGTT, but its positive predictive value is limited in many populations.

    “Although HbA1c at these thresholds is highly specific for gestational diabetes mellitus diagnosed on POGTT, the positive predictive value is limited in many populations. 48”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [48] Renz PB, Chume FC, Timm JRT, et al. Diagnostic accuracy of glycated hemoglobin for gestational diabetes mellitus: a systematic review and meta‐analysis. Clin Chem Lab Med 2019; 57: 1435‐ 1449. 30893053 source

      The ‘Effect of the HbA1c threshold on diagnostic accuracy’ section (page not provided) reports 98.7% pooled specificity at ≥6.0% (42 mmol/mol). ‘Applicability of findings to the review question’ reports a 69% probability of GDM after a positive result, assuming 18% prevalence, which supports a limitation on predictive value. The review does not evaluate a 6.0–6.4% range or establish that this predictive value applies to early pregnancy or many populations. (LLM, conf=0.88)

      Experimental — accuracy not yet measured

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    Premisecitation

    For others, the experience of both internalised stigma (guilt, shame, fear and anxiety) and externalised stigma (labelling, discrimination, depersonalising and judgment), coupled with burden of care that may include financial strain, increased surveillance, and dietary restriction, can lead to a reduced quality of life and negative pregnancy experiences that can persist post partum.

    “For others, the experience of both internalised stigma (guilt, shame, fear and anxiety) and externalised stigma (labelling, discrimination, depersonalising and judgment), coupled with burden of care that may include financial strain, increased surveillance, and dietary restriction, can lead to a reduced quality of life and negative pregnancy experiences that can persist post partum. 39”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [39] Pham S, Churruca K, Ellis LA, Braithwaite J. A scoping review of gestational diabetes mellitus healthcare: experiences of care reported by pregnant women internationally. BMC Pregnancy Childbirth 2022; 22: 627. 35941555 PMC9361509 source

      Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

      Experimental — accuracy not yet measured

  • Classified as probably not a substantial claim.

    Premisecitation

    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”
    Quote in the paperSubstantial claim1 of 3 sources checked
    • cites [20] Sweeting A, McMillan F, Simmons D; TOBOGM Summit attendees. The first International Association of Diabetes and Pregnancy Study Groups summit on the diagnosis of gestational diabetes in Early Pregnancy: TOBOGM Summit report. Aus N Z J Obstet Gyanecol 2024; 64: 519‐ 523. PMC11660013 38634525 source

      The Findings identify consensus on early-GDM criteria as a frequent issue for summit delegates. The Conclusions and Future Directions say the impact of those criteria on diagnosis at 24–28 weeks must be considered, but do not say that using consistent criteria across pregnancy was a key stakeholder priority. Page numbers are unavailable in our copy. (LLM, conf=0.82)

      Experimental — accuracy not yet measured
    • cites [21] Rhou J. TOBOGM Workshop 2023: options for diagnostic approaches for early gestational diabetes mellitus. https://www.adips.org/TOBOGM%20Workshop%20Summary%20Aug%202023%20Final%2020231129.pdf (viewed Jan 2025).

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [22] Sweeting A, Hare MJL, de Jersey S, et al. ADIPS report on 2024 Gestational Diabetes Screening and Diagnosis Conference. Australasian Diabetes in Pregnancy Society; Sydney (Australia); 10 May 2024. https://www.adips.org/ADIPS%20GDM%20Meeting%20Report%20Final%20with%20cover.pdf (viewed Jan 2025). PMC12318493 40544364 source

  • May combine two claims.

    Premisecitation

    HbA1c has poor sensitivity for screening for gestational diabetes mellitus in later pregnancy, because the physiological fall in HbA1c by the second trimester leads to underestimation of HbA1c.

    “In later pregnancy, HbA1c is not recommended for gestational diabetes mellitus screening due to poor sensitivity, arising from the physiological fall of HbA1c by the second trimester, leading to the underestimation of HbA1c. 48”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [48] Renz PB, Chume FC, Timm JRT, et al. Diagnostic accuracy of glycated hemoglobin for gestational diabetes mellitus: a systematic review and meta‐analysis. Clin Chem Lab Med 2019; 57: 1435‐ 1449. 30893053 source

      The Study selection section says the included studies tested women in the second or third trimester, and the Conclusions report low sensitivity and many false negatives, supporting the concern about using HbA1c alone for GDM screening in later pregnancy. The Introduction says HbA1c is lower during pregnancy and significantly lower in the first trimesters, but the paper does not establish that a fall by the second trimester causes the poor sensitivity or leads to underestimation in later pregnancy. Page numbers are unavailable in our copy. (LLM, conf=0.87)

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  • May combine two claims.

    Premisecitation

    For some women, the diagnosis is a catalyst for positive behavioural change and improved quality of life.

    “For some women, the diagnosis is a catalyst for positive behavioural change 36 and improved quality of life. 15”
    Quote in the paperNot a substantial claim2 of 2 sources checked
    • cites [36] Roesler A, Butten K, Taylor P, et al. The experiences of individuals who have had gestational diabetes: a qualitative exploration. Diabet Med 2024; 41: e15374. 38853396 source
    • cites [15] Crowther CA, Hiller JA, Moss JR, et al. Australian Carbohydrate Intolerance Study in Pregnant Women Trial Group. Effect of treatment of gestational diabetes mellitus on pregnancy outcomes. New Eng J Med 2005; 352: 2477‐ 2486. 15951574 source

      The secondary outcomes section reports improved health-related quality of life in the intervention group during pregnancy and three months after birth. But the trial compared diagnosis plus treatment with routine care, so it does not establish that diagnosis itself caused the improvement. The separate behavioural-change claim is cited to another source, not this one. (LLM, conf=0.83)

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  • May combine two claims.

    Premisecitation

    The recommended approach to screening and diagnosis of gestational diabetes mellitus relies on a single OGTT, which has limited reproducibility.

    “The recommended approach to screening and diagnosis of gestational diabetes mellitus relies on a single OGTT, which has limited reproducibility. 49”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [49] Potter JM, Hickman PE, Oakman C, et al. Strict preanalytical oral glucose tolerance test blood sample handling is essential for diagnosing gestational diabetes mellitus. Diabetes Care 2020; 43: 1438‐ 1441. 32350020 PMC7305001 source

      The Introduction describes a recommended one-step OGTT for gestational diabetes diagnosis. The Conclusions show that diagnosis rates changed substantially with blood-sample handling, but the paper does not assess whether a single OGTT gives reproducible results when repeated in the same person. Sensitivity to sample handling supports a narrower point than the claimed limited reproducibility. (LLM, conf=0.85)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Improving pregnancy outcomes relating to diabetes is an identified priority in remote First Nations communities in Australia.

    “where improving pregnancy outcomes relating to diabetes is an identified priority. 57”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [57] Maple‐Brown L, Lee I, Longmore D, et al. Pregnancy and neonatal diabetes outcomes in remote Australia: the PANDORA study — an observational birth cohort. Int J Epi 2019; 48: 307‐ 318. 30508095 source

  • May combine two claims.

    Premisecitation

    Women with HbA1c ≥ 6.0-6.4% (≥ 42-47 mmol/mol) in early pregnancy may have pre-existing intermediate hyperglycaemia and are at high risk of developing future type 2 diabetes.

    “Women with HbA1c ≥ 6.0‐6.4% (≥ 42–47 mmol/mol) in early pregnancy may have pre‐existing intermediate hyperglycaemia and are at high risk of developing future type 2 diabetes. 18 , 40”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites [18] Scottish Intercollegiate Guidelines Network. Management of diabetes in pregnancy (SIGN 171). Edinburgh: SIGN, 2024. http://www.sign.ac.uk (viewed June 2024).

      Not checked in the free run.

    • cites [40] Wood AJ, Boyle JA, Barr ELM, et al. Type 2 diabetes after a pregnancy with gestational diabetes among first nations women in Australia: the PANDORA study. Diabetes Res Clin Pract 2021; 181: 109092. 34653565 source

      The Outcomes section defines HbA1c 6.0–6.4% (42–47 mmol/mol) as prediabetes when measured postpartum. The Discussion says women meeting diabetes-in-pregnancy criteria are at high risk of progressing to type 2 diabetes, but it does not establish that this lower HbA1c range in early pregnancy indicates pre-existing intermediate hyperglycaemia or carries that same high risk. (LLM, conf=0.85)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    Given the continuum of risk between glycaemia and adverse pregnancy outcomes, there will always be arguments for and against any specific diagnostic thresholds.

    “Given the continuum of risk between glycaemia and adverse pregnancy outcomes, there will always be arguments for and against any specific diagnostic thresholds.”
    Quote in the paperNot a substantial claim

  • May combine two claims. The quote only partly states this claim.

    Premisecitation

    In pre-specified subgroup analysis, benefit was observed in women who had the OGTT and were treated before 14 weeks' gestation (aOR, 0.75; 95% CI, 0.57-0.98), but not in women who had the OGTT at or after 14 weeks' gestation (aOR, 0.84; 95% CI, 0.64-1.09).

    “benefit was observed in women who had the OGTT and were treated before 14 weeks’ gestation (adjusted odds ratio [aOR], 0.75; 95% confidence interval [CI], 0.57–0.98)”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [25] Simmons D, Immanuel J, Hague WM, et al, TOBOGM Research Group. Treatment of gestational diabetes mellitus diagnosed early in pregnancy. N Engl J Med 2023; 388: 2132‐ 2144. 37144983 source

  • May combine two claims.

    Premisecitation

    In the subgroup with OGTT results between lower and higher glycaemic criteria, treatment for gestational diabetes mellitus was associated with reduced risk of large for gestational age babies (aRR, 0.49; 95% CI, 0.29-0.83) and pre-eclampsia (aRR, 0.08; 95% CI, 0.002-0.60).

    “In this subgroup, treatment for gestational diabetes mellitus was associated with reduced risk of large for gestational age babies (adjusted relative risk [aRR], 0.49; 95% CI, 0.29–0.83) and pre‐eclampsia (aRR, 0.08; 95% CI, 0.002–0.60).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [27] Crowther CA, Samuel D, McCowan LME, et al. GEMS Trial Group. Lower versus higher glycemic criteria for diagnosis of gestational diabetes. N Engl J Med 2022; 387: 587‐ 598. 36070709 source

  • May combine two claims.

    Premisecitation

    No differences were observed in the other primary outcomes of pregnancy-related hypertension or neonatal lean body mass.

    “No differences were observed in the other primary outcomes of pregnancy‐related hypertension or neonatal lean body mass.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [25] Simmons D, Immanuel J, Hague WM, et al, TOBOGM Research Group. Treatment of gestational diabetes mellitus diagnosed early in pregnancy. N Engl J Med 2023; 388: 2132‐ 2144. 37144983 source

  • May combine two claims.

    Premisecitation

    Treatment at lower glycaemic thresholds was associated with greater health service use and an increased risk of small for gestational age offspring, as well as lower lean mass and increased risk of early term birth, compared with women who were not treated.

    “However, treatment at these lower glycaemic thresholds was also associated with greater health service use and an increased risk of small for gestational age offspring, 27 as well as lower lean mass and increased risk of early term birth, 28 compared with women who were not treated.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [27] Crowther CA, Samuel D, McCowan LME, et al. GEMS Trial Group. Lower versus higher glycemic criteria for diagnosis of gestational diabetes. N Engl J Med 2022; 387: 587‐ 598. 36070709 source
    • cites [28] Manerkar K, Crowther CA, Harding JE, et al. Impact of gestational diabetes detection thresholds on infant growth and body composition: a prospective cohort study within a randomized trial. Diabetes Care 2024; 47: 56‐ 65. 37643291 source

  • May combine two claims.

    Premisecitation

    In the overall population, the IADPSG criteria more than doubled the prevalence of gestational diabetes mellitus compared with the New Zealand guidelines (15.3% v 6.1%), with no difference in the primary outcome of large for gestational age offspring.

    “In the overall population, the IADPSG criteria more than doubled the prevalence of gestational diabetes mellitus compared with the New Zealand guidelines (15.3% v 6.1%), with no difference in the primary outcome of large for gestational age offspring.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [27] Crowther CA, Samuel D, McCowan LME, et al. GEMS Trial Group. Lower versus higher glycemic criteria for diagnosis of gestational diabetes. N Engl J Med 2022; 387: 587‐ 598. 36070709 source

  • May combine two claims.

    Interpretationreasoning

    These trials examined outcomes among all women undergoing screening; gestational diabetes mellitus status, and thus treatment, differed between trial arms for only a small proportion of women.

    “These trials examined outcomes among all women undergoing screening. Gestational diabetes mellitus status, and thus treatment, differed between trial arms for only a small proportion of women.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    The remaining 33% of the women had discordant OGTTs, that is a negative OGTT at 24-28 weeks' gestation despite their positive OGTT in early pregnancy (22% in the higher band and 49% in the lower band).

    “The remaining 33% of the women had discordant OGTTs, that is a negative OGTT at 24–28 weeks’ gestation despite their positive OGTT in early pregnancy (22% in the higher band and 49% in the lower band).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [25] Simmons D, Immanuel J, Hague WM, et al, TOBOGM Research Group. Treatment of gestational diabetes mellitus diagnosed early in pregnancy. N Engl J Med 2023; 388: 2132‐ 2144. 37144983 source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    In 2014, ADIPS recommended gestational diabetes mellitus be diagnosed any time during pregnancy based on HAPO OR 1.75 one-step POGTT glucose thresholds, as well as testing in early pregnancy in individuals with risk factors for hyperglycaemia in pregnancy, ideally with a POGTT or a glycated haemoglobin (HbA1c) test.

    “In 2014, ADIPS recommended gestational diabetes mellitus be diagnosed any time during pregnancy based on HAPO OR 1.75 one‐step POGTT glucose thresholds, as well as testing in early pregnancy in individuals with risk factors for hyperglycaemia in pregnancy, ideally with a POGTT or a glycated haemoglobin (HbA1c) test. 13”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [13] Nankervis A, McIntyre HD, Moses R, et al. Australasian Diabetes in Pregnancy Society. ADIPS Consensus Guidelines for the Testing and Diagnosis of Hyperglycaemia in Pregnancy in Australia and New Zealand (modified November 2014). www.adips.org/downloads/2014ADIPSGDMGuidelinesV18.11.2014_000.pdf (viewed Jan 2025).

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Pre-specified subgroup analyses suggested an effect from immediate treatment among women with high glycaemic band (HAPO OR 2.0) OGTT diagnostic thresholds, but not in women diagnosed with the currently recommended low glycaemic band thresholds (HAPO OR 1.75).

    “Pre‐specified subgroup analyses suggested an effect from immediate treatment among women with high glycaemic band (HAPO OR 2.0) OGTT diagnostic thresholds, but not in women diagnosed with the currently recommended low glycaemic band thresholds (HAPO OR 1.75).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [25] Simmons D, Immanuel J, Hague WM, et al, TOBOGM Research Group. Treatment of gestational diabetes mellitus diagnosed early in pregnancy. N Engl J Med 2023; 388: 2132‐ 2144. 37144983 source

  • May combine two claims.

    Premisecitation

    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”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [1] Report of a World Health Organization Consultation: diagnostic criteria and classification of hyperglycaemia first detected in pregnancy: a World Health Organization guideline. Diabetes Res Clin Pract 2014; 103: 341‐ 363. 24847517 source
    • cites [2] Sweeting A, Wesley H, Backman H, et al. Epidemiology and management of gestational diabetes. Lancet 2024; 404: 175‐ 192. 38909620 source
    • cites [3] HAPO Study Cooperative Research Group; Metzger BE, Lowe LP, Dyer AR, et al. Hyperglycemia and adverse pregnancy outcomes. New Eng J Med 2008; 358: 1991‐ 2002. 18463375 source

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    Gestational diabetes mellitus cannot be excluded without a POGTT.

    “gestational diabetes mellitus cannot be excluded without a POGTT.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    Inclusion of HbA1c screening in early pregnancy will help ensure women with overt diabetes in pregnancy (DIP) and highest risk of adverse outcomes are afforded appropriate care.

    “Inclusion of HbA1c screening in early pregnancy will help ensure women with overt DIP and highest risk of adverse outcomes are afforded appropriate care.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Gestational diabetes mellitus detection allows implementation of appropriate management to reduce risk of adverse pregnancy outcomes.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    GEMS suggested that women diagnosed with gestational diabetes mellitus via the lower POGTT thresholds had some maternal and infant health benefits compared with women with the same mild degree of hyperglycaemia who were not diagnosed with (or treated for) gestational diabetes mellitus.

    “GEMS suggested that women diagnosed with gestational diabetes mellitus via the lower POGTT thresholds had some maternal and infant health benefits compared with women with the same mild degree of hyperglycaemia who were not diagnosed with (or treated for) gestational diabetes mellitus. 27”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [27] Crowther CA, Samuel D, McCowan LME, et al. GEMS Trial Group. Lower versus higher glycemic criteria for diagnosis of gestational diabetes. N Engl J Med 2022; 387: 587‐ 598. 36070709 source

  • May combine two claims.

    Premisecitation

    Factors may alter the reliability of HbA1c as a marker of glycaemia (eg, increased or reduced red cell turnover) or interfere with some assays.

    “clinicians should be aware of factors that may alter the reliability of HbA1c as a marker of glycaemia (eg, increased or reduced red cell turnover) or interfere with some assays. 58”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [58] National Institutes of Diabetes and Digestive and Kidney Diseases. Factors that interfere with HbA1c test results. Missouri: NGSP, 2024. https://ngsp.org/factors.asp (viewed Jan 2025).

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Key risk factors for hyperglycaemia in pregnancy include previous history of gestational diabetes mellitus and HbA1c ≥ 6.0-6.4% (≥ 42-47 mmol/mol).

    “Key risk factors for hyperglycaemia in pregnancy include previous history of gestational diabetes mellitus and HbA1c ≥ 6.0‐6.4% (≥ 42–47 mmol/mol). 3 , 18”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [3] HAPO Study Cooperative Research Group; Metzger BE, Lowe LP, Dyer AR, et al. Hyperglycemia and adverse pregnancy outcomes. New Eng J Med 2008; 358: 1991‐ 2002. 18463375 source
    • cites [18] Scottish Intercollegiate Guidelines Network. Management of diabetes in pregnancy (SIGN 171). Edinburgh: SIGN, 2024. http://www.sign.ac.uk (viewed June 2024).

      Not checked in the free run.

29 of 29

  • The paper relies on this without support.

    Substantial variation in practice exists locally and internationally.

    “Substantial variation in practice exists locally and internationally.”

  • The paper relies on this without support.

    Despite recent trials relevant to gestational diabetes mellitus screening and diagnosis, there remains no single best evidence-based approach.

    “Despite recent trials relevant to gestational diabetes mellitus screening and diagnosis, there remains no single best evidence‐based approach.”

  • The paper relies on this without support.

    Some women are unable to tolerate the POGTT and/or will choose not to have a POGTT.

    “Some women are unable to tolerate the POGTT (eg, women who have had bariatric surgery) and/or will choose not to have a POGTT.”

  • The paper relies on this without support.

    There is limited evidence for alternatives to POGTT in early pregnancy.

    “There is limited evidence for alternatives to POGTT in early pregnancy.”

  • The paper relies on this without support.

    There is currently no established evidence to guide the duration of monitoring, glucose thresholds or metrics required for gestational diabetes mellitus diagnosis via self-blood glucose monitoring or continuous glucose monitoring.

    “There is currently no established evidence to guide the duration of monitoring, glucose thresholds or metrics required for gestational diabetes mellitus diagnosis via self‐blood glucose monitoring or continuous glucose monitoring.”

  • The paper relies on this without support.

    In Australia, government subsidies for glucose monitoring supplies are restricted to people with a diabetes diagnosis.

    “In Australia, government subsidies for glucose monitoring supplies are restricted to people with a diabetes diagnosis.”

  • The paper relies on this without support.

    POGTT before ten weeks’ gestation has poor tolerance and limited evidence of benefit.

    “POGTT should not be performed before ten weeks’ gestation due to poor tolerance and limited evidence of benefit.”

  • The paper relies on this without support.

    HbA1c ≥ 6.5% (≥ 48 mmol/mol) is diagnostic of diabetes outside pregnancy and, in pregnancy, likely represents previously undiagnosed diabetes.

    “HbA1c ≥ 6.5% (≥ 48 mmol/mol) is diagnostic of diabetes outside pregnancy and, in pregnancy, likely represents previously undiagnosed diabetes.”

  • The paper relies on this without support.

    Gestational diabetes mellitus detection allows implementation of appropriate management to reduce risk of adverse pregnancy outcomes.

    “Although gestational diabetes mellitus detection allows implementation of appropriate management to reduce risk of adverse pregnancy outcomes,”

  • The paper relies on this without support.

    A gestational diabetes mellitus diagnosis can be associated with adverse experiences for some women, often related to how care is delivered.

    “a gestational diabetes mellitus diagnosis can also be associated with adverse experiences for some women, often related to how care is delivered.”

  • The paper relies on this without support.

    HbA1c has greater pre-analytical stability compared with glucose.

    “Despite the greater pre‐analytical stability of HbA1c compared with glucose,”

  • The paper relies on this without support.

    Dichotomising the risk continuum between maternal glucose and adverse pregnancy outcomes for gestational diabetes mellitus diagnosis has inherent limitations.

    “Dichotomising the risk continuum between maternal glucose and adverse pregnancy outcomes for gestational diabetes mellitus diagnosis has inherent limitations.”
12 of 12

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • FPG advice overlaps with the overt-diabetes threshold

    Minor

    The advice to diagnose gestational diabetes at any FPG ≥ 5.3 mmol/L includes values ≥ 7.0 mmol/L, which the paper classifies as overt diabetes in pregnancy. The gestational-diabetes criteria elsewhere cap the fasting range at 6.9 mmol/L.

  • Reference 32 gives conflicting publication years

    Minor

    Reference 32 lists the article as published in 2019, while its supplied journal URL places the same article in the 2023 issue of volume 219.

2 of 2

Cites

Flagged first, then by citations

Research works printed but not linked: 4

  1. Scottish Intercollegiate Guidelines Network, 2024, Management of diabetes in pregnancy (SIGN 171)
  2. RhouJ.TOBOGM Workshop 2023: options for diagnostic approaches for early gestational diabetes mellitus.https://www.adips.org/TOBOGM%20Workshop%20Summary%20Aug%202023%20Final%2020231129.pdf(viewed Jan 2025).
  3. Sweeting A, 2024, ADIPS report on 2024 Gestational Diabetes Screening and Diagnosis Conference
  4. National Institutes of Diabetes and Digestive and Kidney Diseases, 2024, Factors that interfere with HbA1c test results

Cited by

Sorted by citations

Related

Authors
Sweeting, A., Hare, M. J., de Jersey, S. J., Shub, A. L., Zinga, J., Foged, C., Hall, R. M., Wong, T., & Simmons, D.
Affiliations
  • The University of Sydney (AU)
  • Charles Darwin University (AU)
  • Royal Brisbane and Women's Hospital Brisbane QLD
  • The University of Melbourne (AU)
  • Royal Women's Hospital (AU)
  • Mercy Hospital for Women (AU)
  • Wellington Hospital (NZ)
  • Bankstown Lidcombe Hospital (AU)
  • Camden and Campbelltown Hospitals (AU)
Corresponding author
Hare, Matthew JL
ORCID
Venue
Medical Journal of Australia
Publisher
Wiley
Published
2025-06-22
Volume
223
Issue
3
Pages
161-167
ISSN
  • 0025-729X (ISSN-L)
  • 1326-5377
DOI
10.5694/mja2.52696
PMC
PMC12318493
OpenAlex
W4411522748
Semantic Scholar
3a8d9e12aa0f91d0223496932f1edd196e1b62bb
Cited by
26
References
55
Citations by year
2026: 18 · 2025: 8
FWCI
26.86
Type
journal article
Language
en
Open access
Licence
Locations
  • The Medical Journal of Australia (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • PubMed Central (submittedVersion, cc-by-nc)
  • Figshare (submittedVersion, cc-by-nc)
  • Minerva Access (University of Melbourne) (submittedVersion, cc-by-nc)
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, hyperglycemia in pregnancy, overt diabetes in pregnancy, screening, diagnosis, classification, oral glucose tolerance test, HbA1c, fasting blood glucose, first-trimester screening, risk factors, gestational diabetes management, pregnancy complications, consensus recommendations
MeSH terms
Australia, Blood Glucose, Female, Glucose Tolerance Test, Glycated Hemoglobin, Humans, Hyperglycemia, Mass Screening, Pregnancy, Societies, Medical, Diabetes, Gestational, Consensus

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.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-20.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-20.

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