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The Australasian Diabetes in Pregnancy Society has updated guidance for the screening, diagnosis and classification of hyperglycaemia in pregnancy.
Gestational diabetes mellitus (GDM) is one of the most common disorders of pregnancy, affecting 1 in 6 Australian women.
GDM is associated with increased risk of adverse pregnancy outcomes and neonatal complications, as well as long term health impacts for mother and child.
The Australasian Diabetes in Pregnancy Society (ADIPS) has released new national consensus recommendations, published in the Medical Journal of Australia, to update our approach to screening, diagnosis and classification of GDM in pregnancy.
“The multidisciplinary specialised Australasian Diabetes in Pregnancy Society (ADIPS) has historically developed national diabetes in pregnancy clinical guidelines, last updated over a decade ago,” co-author Dr Arianne Sweeting, Maternal Metabolic Health Lead with the Royal Prince Alfred Hospital, told InSight+.
“The 2025 update to the recommendations was prompted by stakeholder feedback, recent trial evidence providing further insight into the diagnosis and treatment of gestational diabetes both in early and later pregnancy, and our increasing understanding of the need for a life course approach to gestational diabetes, given the increase in pre-diabetes, diabetes and risk factors for gestational diabetes in women of reproductive age, and the long-term risk of cardiovascular disease, increased BMI and diabetes for both women and their offspring.”
The recommendations
The updated recommendations bring Australia in line with international criteria for the screening and diagnosis of GDM.
“While both previous national ADIPS and international guidelines had recommended early testing for women with risk factors for diabetes, the 2025 ADIPS recommendations raise the diagnostic glucose thresholds for gestational diabetes in both early and later pregnancy, based on recent evidence,” Dr Sweeting said.
The main recommendations are:
- Overt diabetes in pregnancy (overt DIP) should be diagnosed at any time in pregnancy if one or more of the following criteria are met:
- fasting plasma glucose (FPG) ³ 7.0 mmol/L;
- two-hour plasma glucose (2hPG) ³ 11.1 mmol/L following a 75 g two-hour pregnancy oral glucose tolerance test (POGTT); and/or
- glycated haemoglobin (HbA1c) ³ 6.5% (³ 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:
- FPG ³ 5.3–6.9 mmol/L;
- one-hour plasma glucose (1hPG) ³ 10.6 mmol/L;
- 2hPG ³ 9.0–11.0 mmol/L.
- Women with risk factors for hyperglycaemia in pregnancy should be advised to have their HbA1c level measured in the first trimester. Women with a HbA1c level ³ 6.5% (³ 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 HbA1c levels ³ 6.0–6.4% (³ 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.
Person-centred, culturally safe care
The updated guidelines emphasise the importance of person-centred, culturally safe and holistic care for women diagnosed with GDM.
While a diagnosis can be a catalyst for positive behavioural change for some, for others it can cause psychological distress due to internal and external stigma, financial strain, increased surveillance and dietary restriction.
Dr Sweeting told InSight+ that clear, empathetic communication and a collaborative therapeutic relationship between women and their care providersis critical.
“Gestational diabetes is essentially a metabolic stress test, and provides an important opportunity to advocate and optimise women’s health across the life course for future prevention of cardiovascular complications and diabetes,” Dr Sweeting said.
“It is important for clinicians to reassure women that our current treatment approach is very effective in normalising of pregnancy outcomes, and to ensure flexible models of care following a gestational diabetes diagnosis and nutritional education.”
Further glucose monitoring guidelines on the way
Dr Sweeting is also involved with further continuous glucose monitoring (CGM) guidelines and recommendations to be published later this year from the World Health Organization and diaTribe.
“Ultimately, it is becoming increasingly clear from this CGM data and our increasing understanding of early developmental fetal programming that we can identify and intervene earlier in pregnancy than the traditional 1960s paradigm of later detection and treatment of gestational diabetes,” Dr Sweeting said.
“We continue to work on implementing precision medicine in gestational diabetes, specifically characterising subtypes of gestational diabetes at lower and greater risk of complications to ensure more personalised and precise approaches to care — continually seeking to improve women’s experiences and health outcomes.”
Read the consensus statement in the Medical Journal of Australia.
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