Gestational diabetes: update on screening, diagnosis and maternal management

SUMMARY

Gestational diabetes is common and increasing in prevalence in Australia.

New Australasian consensus recommendations released in June 2025 include higher diagnostic thresholds for gestational diabetes and guidance on early pregnancy screening. Women with risk factors for hyperglycaemia in pregnancy are recommended to have glycated haemoglobin (HbA1c) measured in the first trimester. Women with a previous history of gestational diabetes or a first-trimester HbA1c of 6.0 to 6.4% should undergo a pregnancy oral glucose tolerance test (POGTT) before 20 weeks gestation.

All pregnant women without early gestational diabetes or existing diabetes should undergo a POGTT at 24 to 28 weeks gestation.

Insulin remains the mainstay of pharmacological therapy. Metformin may have a role, but its use should be evaluated on an individual basis. Other non-insulin antihyperglycaemic therapies are contraindicated in pregnancy.

Gestational diabetes is a significant risk factor for the development of type 2 diabetes and cardiovascular disease, and long-term surveillance is indicated.

 

Introduction

Hyperglycaemia that is first noted in pregnancy is diagnosed as either gestational diabetes, or overt diabetes in pregnancy (if criteria for diabetes in nonpregnant adults are met).¹ The incidence and prevalence of gestational diabetes is increasing in Australia;² almost 54,000 women in 2021 were diagnosed with gestational diabetes, which has more than doubled since 2009.^3-5 This has been driven by multiple factors, including increasing rates of obesity, maternal age and the proportion of women from ethnic groups with higher risk, and changes made to diagnostic criteria.⁶ The prevalence of gestational diabetes globally is estimated at 14%, which is consistent with the estimates for the Australian population.^2,7

Gestational diabetes is associated with increased risk of maternal complications such as pre-eclampsia and, in the longer term, cardiometabolic disease (including type 2 diabetes),² as well as adverse impacts on the fetus or neonate, including neonatal hypoglycaemia and macrosomia.^8-10 Timely diagnosis and treatment according to guidelines is vital to reduce both maternal and fetal complications of hyperglycaemia.^2,8-10 Models of care for gestational diabetes vary across Australia depending on local practices, which include step-up and step-down pathways between usual antenatal care and specialist antenatal care services.¹¹

The management of gestational diabetes continues to evolve as new data emerge, and many recommendations are consensus-driven in the absence of robust evidence. This article aims to provide an overview of current best-practice diagnosis and treatment of gestational diabetes in Australia, focusing on maternal management during pregnancy and postpartum. It takes into consideration new consensus recommendations of the Australasian Diabetes in Pregnancy Society (ADIPS) on screening, diagnosis and classification of gestational diabetes, released in June 2025.¹²

 

Screening and diagnosis

Recently updated guidelines maintain the recommendation that all pregnant women without early gestational diabetes or diabetes already detected undergo a 75-g 2-hour pregnancy oral glucose tolerance test (POGTT) at 24 to 28 weeks gestation.^1,12

In the updated diagnostic criteria for gestational diabetes (Table 1), the thresholds for fasting plasma glucose concentration and POGTT have been raised.^4,12

Table 1 Diagnostic criteria for gestational diabetes and overt diabetes in pregnancy

Glycaemic parameter	Concentration
Gestational diabetes12
Fasting plasma glucose	5.3 to 6.9 mmol/L (previously 5.1 to 6.9 mmol/L)
OR
Plasma glucose 1 hour post 75-g oral glucose tolerance test	10.6 mmol/L or more (previously 10.0 mmol/L)
OR
Plasma glucose 2 hours post 75-g oral glucose tolerance test	9.0 to 11.0 mmol/L (previously 8.6 to 11.0 mmol/L)
Overt diabetes in pregnancy (same criteria as diabetes in nonpregnant adults)12,13
Fasting plasma glucose	7.0 mmol/L or more
OR
Random plasma glucose	11.1 mmol/L or more
OR
Plasma glucose 2 hours post 75-g oral glucose tolerance test	11.1 mmol/L or more
OR
Glycated haemoglobin (HbA1c)	6.5% (48 mmol/mol) or more

If measures of glycaemia in pregnancy meet the diagnostic thresholds for diabetes in nonpregnant adults (Table 1), a diagnosis of 'overt diabetes in pregnancy',^12,14 also referred to as 'diabetes in pregnancy',¹³ is made. These thresholds remain unchanged in the updated guidelines. Women with overt diabetes in pregnancy should be managed in pregnancy as if they have pre-existing diabetes.

Early testing for gestational diabetes

Women with risk factors for hyperglycaemia in pregnancy (Box 1) are recommended to have glycated haemoglobin (HbA1c) measured in the first trimester to exclude overt diabetes in pregnancy.¹²

Women with a previous history of gestational diabetes or a first-trimester HbA1c of 6.0 to 6.4% (42 to 47 mmol/mol) should have a POGTT before 20 weeks gestation, ideally between 10 and 14 weeks.^1,12 ADIPS recommends the use of their 2025 diagnostic cut-offs (Table 1), irrespective of gestational age.¹²

Clinicians may offer an early screening POGTT depending on individual risk and discussion with the patient, even in the absence of prior gestational diabetes or if HbA1c is below 6.0% (42 mmol/mol).¹²

Women with risk factors who receive early testing and have normal glycaemic values should still have a POGTT at the usual screening period of 24 to 28 weeks gestation.^1,12 These individuals are then managed as per other women who are screened at 24 to 28 weeks.

While early screening for overt diabetes in pregnancy in women with risk factors is recommended with broad consensus,^1,12 prior to the 2025 ADIPS recommendations, there were no clear guidelines on what to do if diagnostic criteria for gestational diabetes were met earlier than 24 to 28 weeks.^1,16 An Australian-led randomised controlled trial showed that women diagnosed with gestational diabetes before 20 weeks gestation (using the 2014 ADIPS criteria), who received immediate treatment compared with deferred or no treatment, had fewer adverse neonatal outcomes (24.9% versus 30.5%, adjusted mean difference −5.6%, 95% confidence interval [CI] −10.1 to −1.2). These included birth before 37 weeks gestation, birth trauma, birth weight of 4500 g or greater, respiratory distress, phototherapy, stillbirth, neonatal death and shoulder dystocia.¹⁷ Greater benefit was seen among the women with glycaemic values in the higher end of the diagnostic range at the time of randomisation (fasting glucose 5.3 to 6.0 mmol/L, 1-hour POGTT 10.6 mmol/L or greater, 2-hour POGTT 9.0 to 11.0 mmol/L) compared with those in the lower end of the range. Early treatment had no effect on the occurrence of maternal hypertensive disorders in pregnancy; however, perineal trauma was reduced by about 78% (0.8% versus 3.6%, adjusted mean difference −2.8%, 95% CI −4.1 to −1.5).¹⁷

With respect to the use of HbA1c in early pregnancy, a cut-off of 5.4% (35 mmol/mol) was shown to have low sensitivity (0.55) and specificity (0.67) to predict fasting or post-load plasma glucose above the 90th percentile in early POGTT testing, but had modest value for predicting the need for antihyperglycaemic drugs (sensitivity 0.75, specificity 0.65).¹⁸ HbA1c cut-offs of 5.7% and 5.9% (39 and 41 mmol/mol, respectively) in early pregnancy have poor sensitivity for diagnosis of gestational diabetes and, in some studies, are associated with higher rates of adverse pregnancy outcomes (e.g. congenital anomaly, pre-eclampsia, shoulder dystocia, perinatal death).^19,20 Use of HbA1c for screening for gestational diabetes is not recommended later in pregnancy.¹²

 

Management

Management of gestational diabetes includes patient education, self-monitoring of blood glucose concentrations, optimising glycaemic management through lifestyle modifications and, if necessary, adding antihyperglycaemic therapy.^2,21-23 Women who register for the National Diabetes Services Scheme (NDSS) get their details added to the National Gestational Diabetes Register (unless they opt out). The register provides information, access to subsidised equipment, advice, and after-pregnancy reminders to undertake follow-up screening for the development of permanent diabetes. Management often utilises a multidisciplinary approach, with involvement of diabetes nurse educators, dietitians, general practitioners, endocrinologists and obstetricians.

Education

Women should be provided with education on gestational diabetes – what it is, the potential short-term implications for their own health and that of their baby in pregnancy (e.g. pregnancy-induced hypertension, pre-eclampsia, large-for-gestational-age babies, neonatal hypoglycaemia), as well as the longer term implications, such as increased risk of type 2 diabetes and cardiovascular disease.^2,11,23 They should also be educated on the need for management and what this involves, including self-monitoring of blood glucose concentrations, lifestyle modifications and addressing modifiable risk factors for cardiovascular disease.^2,11,23 Patient resources are available through Diabetes Australia and NDSS.

Blood glucose monitoring

The key to management of gestational diabetes is blood glucose monitoring to ensure glycaemic targets are met (Table 2). Self-monitoring should be performed using capillary (finger-prick) blood testing at least 4 times a day, including a fasting concentration, and a concentration taken 1 or 2 hours after each meal (breakfast, lunch and dinner). However, due to the lack of high-quality evidence on optimal targets, there is some variation across centres in Australia, and local guidelines may be referred to.¹¹ If targets are not being achieved following diet and lifestyle modifications, antihyperglycaemic pharmacological therapy is the next step in management.

Table 2 Glycaemic targets for gestational diabetes²³

Glycaemic parameter	Blood glucose target
fasting capillary blood glucose concentration	less than 5.3 mmol/L
AND EITHER
1-hour postprandial glucose	less than 7.8 mmol/L
OR
2-hour postprandial glucose	less than 6.7 mmol/L

Lifestyle modifications

First-line treatment for optimising glycaemic management is lifestyle modifications, including providing advice on physical activity, nutrition, and weight management, depending on the patient's pre-pregnancy weight.^2,23 Cultural dietary preferences need to be taken into consideration when providing nutritional advice, with a focus on modest intake of low–glycaemic index carbohydrates.²⁴ Pooled data from trials that implemented modified dietary interventions in women with gestational diabetes found there was a greater reduction in fasting and postprandial glucose concentrations, and a lower need for pharmacological therapy, compared with no dietary intervention. There was also an improvement in neonatal outcomes, such as lower birth weight and reduced macrosomia; however, quality of evidence was low because of limitations in the design of the trials.²⁵ In a survey of diabetes in pregnancy services in Australia and New Zealand, diet alone was used for glycaemic management in 39.4% (ranging from 28.8 to 57.3% across centres) of women diagnosed with gestational diabetes.²⁶

Pharmacological therapies

In Australia, insulin is the pharmacological therapy of choice in most centres; however, metformin is also sometimes used.⁴ Other antihyperglycaemic therapies should not be used in pregnancy.

Insulin

In Australia, insulin is most commonly administered as multiple daily injections of rapid-acting insulin analogues, or a single longer acting injection, or both. Multiple daily injections can be administered before meals (e.g. NovoRapid [insulin aspart], Humalog [insulin lispro]) and a longer acting insulin at night (e.g. Humulin NPH [insulin isophane]).²⁷ Depending on the availability of Humulin NPH, Optisulin (insulin glargine U100) for the management of fasting hyperglycaemia may need to be considered. Fixed-dose biphasic insulin, such as NovoMix 30 (insulin aspart and insulin aspart protamine) and Humalog Mix25 (insulin lispro and insulin lispro protamine), may be considered for patients unable to use multiple daily injections.

There are limited data on the safety and effectiveness of newer insulin analogues in gestational diabetes, such as Fiasp (fast-acting insulin aspart), Toujeo (insulin glargine U300) and Ryzodeg (insulin degludec and insulin aspart), such that they are not routinely used for this condition in Australia.

The number of injections and doses depends on the individual's glycaemic profile, with rapid-acting insulin used to manage elevated postprandial glucose and longer acting insulin used to manage elevated fasting glucose. Protocols that guide self-titration of insulin doses are increasingly being used when appropriate.

Metformin

Metformin has been widely used in the treatment of hyperglycaemia.²⁸ However, there is conflicting evidence regarding its safety and efficacy in gestational diabetes. Metformin alone has been found to be insufficient to achieve adequate glycaemic management in 14 to 46% of women with gestational diabetes, necessitating the addition of insulin therapy.²³ However, metformin has been associated with less maternal weight gain and lower rates of neonatal hypoglycaemia when compared with insulin.²⁹

Although metformin crosses the placenta, clinical trial and observational data have not shown any evidence of teratogenicity.²⁸ In an open-label randomised controlled trial of women with gestational diabetes (n=363), metformin (either alone or in combination with insulin) was not associated with increased perinatal complications compared with insulin alone (32.0% versus 32.2%, respectively).³⁰ In a follow-up trial, children of women treated with metformin were assessed at 9 years of age (n=45), and were found to be larger by various anthropometric measures (e.g. body weight, waist circumference) than the children exposed to insulin (n=54).³¹ However, this outcome was not observed among children assessed at 7 years of age (n=58 metformin, n=51 insulin).³¹ While these findings raise some concern about the longer term impacts of metformin on the offspring, interpretation needs to be with caution as there was incomplete participant follow-up.

A large retrospective, register-based cohort study found that maternal exposure to metformin (alone or in combination with insulin) was not correlated with long-term obesity, dysglycaemia, or diabetes risk in children compared with insulin alone, but was associated with increased risk of small-for-gestational-age infants.³²This finding was also reported in a meta-analysis.³³ Metformin should therefore be avoided in the setting of intrauterine growth restriction, in women with low body mass index and inadequate weight gain, and in women with pre-eclampsia.

While not currently endorsed by ADIPS for routine use in the treatment of gestational diabetes, the appropriateness of metformin use should be evaluated on an individual basis.⁴ Metformin may be appropriate in the presence of maternal needle phobia, for limiting insulin use, or in context of excessive maternal weight gain with insulin. A detailed discussion with individual women is warranted, clearly outlining the potential benefits and harms with use during pregnancy.²⁸

Other antihyperglycaemic therapies

Other non-insulin antihyperglycaemic drugs used for the treatment of diabetes are not recommended for the treatment of gestational diabetes in Australia.³⁴ These include sodium-glucose co-transporter 2inhibitors, glucagon-like peptide-1 (GLP-1) receptor agonists, dual glucose-dependent insulinotropic polypeptide and GLP-1 receptor agonists, and dipeptidyl peptidase-4 inhibitors. These drugs have limited data on their use in pregnancy and, through known mechanisms of action, have potential to cause fetal harm.

Sulfonylureas, with glibenclamide mostly studied, have been associated with adverse neonatal outcomes, including macrosomia, hypoglycaemia and respiratory distress, and are not recommended in Australia.³⁴

 

Maternal postpartum care and follow-up

Approximately 85% of women with gestational diabetes have resolution of hyperglycaemia following delivery.³⁵ Insulin therapy, when required, is usually stopped when active labour starts or delivery via caesarean section occurs. In the early stages of labour, or if fasting for a caesarean section, insulin doses may be reduced (e.g. by about one-third depending on individual patient factors).

All women diagnosed with gestational diabetes should undergo a 75-g 2-hour oral glucose tolerance test 6 to 12 weeks postpartum to check for persistent hyperglycaemia using the nonpregnant diagnostic cut-offs (Table 1).^1,4 Women who develop gestational diabetes often have a predisposition to underlying islet beta cell dysfunction or insulin resistance, which is unmasked by the added physiological stress of pregnancy.⁸ The recurrence rate of gestational diabetes in subsequent pregnancies is reported to be between 39 and 73%.³⁶

Women diagnosed with overt diabetes in pregnancy should also be re-evaluated after pregnancy, as only some will meet the diagnostic criteria for diabetes after pregnancy.³⁷

Lifelong surveillance is recommended following diagnosis of gestational diabetes, as there is increased risk of developing type 2 diabetes in 50 to 60% of women 10 years after their pregnancy.² Registrants of the National Gestational Diabetes Register will receive a 'Life after gestational diabetes' booklet and reminders for diabetes screening. Assessment of glycaemic management using HbA1c, fasting plasma glucose or oral glucose tolerance test should be performed every 1 to 3 years depending on risk stratification and future pregnancy plans.^4,23 In women planning another pregnancy after gestational diabetes, the oral glucose tolerance test is the optimal test for diagnosis of prediabetes. As gestational diabetes is also associated with an increased risk of cardiovascular disease (twofold), cardiovascular disease risk factors should be regularly assessed and managed.³⁸

Optimisation of lifestyle factors remains key in prevention of progression to type 2 diabetes. Surveillance provides an avenue for early detection and subsequent commencement of appropriate therapies to prevent progression to uncontrolled hyperglycaemia and diabetes-related complications.

 

Conclusion

All women should be screened at 24 to 28 weeks gestation, and those with high-risk features should be tested in early pregnancy. Lifestyle modifications, plus insulin if pharmacological therapy is required, remain the mainstay of treatment. All women diagnosed with gestational diabetes should be screened lifelong for the development of type 2 diabetes and cardiovascular disease.

This article was finalised on 15 September 2025.

Conflicts of interest: Christopher Nolan was a chief investigator on the Treatment of Booking Gestational Diabetes Mellitus study, which was funded by the National Health and Medical Research Council. Christopher has received support from the Canberra Hospital Private Practice Fund to attend conferences related to diabetes in pregnancy and has contributed to the development of various guidelines on diabetes, including the Australian Evidence-based Clinical Guidelines for Diabetes. Christopher received an honorarium for his role as a Diabetologia advisory board member from 2020 to 2022.

Stephanie Baddock and Carolyn Petersons have no conflicts of interest to declare.

This article is peer reviewed.

 

References

1. American Diabetes Association Professional Practice Committee. Diagnosis and Classification of Diabetes: Standards of Care in Diabetes-2025. Diabetes Care 2025;48:S27-S49.
2. Sweeting A, Hannah W, Backman H, Catalano P, Feghali M, Herman WH, et al. Epidemiology and management of gestational diabetes. Lancet 2024;404:175-92.
3. Diabetes Australia. Position Statement: Gestational Diabetes in Australia. 2020. [cited 2025 Aug 19]
4. Nankervis A, McIntyre HD, Moses R, Ross GP, Callaway L, Porter C, et al. ADIPS consensus guidelines for the testing and diagnosis of gestational diabetes mellitus in Australia. 2014. [cited 2025 Aug 19]
5. Australian Institute of Health and Welfare. Diabetes: Australia Facts. 2024. [cited 2025 Aug 19]
6. Laurie JG, McIntyre HD. A Review of the Current Status of Gestational Diabetes Mellitus in Australia-The Clinical Impact of Changing Population Demographics and Diagnostic Criteria on Prevalence. Int J Environ Res Public Health 2020;17.
7. Moses RG, Wong VC, Lambert K, Morris GJ, San Gil F. The prevalence of hyperglycaemia in pregnancy in Australia. Aust N Z J Obstet Gynaecol 2016;56:341-5.
8. Hivert MF, Backman H, Benhalima K, Catalano P, Desoye G, Immanuel J, et al. Pathophysiology from preconception, during pregnancy, and beyond. Lancet 2024;404:158-74.
9. Hapo Study Cooperative Research Group, Metzger BE, Lowe LP, Dyer AR, Trimble ER, Chaovarindr U, et al. Hyperglycemia and adverse pregnancy outcomes. N Engl J Med 2008;358:1991-2002.
10. McIntyre HD, Catalano P, Zhang C, Desoye G, Mathiesen ER, Damm P. Gestational diabetes mellitus. Nat Rev Dis Primers 2019;5:47.
11. Sina M, Cade TJ, Flack J, Nolan CJ, Rajagopal R, Wong V, et al. Antenatal models of care for women with gestational diabetes mellitus: Vignettes from an international meeting. Aust N Z J Obstet Gynaecol 2020;60:720-8.
12. Sweeting A, Hare MJ, de Jersey SJ, Shub AL, Zinga J, Foged C, et al. Australasian Diabetes in Pregnancy Society (ADIPS) 2025 consensus recommendations for the screening, diagnosis and classification of gestational diabetes. Med J Aust 2025;223:161-7.
13. Diagnostic criteria and classification of hyperglycaemia first detected in pregnancy: a World Health Organization Guideline. Diabetes Res Clin Pract 2014;103:341-63.
14. International Association of Diabetes and Pregnancy Study Groups Consensus Panel, Metzger BE, Gabbe SG, Persson B, Buchanan TA, Catalano PA, et al. International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care 2010;33:676-82.
15. Li Y, Ren X, He L, Li J, Zhang S, Chen W. Maternal age and the risk of gestational diabetes mellitus: A systematic review and meta-analysis of over 120 million participants. Diabetes Res Clin Pract 2020;162:108044.
16. McIntyre HD, Sacks DA, Barbour LA, Feig DS, Catalano PM, Damm P, et al. Issues With the Diagnosis and Classification of Hyperglycemia in Early Pregnancy. Diabetes Care 2016;39:53-4.
17. Simmons D, Immanuel J, Hague WM, Teede H, Nolan CJ, Peek MJ, et al. Treatment of Gestational Diabetes Mellitus Diagnosed Early in Pregnancy. N Engl J Med 2023;388:2132-44.
18. Jokelainen M, Kautiainen H, Nenonen A, Stach-Lempinen B, Klemetti MM. First-trimester HbA(1c) in relation to plasma glucose concentrations in an oral glucose tolerance test at 12 to 16 weeks' gestation-a population-based study. Diabetol Metab Syndr 2024;16:53.
19. Hughes RC, Moore MP, Gullam JE, Mohamed K, Rowan J. An early pregnancy HbA1c >/=5.9% (41 mmol/mol) is optimal for detecting diabetes and identifies women at increased risk of adverse pregnancy outcomes. Diabetes Care 2014;37:2953-9.
20. Kattini R, Hummelen R, Kelly L. Early Gestational Diabetes Mellitus Screening With Glycated Hemoglobin: A Systematic Review. J Obstet Gynaecol Can 2020;42:1379-84.
21. Crowther CA, Hiller JE, Moss JR, McPhee AJ, Jeffries WS, Robinson JS, et al. Effect of treatment of gestational diabetes mellitus on pregnancy outcomes. N Engl J Med 2005;352:2477-86.
22. Landon MB, Spong CY, Thom E, Carpenter MW, Ramin SM, Casey B, et al. A multicenter, randomized trial of treatment for mild gestational diabetes. N Engl J Med 2009;361:1339-48.
23. American Diabetes Association Professional Practice Committee. Management of Diabetes in Pregnancy: Standards of Care in Diabetes-2025. Diabetes Care 2025;48:S306-S20.
24. Sweeting A, Mijatovic J, Brinkworth GD, Markovic TP, Ross GP, Brand-Miller J, et al. The Carbohydrate Threshold in Pregnancy and Gestational Diabetes: How Low Can We Go? Nutrients 2021;13.
25. Yamamoto JM, Kellett JE, Balsells M, Garcia-Patterson A, Hadar E, Sola I, et al. Gestational Diabetes Mellitus and Diet: A Systematic Review and Meta-analysis of Randomized Controlled Trials Examining the Impact of Modified Dietary Interventions on Maternal Glucose Control and Neonatal Birth Weight. Diabetes Care 2018;41:1346-61.
26. Immanuel J, Flack J, Wong VW, Yuen L, Eagleton C, Graham D, et al. The ADIPS Pilot National Diabetes in Pregnancy Benchmarking Programme. Int J Environ Res Public Health 2021;18.
27. Donovan PJ, McIntyre HD. Drugs for gestational diabetes. Aust Prescr 2010;33:141-4.
28. Newman C, Rabbitt L, Ero A, Dunne FP. Focus on Metformin: Its Role and Safety in Pregnancy and Beyond. Drugs 2023;83:985-99.
29. Balsells M, Garcia-Patterson A, Sola I, Roque M, Gich I, Corcoy R. Glibenclamide, metformin, and insulin for the treatment of gestational diabetes: a systematic review and meta-analysis. BMJ 2015;350:h102.
30. Rowan JA, Hague WM, Gao W, Battin MR, Moore MP, Mi GTI. Metformin versus insulin for the treatment of gestational diabetes. N Engl J Med 2008;358:2003-15.
31. Rowan JA, Rush EC, Plank LD, Lu J, Obolonkin V, Coat S, et al. Metformin in gestational diabetes: the offspring follow-up (MiG TOFU): body composition and metabolic outcomes at 7-9 years of age. BMJ Open Diabetes Res Care 2018;6:e000456.
32. Brand KMG, Saarelainen L, Sonajalg J, Boutmy E, Foch C, Vaarasmaki M, et al. Metformin in pregnancy and risk of adverse long-term outcomes: a register-based cohort study. BMJ Open Diabetes Res Care 2022;10.
33. Tarry-Adkins JL, Aiken CE, Ozanne SE. Neonatal, infant, and childhood growth following metformin versus insulin treatment for gestational diabetes: A systematic review and meta-analysis. PLoS Med 2019;16:e1002848.
34. Rudland VL, Price SAL, Hughes R, Barrett HL, Lagstrom J, Porter C, et al. ADIPS 2020 guideline for pre-existing diabetes and pregnancy. Aust N Z J Obstet Gynaecol 2020;60:E18-E52.
35. Noctor E, Crowe C, Carmody LA, Saunders JA, Kirwan B, O'Dea A, et al. Abnormal glucose tolerance post-gestational diabetes mellitus as defined by the International Association of Diabetes and Pregnancy Study Groups criteria. Eur J Endocrinol 2016;175:287-97.
36. Schwartz N, Nachum Z, Green MS. The prevalence of gestational diabetes mellitus recurrence--effect of ethnicity and parity: a metaanalysis. Am J Obstet Gynecol 2015;213:310-7.
37. Wong T, Ross GP, Jalaludin BB, Flack JR. The clinical significance of overt diabetes in pregnancy. Diabet Med 2013;30:468-74.
38. Kramer CK, Campbell S, Retnakaran R. Gestational diabetes and the risk of cardiovascular disease in women: a systematic review and meta-analysis. Diabetologia 2019;62:905-14.