# No single agreed way to diagnose gestational diabetes

Bottleneck · id `maternal:bottleneck-gdm-diagnostic-criteria` · Maternal & Newborn Atlas · release `c7fb95f1d15a7d13` (public)

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Browse, life stage: Pregnancy  
Browse, care area: Pregnancy conditions  

## In plain language

Doctors use two main ways to test for gestational diabetes, a one-step and a two-step approach, and they do not label the same women. In a large US trial, about 16.5% of women were diagnosed with the one-step approach and about 8.5% with the two-step approach. The trial found no significant difference in the main pregnancy outcomes between the two, so it is still debated which approach is better.

## Technical summary

The ScreenR2GDM abstract (NEJM 2021) states that experts recommend universal screening but that consensus is lacking on which of the two recommended approaches to use. Diagnosis rates were 16.5% and 8.5% (unadjusted relative risk 1.94, 97.5% CI 1.79 to 2.11); adherence to the assigned approach was 66% and 92%; the primary outcomes did not differ significantly. The IADPSG consensus report recommends a one-step 75-g test; a 2021 US screening statement does not choose a test. Current efforts listed are the screening test page and that statement.

## Connected pages

- Filed under this front: Screening and tests (`maternal:front-screening-and-tests`)
- Choice of test and thresholds: Glucose tests for gestational diabetes (one-step and two-step) (`maternal:gdm-glucose-screening-test`)

## Provenance

Content hash: 50502d93fc1532cb7ba4f59aeecda26a80308440a22dcc804e19719a19d2e8c2
Last substantive edit: 2026-10-14
Evidence last checked: 2026-10-14