Gestational diabetes
Gestational diabetes is diabetes that first appears during pregnancy, usually around the 24th week. It often has no symptoms, so pregnant people are usually tested. It usually goes away after the baby is born, but it raises the chance of developing type 2 diabetes later. It is linked with more risk of pre-eclampsia in the mother and, in the baby, with being larger than average, which can cause shoulder dystocia and birth injury, and with low blood sugar after birth.
- Condition
- In this atlas
Overview
Technical summary
This page is the hub for screening, diagnosis criteria and treatment trials in this atlas. The US Preventive Services Task Force (2021) estimates US prevalence at 5.8% to 9.2% by traditional diagnostic criteria, possibly higher by more inclusive criteria. Which women are labelled with gestational diabetes depends on the diagnostic approach (see the bottleneck page). HAPO relates maternal glucose to outcomes across the range.
Recognition
Often no symptoms; found by blood glucose tests, usually between 24 and 28 weeks of pregnancy.
Burden
The USPSTF reports that the prevalence of gestational diabetes in the United States has been estimated at 5.8% to 9.2% based on traditional diagnostic criteria, although it may be higher if more inclusive criteria are used. It lists preeclampsia among the complications for which pregnant persons with gestational diabetes are at increased risk.
Source problem. A cited source is corrected. Check the sources before relying on this claim.
Applies to Maternal- Pregnant persons who have not been previously diagnosed with type 1 or type 2 diabetes.
- Not stated in the PubMed abstract
- United States (statement of the US Preventive Services Task Force); the abstract names no country.
- Pregnancy
- Gestational age Not reported
- Postnatal age Not reported
- Certainty method
- Not assessed
- Limitations
- This is a background statement in the abstract, not a new analysis, and the abstract does not give the source of the prevalence estimate. The criteria that label a woman as having gestational diabetes differ between approaches (see the page on glucose tests). Fetal and newborn complications that the same abstract lists are not part of this maternal claim. Only the PubMed abstract was read. PubMed links a published erratum (PMID 34609473, Incorrect Value in Table); its correction text was not read, so whether it changes this claim is not known.
- Last checked
- 2026-10-14
- Next evidence check due
- Not scheduled
Sources and citations (2)
-
Supports Screening for Gestational Diabetes: US Preventive Services Task Force Recommendation Statement
- Locator
- Abstract, IMPORTANCE, sentence 2
- How it applies
- PubMed abstract of the USPSTF 2021 statement, background section.
- Retrieved
- Source effective date
- Not reported
- Source state
- Corrected
- Snapshot hash
178631f5dca566eb6af7f1a40ccd4d56431ea24170c6ef78b2942f5e4efccd97- Reuse basis
- PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). Short factual quotations under 25 words, with the citation.
-
Supports Screening for Gestational Diabetes: US Preventive Services Task Force Recommendation Statement
- Locator
- Abstract, IMPORTANCE, sentence 3
- How it applies
- PubMed abstract of the USPSTF 2021 statement, background section.
- Retrieved
- Source effective date
- Not reported
- Source state
- Corrected
- Snapshot hash
178631f5dca566eb6af7f1a40ccd4d56431ea24170c6ef78b2942f5e4efccd97- Reuse basis
- PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). Short factual quotations under 25 words, with the citation.
Claims and evidence
Context HAPO women with blinded 75-g glucose tolerance test data
- Recipient
- Maternal
- Population
- Pregnant women in the HAPO study who had 75-g oral glucose-tolerance testing at 24 to 32 weeks of gestation, 23,316 of whom had blinded data. The outcome in this context is primary cesarean delivery.
- Care setting
- 15 centers in nine countries; the abstract does not describe the settings or name the countries.
- Geography
- Not stated in the PubMed abstract
- Life stage
- Pregnancy (testing at 24 to 32 weeks) and delivery
- Gestational age
- at least 24 weeks 0 days (168 days), measured at the time of measurement
- Postnatal age
- Not reported
- Follow-up
- From the 24 to 32 week test to delivery
Eligibility: 1 inclusion criterion; 1 exclusion criterion
- Included
- Pregnant women who had a 75-g oral glucose-tolerance test at 24 to 32 weeks of gestation
- Excluded
- Women whose data were unblinded: fasting plasma glucose above 105 mg per deciliter (5.8 mmol per liter) or 2-hour plasma glucose above 200 mg per deciliter (11.1 mmol per liter)
In the HAPO study, among 23,316 participants with blinded data, an increase of 1 standard deviation in the fasting, 1-hour and 2-hour plasma glucose at a 75-g oral glucose-tolerance test (24 to 32 weeks of gestation) was associated, in that order, with adjusted odds ratios for primary cesarean delivery of 1.11 (95% CI 1.06 to 1.15), 1.10 (1.06 to 1.15) and 1.08 (1.03 to 1.12).
Applies to Maternal- Pregnant women in the HAPO study who had 75-g oral glucose-tolerance testing at 24 to 32 weeks of gestation, 23,316 of whom had blinded data. The outcome in this context is primary cesarean delivery.
- 15 centers in nine countries; the abstract does not describe the settings or name the countries.
- Not stated in the PubMed abstract
- Pregnancy (testing at 24 to 32 weeks) and delivery
- Gestational age at least 24 weeks 0 days, measured at the time of measurement
- Postnatal age Not reported
- Certainty method
- Not assessed
- Limitations
- An observational study, so these are associations. Data stayed blinded only if the fasting glucose was 105 mg per deciliter or less and the 2-hour glucose was 200 mg per deciliter or less. The abstract names primary cesarean delivery as one of four primary outcomes; the newborn outcomes are in a separate claim. Only the PubMed abstract was read.
- Last checked
- 2026-10-14
- Next evidence check due
- Not scheduled
Sources and citations (5)
-
Supports Hyperglycemia and adverse pregnancy outcomes
- Locator
- Abstract, RESULTS, sentence 2
- How it applies
- PubMed abstract of the HAPO report (NEJM 2008).
- Retrieved
- Source effective date
- Not reported
- Source state
- Current
- Snapshot hash
df9ac5395730e8be76f56156340144b92a85d82ac39a1cd6d4c2f0679a85455c- Reuse basis
- PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). Short factual quotations under 25 words, with the citation.
-
Background Hyperglycemia and adverse pregnancy outcomes
- Locator
- Abstract, METHODS, sentence 1
- How it applies
- Design, methods and the blinded analysis set.
- Retrieved
- Source effective date
- Not reported
- Source state
- Current
- Snapshot hash
df9ac5395730e8be76f56156340144b92a85d82ac39a1cd6d4c2f0679a85455c- Reuse basis
- PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). Short factual quotations under 25 words, with the citation.
-
Background Hyperglycemia and adverse pregnancy outcomes
- Locator
- Abstract, METHODS, sentence 2
- How it applies
- Design, methods and the blinded analysis set.
- Retrieved
- Source effective date
- Not reported
- Source state
- Current
- Snapshot hash
df9ac5395730e8be76f56156340144b92a85d82ac39a1cd6d4c2f0679a85455c- Reuse basis
- PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). Short factual quotations under 25 words, with the citation.
-
Background Hyperglycemia and adverse pregnancy outcomes
- Locator
- Abstract, METHODS, sentence 3
- How it applies
- Design, methods and the blinded analysis set.
- Retrieved
- Source effective date
- Not reported
- Source state
- Current
- Snapshot hash
df9ac5395730e8be76f56156340144b92a85d82ac39a1cd6d4c2f0679a85455c- Reuse basis
- PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). Short factual quotations under 25 words, with the citation.
-
Background Hyperglycemia and adverse pregnancy outcomes
- Locator
- Abstract, RESULTS, sentence 1
- How it applies
- Design, methods and the blinded analysis set.
- Retrieved
- Source effective date
- Not reported
- Source state
- Current
- Snapshot hash
df9ac5395730e8be76f56156340144b92a85d82ac39a1cd6d4c2f0679a85455c- Reuse basis
- PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). Short factual quotations under 25 words, with the citation.
Context Infants born to HAPO women with blinded 75-g glucose tolerance test data
- Recipient
- Newborn
- Population
- Infants born to women in the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study. 25,505 pregnant women at 15 centers in nine countries underwent 75-g oral glucose-tolerance testing at 24 to 32 weeks of gestation; 23,316 participants with blinded data were analysed. The outcomes in this context are counted in the baby: birth weight above the 90th percentile, cord-blood C-peptide above the 90th percentile and neonatal hypoglycemia.
- Care setting
- 15 centers in nine countries; the abstract does not describe the settings or name the countries.
- Geography
- Not stated in the PubMed abstract
- Life stage
- Pregnancy (testing at 24 to 32 weeks) and birth
- Gestational age
- at least 24 weeks 0 days (168 days), measured at the time of measurement
- Postnatal age
- Not reported
- Follow-up
- From the 24 to 32 week test to delivery
Eligibility: 1 inclusion criterion; 1 exclusion criterion
- Included
- Pregnant women who had a 75-g oral glucose-tolerance test at 24 to 32 weeks of gestation
- Excluded
- Women whose data were unblinded: fasting plasma glucose above 105 mg per deciliter (5.8 mmol per liter) or 2-hour plasma glucose above 200 mg per deciliter (11.1 mmol per liter)
In the HAPO study, 25,505 pregnant women at 15 centers in nine countries had a 75-g oral glucose-tolerance test at 24 to 32 weeks of gestation. For the 23,316 participants with blinded data, an increase of 1 standard deviation in the fasting (6.9 mg per deciliter), 1-hour (30.9 mg per deciliter) and 2-hour (23.5 mg per deciliter) plasma glucose was associated, in that order, with adjusted odds ratios for a birth weight above the 90th percentile of 1.38 (95% CI 1.32 to 1.44), 1.46 (1.39 to 1.53) and 1.38 (1.32 to 1.44); for cord-blood C-peptide above the 90th percentile, 1.55 (1.47 to 1.64), 1.46 (1.38 to 1.54) and 1.37 (1.30 to 1.44); and for neonatal hypoglycemia, 1.08 (0.98 to 1.19), 1.13 (1.03 to 1.26) and 1.10 (1.00 to 1.12). The abstract reports no obvious thresholds at which risks increased, and associations with secondary outcomes tended to be weaker.
Applies to Newborn- Infants born to women in the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study. 25,505 pregnant women at 15 centers in nine countries underwent 75-g oral glucose-tolerance testing at 24 to 32 weeks of gestation; 23,316 participants with blinded data were analysed. The outcomes in this context are counted in the baby: birth weight above the 90th percentile, cord-blood C-peptide above the 90th percentile and neonatal hypoglycemia.
- 15 centers in nine countries; the abstract does not describe the settings or name the countries.
- Not stated in the PubMed abstract
- Pregnancy (testing at 24 to 32 weeks) and birth
- Gestational age at least 24 weeks 0 days, measured at the time of measurement
- Postnatal age Not reported
- Certainty method
- Not assessed
- Limitations
- An observational study, so these are associations. Data stayed blinded only if the fasting glucose was 105 mg per deciliter or less and the 2-hour glucose was 200 mg per deciliter or less, so the analysis covers women below those limits. The last interval for neonatal hypoglycemia (1.00 to 1.12) is reported as the PubMed abstract prints it; the full text was not read to check it. Maternal outcomes are in a separate claim. The abstract does not name the 15 centers or the nine countries. Only the PubMed abstract was read.
- Last checked
- 2026-10-14
- Next evidence check due
- Not scheduled
Sources and citations (8)
-
Supports Hyperglycemia and adverse pregnancy outcomes
- Locator
- Abstract, RESULTS, sentence 2
- How it applies
- PubMed abstract of the HAPO report (NEJM 2008).
- Retrieved
- Source effective date
- Not reported
- Source state
- Current
- Snapshot hash
df9ac5395730e8be76f56156340144b92a85d82ac39a1cd6d4c2f0679a85455c- Reuse basis
- PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). Short factual quotations under 25 words, with the citation.
-
Supports Hyperglycemia and adverse pregnancy outcomes
- Locator
- Abstract, RESULTS, sentence 3
- How it applies
- PubMed abstract of the HAPO report (NEJM 2008).
- Retrieved
- Source effective date
- Not reported
- Source state
- Current
- Snapshot hash
df9ac5395730e8be76f56156340144b92a85d82ac39a1cd6d4c2f0679a85455c- Reuse basis
- PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). Short factual quotations under 25 words, with the citation.
-
Supports Hyperglycemia and adverse pregnancy outcomes
- Locator
- Abstract, RESULTS, sentence 4
- How it applies
- PubMed abstract of the HAPO report (NEJM 2008).
- Retrieved
- Source effective date
- Not reported
- Source state
- Current
- Snapshot hash
df9ac5395730e8be76f56156340144b92a85d82ac39a1cd6d4c2f0679a85455c- Reuse basis
- PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). Short factual quotations under 25 words, with the citation.
-
Supports Hyperglycemia and adverse pregnancy outcomes
- Locator
- Abstract, CONCLUSIONS, sentence 1
- How it applies
- PubMed abstract of the HAPO report (NEJM 2008).
- Retrieved
- Source effective date
- Not reported
- Source state
- Current
- Snapshot hash
df9ac5395730e8be76f56156340144b92a85d82ac39a1cd6d4c2f0679a85455c- Reuse basis
- PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). Short factual quotations under 25 words, with the citation.
-
Background Hyperglycemia and adverse pregnancy outcomes
- Locator
- Abstract, METHODS, sentence 1
- How it applies
- Design, methods and the blinded analysis set.
- Retrieved
- Source effective date
- Not reported
- Source state
- Current
- Snapshot hash
df9ac5395730e8be76f56156340144b92a85d82ac39a1cd6d4c2f0679a85455c- Reuse basis
- PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). Short factual quotations under 25 words, with the citation.
-
Background Hyperglycemia and adverse pregnancy outcomes
- Locator
- Abstract, METHODS, sentence 2
- How it applies
- Design, methods and the blinded analysis set.
- Retrieved
- Source effective date
- Not reported
- Source state
- Current
- Snapshot hash
df9ac5395730e8be76f56156340144b92a85d82ac39a1cd6d4c2f0679a85455c- Reuse basis
- PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). Short factual quotations under 25 words, with the citation.
-
Background Hyperglycemia and adverse pregnancy outcomes
- Locator
- Abstract, METHODS, sentence 3
- How it applies
- Design, methods and the blinded analysis set.
- Retrieved
- Source effective date
- Not reported
- Source state
- Current
- Snapshot hash
df9ac5395730e8be76f56156340144b92a85d82ac39a1cd6d4c2f0679a85455c- Reuse basis
- PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). Short factual quotations under 25 words, with the citation.
-
Background Hyperglycemia and adverse pregnancy outcomes
- Locator
- Abstract, RESULTS, sentence 1
- How it applies
- Design, methods and the blinded analysis set.
- Retrieved
- Source effective date
- Not reported
- Source state
- Current
- Snapshot hash
df9ac5395730e8be76f56156340144b92a85d82ac39a1cd6d4c2f0679a85455c- Reuse basis
- PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). Short factual quotations under 25 words, with the citation.
Clinical links
Each link reports what one cited claim says about one population. "Evaluated for" means studied, not shown to work. These links do not show that anything is effective or right for you.
-
Claim, not a settled fact Recommended for this: Glucose tests for gestational diabetes (one-step and two-step)
Applies to Maternal- Asymptomatic pregnant persons who have not been previously diagnosed with type 1 or type 2 diabetes, at 24 weeks of gestation or after.
- Not stated in the PubMed abstract
- United States (statement of the US Preventive Services Task Force); the abstract names no country.
- Pregnancy, 24 weeks of gestation or after
- Gestational age at least 24 weeks 0 days, measured at the time of measurement
- Postnatal age Not reported
The USPSTF recommends screening for gestational diabetes in asymptomatic pregnant persons at 24 weeks of gestation or after. It grades this a B recommendation and concludes with moderate certainty that there is a moderate net benefit to screening for gestational diabetes at 24 weeks of gestation or after to improve maternal and fetal outcomes.Source problem. A cited source is corrected. Check the sources before relying on this claim.
Limitations. The recommendation is for screening in general. It does not choose between the one-step and two-step tests, which is why it is linked to the page on glucose tests. PubMed links a published erratum (PMID 34609473, titled Incorrect Value in Table); its PubMed and PMC records hold only the title and no correction text (the correction is in the journal PDF, which was not fetched), so whether it changes anything in this claim is not known. The PubMed abstract prints each grade after its statement, so the B appears at the start of the next sentence. USPSTF certainty levels are the task force’s own wording and not a GRADE rating. Only the PubMed abstract was read.
-
Claim, not a settled fact Treated by: Treatment of gestational diabetes (diet, glucose monitoring, insulin or metformin)
Applies to Mixed recipients- Infants of the 490 women in the intervention group and the 510 women in the routine-care group. The outcomes in this context are serious perinatal complications (death, shoulder dystocia, bone fracture and nerve palsy) and admission to the neonatal nursery. The composite includes deaths before or around birth, so the context covers fetuses and newborns and is not split by recipient.
- Not stated in the PubMed abstract
- Not stated in the PubMed abstract
- Birth and the neonatal period
- Gestational age Not reported
- Postnatal age Not reported
In the ACHOIS randomized trial, women with gestational diabetes between 24 and 34 weeks of gestation were assigned to dietary advice, blood glucose monitoring and insulin therapy as needed (intervention group) or to routine care. The rate of serious perinatal complications (death, shoulder dystocia, bone fracture and nerve palsy) was significantly lower among the infants of the 490 women in the intervention group than among the infants of the 510 women in the routine-care group (1 percent versus 4 percent; relative risk adjusted for maternal age, race or ethnic group and parity 0.33, 95 percent confidence interval 0.14 to 0.75; P=0.01). More infants of women in the intervention group were admitted to the neonatal nursery (71 percent versus 61 percent; adjusted relative risk 1.13, 95 percent confidence interval 1.03 to 1.23; P=0.01).Limitations. Only the PubMed abstract was read. The abstract gives no gestational-diabetes criteria (each trial used its own, so results from different trials are kept in separate claims), no blinding details and no counts of events, so none are recorded. The trial tested a package (diet, monitoring and insulin as needed) against routine care; it does not show the effect of any single part. Maternal outcomes are in a separate claim.
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Claim, not a settled fact Evaluated for this: Treatment of gestational diabetes (diet, glucose monitoring, insulin or metformin)
Applies to Mixed recipients- Infants of the women in the MFMU trial of treatment for mild gestational diabetes. The primary outcome is a neonatal composite: stillbirth or perinatal death and neonatal complications including hyperbilirubinemia, hypoglycemia, hyperinsulinemia and birth trauma. Secondary outcomes in this context include birth weight, neonatal fat mass, large for gestational age, birth weight above 4000 g and shoulder dystocia. The composite includes deaths before or around birth, so the context covers fetuses and newborns and is not split by recipient.
- Not stated in the PubMed abstract
- United States (the registry lists 16 study locations in the United States).
- Birth and the neonatal period
- Gestational age Not reported
- Postnatal age Not reported
In the MFMU randomized trial in women with mild gestational diabetes, treatment (dietary intervention, self-monitoring of blood glucose, and insulin therapy if necessary) did not significantly reduce the primary outcome, a composite of stillbirth or perinatal death and neonatal complications including hyperbilirubinemia, hypoglycemia, hyperinsulinemia and birth trauma. The composite occurred in 32.4% of the treatment group and 37.0% of the control group (usual prenatal care; P=0.14). There were no perinatal deaths.Limitations. The primary result was not significant and is stated first for that reason; the prespecified secondary outcomes (separate claims) favoured treatment. Only the PubMed abstract and the registry record were read. The abstract gives the percentages but not the numbers of infants analysed. The registry enrollment of 7381 and the 958 women randomized in the paper are different counts; the abstract does not explain the difference and the atlas does not reconcile them. This trial used its own criteria for mild gestational diabetes, so its result is not combined with other trials.
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Claim, not a settled fact Evaluated for this: Treatment of gestational diabetes (diet, glucose monitoring, insulin or metformin)
Applies to Newborn- Infants of 751 women with gestational diabetes at 20 to 33 weeks of gestation who were randomly assigned to open treatment with metformin (with supplemental insulin if required) or insulin. The outcome is a composite of neonatal hypoglycemia, respiratory distress, need for phototherapy, birth trauma, 5-minute Apgar score less than 7, or prematurity.
- Not stated in the PubMed abstract
- Not stated in the PubMed abstract
- Pregnancy (20 to 33 weeks at entry) and the neonatal period
- Gestational age at least 20 weeks 0 days, measured at enrolment
- Postnatal age Not reported
In the MiG randomized trial, 751 women with gestational diabetes at 20 to 33 weeks of gestation were assigned to open treatment with metformin (with supplemental insulin if required) or insulin. The primary composite outcome in the infants occurred in 32.0% of the metformin group and 32.2% of the insulin group (relative risk 0.99, 95% CI 0.80 to 1.23, values the abstract marks as corrected). The authors conclude that metformin, alone or with supplemental insulin, was not associated with increased perinatal complications compared with insulin.Source problem. A cited source is corrected. Check the sources before relying on this claim.
Limitations. This trial compares two drug treatments with each other and says nothing about treatment against no treatment. It was designed to rule out a 33% increase in the composite (from 30% to 40%) with metformin. The abstract gives 751 women in total, of whom 363 were assigned to metformin; of these, 92.6% continued metformin until delivery and 46.3% received supplemental insulin. The abstract marks the relative risk and interval as corrected after an erratum (N Engl J Med 2008;359(1):106, no PubMed id); the corrected values printed in the abstract are used and the erratum text was not read. The abstract also reports findings about the women (treatment preference and adverse events) that are outside this newborn claim. Treatment was open-label. Only the PubMed abstract was read.
Record details
- Record id
maternal:gestational-diabetes- Content hash
39423118504803a0e97a0e0bfeebc01cd47141937908251e8f184d94dd13d7f8