Our symposium for health professionals on gestational diabetes screening continues a vital discussion, writes ZOE DELEUIL.
In line with global trends, gestational diabetes (GDM) is the fastest-rising diabetes in Australia, with cases tripling over the last decade.
Here at Diabetes WA, we are committed to ensuring women are being screened and diagnosed with GDM equally, accurately and at the right time. This ensures that women get the support they need through pregnancy and after delivery, improving the short- and long-term health of both mothers and babies.
To talk about ways of doing this, particularly given the challenges of timely screening in rural and remote areas, Diabetes WA hosted a symposium for health professionals this August.
We were joined by some leading voices in the field, including Professor Claire Meek, Dr Zoe Bradfield, Doctor Emma Jamieson, UWA research fellow Erica Spry, Dr Janet Hornbuckle and Associate Professor Lewis MacKinnon.
From Diabetes WA we heard from CEO Melanie Gates, diabetes educator Tara Stevens and endocrinologist Greg Ong.
The limitations of current GDM screening
Central to the conversation was the effectiveness of the oral glucose tolerance test, or OGTT. This is the standard test for diagnosing gestational diabetes and was designed more than 50 years ago.
According to research, Australian women are increasingly declining the OGTT, a trend mirrored in the UK. Some women are doing their own research and choosing not to take the test. It’s also an issue of equity. Taking a morning to attend the appointment is harder for those with inflexible work schedules, caring responsibilities, transport issues or limited family support. For patients navigating the health system in a second language, or without access to Medicare rebates, barriers are even higher.
“It is a tricky test. There are so many competing interests for a women’s time,” says Dr Jamieson. “Women must fast overnight, then sit and wait in the clinic for two hours. They may have to organise childcare or time off work. Our original audit showed that half of women in rural and remote WA were not getting the test, and as a result we are likely missing their gestational diabetes.”
Not only that, but blood glucose samples are notoriously unstable, which means that, even when women are screened, many gestational diabetes diagnoses are missed.
This is something that Dr Meek also found in a UK study.
“It’s been known for some time in clinical biochemistry circles that processing speed and time makes a difference to the amount of glucose in a blood sample. What we didn’t know was the extent of those misdiagnoses in real life. I was fully expecting we would be missing some cases of gestational diabetes. I did not expect it to be half.”
The impact of a missed diagnosis
A sobering statistic is that women at risk of GDM, but not screened, experienced a 44% greater risk of late stillbirth than those not at risk.
Accurate GDM screening is crucial, not only for the pregnancy but for both mothers’ and babies’ long-term health. It can pick up gestational diabetes and identify existing pre-diabetes, undiagnosed type 2 diabetes and early type 1 diabetes.
“We find that women who were not diagnosed but had blood glucose levels consistent with GDM had a higher (almost 40% rate) of a larger baby,” said Dr Meek. “This increased the rate of C-sections, many of which were preventable.
However, if diagnosed in time, women can be supported to do many things that can improve outcomes, including seeing a dietitian, upping their exercise (particularly after meals), tracking their weight gain and, in some cases, taking insulin or metformin.
The way forward
The symposium is part of an ongoing conversation about where healthcare providers focus their attention in the future of GDM care. One option on the table is an at-home test, which has already been trialled in some areas of the UK.
Another prominent topic was the 2025 change to the ADIPS (Australian Diabetes in Pregnancy) guidelines, which increased the blood glucose cut-off point for GDM diagnosis. The implications of this, including the need to focus resources on the highest-risk women, were discussed.
“I think the new ADIPS guidelines tread this very fine line between too much and too little testing,” said Dr Meeks. “There’s now more of a focus on early testing to look for women who are entering pregnancy, who already have high glucose levels, and I think that’s really appropriate for the community we have now.”
Dr Janet Hornbuckle agreed, observing that the Maternity Dashboard, which tracks all pregnancy outcomes in Western Australian since 2016, indicated that according to current risk criteria, seven out of eight women will be recommended for an early HbA1c test in pregnancy.
“So we’re actually almost doing universal screening on a massive group of women. And I think by going to HbA1c screening, we’re going to be avoiding giving oral glucose tolerance tests to those women who actually don’t need one to diagnose their hyperglycaemia in pregnancy, which is really important.”
Also mentioned was the fact that while the researchers look at GDM as a system-wide concern, it’s an individual one for women, and building trust and support through pregnancy and beyond is key.
“One area highlighted on the evening was the lack of health professional awareness of the Baby Steps program,” say Diabetes WA’s Sophie McGough. “Since the symposium, we’ve had obstetricians and midwives reach out from King Edward Memorial Hospital, and we’re already exploring working together on some exciting initiatives to support women postnatally.”
Bringing together so many dedicated health professionals under one roof was inspiring for everyone who attended.
“The buzz in the room at the symposium was palpable,” said Sophie. “There were so many conversations about potential future collaborations and ideas that people stayed around afterwards networking for over an hour.”
How Diabetes WA helps women with GDM
Anyone in Western Australia can call our free helpline for advice and support from our team with any questions related to diabetes.
Call 1300 001 880 or email info@diabeteswa.com.au
If you’re living in a regional or rural area of West Australia and are diagnosed with GDM, your GP will refer you to Diabetes WA for support and monitoring throughout your pregnancy and beyond through Telehealth.
We also see women living in metropolitan areas who want to come to our clinic, either through their GP or self-referral. Your first appointment will focus on self-managing your GDM, and after that we will speak every week over the phone or via email.
Supporting women after gestational diabetes
Women who have GDM during pregnancy have a higher risk of developing type 2 diabetes later on.
In Australia, the postpartum Baby Steps online program, offered here through Diabetes WA, is unique in supporting women after GDM.
This free program is designed to empower women to make lifestyle changes, meet other mums and reduce the risk of developing type 2 diabetes. It offers short videos, learning sessions and interactive activities and covers food choices, exercise and managing stress and medications.
Diabetes WA also supports health professionals – please subscribe to our DIALOG e-newsletter below for more information on upcoming events.
