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Understanding Gestational Diabetes: Testing, Accuracy, and Impact on Birth and Choices

Gestational diabetes is a condition that affects pregnant women, causing high blood sugar levels. It typically occurs during the second or third trimester and can have implications for both the mother and the baby. In the United Kingdom, comprehensive testing procedures are in place to identify and monitor gestational diabetes, allowing healthcare professionals to provide appropriate care and support. This blog post will explore what gestational diabetes is, how it is tested in the UK, the accuracy of the tests, and how it can impact birth choices.



  1. What is Gestational Diabetes? Gestational diabetes is a form of diabetes that develops during pregnancy. Hormonal changes and increased insulin resistance are factors that contribute to this condition. The placenta produces hormones that can impair the effectiveness of insulin in managing blood sugar levels, leading to gestational diabetes. While the condition usually resolves after childbirth, it requires careful management during pregnancy. With gestational diabetes, when there is too much sugar remaining in the mother’s bloodstream, this is passed through to the baby. The baby then has to increase its own insulin production to help process the excess sugars. Insulin is a growth hormone and the result is that the baby’s AC (abdominal circumference) increases. It is adipose tissue (subcutaneous fat) caused by the overproduction of insulin which causes the baby to be ‘big’. Controlling blood sugars with diet, exercise and some will also need meds/insulin, this helps the baby to regulate their insulin production to normal levels and the rate of growth of the baby’s AC slows whilst the rest of the baby’s growth catches up. This means that the baby returns to a ‘normal’ growth size.

  2. Testing for Gestational Diabetes in the UK: In the UK, pregnant women with certain risk factors are routinely offered a screening test for gestational diabetes between weeks 24 and 28 of

pregnancy. The test used is called the Oral Glucose Tolerance Test (OGTT). It involves drinking a glucose solution, followed by blood tests to measure how the body processes the glucose. Initially, a fasting blood sample is taken, followed by two additional samples taken one and two hours after consuming the glucose drink. There are alternatives availbe. If glycosuria (glucose in the urine) of 2+ or above on 1 occasion, or of 1+ or above on 2 or more occasions is detected by urine dip test during routine antenatal appointments, this may indicate undiagnosed gestational diabetes and so women with this should be referred for an OGTT.


3. Accuracy of the Test: The OGTT is considered an effective test for detecting gestational diabetes. However, it is important to note that false-positive and false-negative results can occur. False-positive results indicate that a woman is diagnosed with gestational diabetes when she doesn't have it, potentially leading to unnecessary interventions. False-negative results occur when a woman has gestational diabetes but is not diagnosed, which can have adverse effects on both the mother and baby. Follow-up testing may be recommended if there are concerns or risk factors present.


4. Impact on Birth and Birth Choices: Gestational diabetes can have an impact on birth choices in the UK. Women with gestational diabetes may have a higher chance of requiring induction of labour or a cesarean section, especially if the condition is poorly controlled or if other risk factors are present. Regular monitoring of blood sugar levels, dietary adjustments, exercise, and sometimes medication may be necessary to maintain optimal control. Midwives and obstetricians work together to support women with gestational diabetes in making informed decisions about their birth plans, taking into account individual circumstances and preferences. It is worth remembering that taking the test is your choice and not a requirement.

Gestational diabetes is a condition that affects pregnant women and requires careful management to ensure the health of both the mother and the baby. In the UK, the Oral Glucose Tolerance Test (OGTT) is used to screen for gestational diabetes, although false-positive and false-negative results can occur. The diagnosis of gestational diabetes can influence birth choices, with potential implications for the mode of delivery. However, healthcare professionals work closely with women to provide support and guidance in making informed decisions that prioritize the well-being of both mother and baby.


For more information about GD and how it can impact you and baby, we recommend listening to the Midwives Cauldron 2 part podcast episode on GD:





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