Variation in gestational diabetes diagnosis and care practices in maternity services in three high-income countries; a cross-sectional survey

Objective: International consensus about best diagnostic and care practices for gestational diabetes mellitus (GDM) is limited. We explored variations in GDM practices in relation to national guidelines in the UK, Ireland and Australia. Design: Cross-sectional online survey Setting: UK, Irish and Australian maternity services. Sample: Healthcare professionals providing pregnancy diabetes care. Methods: : Questions addressed guidelines used, diagnostic practices and post-diagnosis management. Data were descriptively analysed. Results: : Sixty-three maternity units participated (35 England and Wales, 12 Ireland, 16 Australia). 94% of units in England and Wales and Australia used their national guidelines to select women for GDM testing, a wider variety of guidelines were used in Ireland. Over 80% of units across countries undertake risk-factor based GDM testing in early pregnancy. At 24-28 weeks’ gestation, 94% of Australian units used universal screening. Risk factors varied between units and countries at both timepoints, including those outside of guidelines. Diagnostic tests for GDM varied between units and countries, and according to gestation and previous GDM. Insulin was the most common first-line treatment in Australia, whereas in Ireland and England and Wales it was Metformin. Induction and caesarean birth were offered at differing gestations according to unit and country, and according to management strategy. Conclusions: : GDM-related practices vary within and between Australia, Ireland and England and Wales. National guidelines are inconsistently applied, which could increase inequalities and impact perinatal outcomes. Further research should address standardised, evidence-informed care and guideline implementation barriers.