The pregnancy risk hiding in plain sight. And why women aren’t being told about it
Pregnant women rely on a gestational diabetes test that often fails in real clinical settings - but emerging technologies offer a safer path forward
If you talk to women about pregnancy, most expect to hear about morning sickness, swollen ankles, and hospital visits. What hardly anyone expects is the idea that a simple testing gap, a missed appointment, a delayed sample, or an inaccurate result, could shape the entire course of their pregnancy.
Yet that is exactly what is happening with gestational diabetes (GDM), the most common medical condition in pregnancy affecting one in seven women globally. It is also a condition that in the UK the NHS is still struggling to detect reliably. Some Trusts and clinical teams deliver excellent GDM pathways, but nationally the system remains inconsistent, and too many women still slip through the gaps.
For many women, GDM is something they’ve vaguely heard of, but don’t fully understand. ‘Isn’t that just high sugar?’ ‘Doesn’t it go away after birth?’ “Doesn’t it just affect overweight mothers?’ ‘Does it really matter?’
The honest answer is: it matters a lot, and we are not talking about it nearly enough.
Here’s an example. A woman in her third trimester attends her routine glucose test, waits for hours, and eventually gets the call: ‘everything’s normal.’ She feels reassured. But the test was processed late, and the glucose in her blood sample degraded before it reached the lab. In reality, she did have gestational diabetes but she didn’t receive the diagnosis that would have protected her and her baby.
This isn’t a hypothetical story. Versions of it play out every day across the NHS.
A known issue
We’ve known about this vulnerability for years. Back in 2019, a major UK study across 41 maternity units uncovered something that should have set off national alarm bells. Women who were ‘at risk’ of GDM but weren’t screened had a 44% higher risk of late stillbirth. Women with raised fasting glucose who weren’t diagnosed had a four-fold increase in stillbirth risk. And when those same women were diagnosed and treated? The excess risk disappeared.
But stillbirth isn’t the only danger. Missed GDM is also linked to preeclampsia, dangerously large babies, obstructed labour, emergency caesareans, birth trauma, neonatal hypoglycaemia, and babies needing intensive care. Longer term, it increases a mother’s risk of developing type 2 diabetes, and raises the chance of future metabolic problems for her child.
The fact is:
Diagnosis saves lives.
Missed diagnosis puts them at risk.
It really is that simple.
And yet, since that study was published, very little has changed.
Missing real cases
More recent NIHR-funded research shows that the NHS’s standard test for GDM can miss over half of real cases. Not because staff don’t care, and not because women aren’t trying to attend their appointments, but because the test itself is incredibly sensitive to timing. Glucose in blood starts dropping within minutes of being taken. If the sample isn’t processed fast enough, and in a busy NHS hospital it often isn’t, the result may look normal even when it isn’t.
And that’s before you even consider how hard it can be to get to the test in the first place. The OGTT is usually offered as a single early-morning, weekday slot, and for many women, especially those working shifts, juggling childcare or relying on long public-transport journeys, that window simply isn’t realistic. This problem isn’t felt equally. Black and Asian women, and women in lower-income or insecure jobs, are more likely to face these barriers and more likely to be at higher risk of GDM in the first place. Often, if you can’t make the allotted slot, you’re not easily offered an alternative appointment. So some women end up missing testing not through choice, but because the system isn’t designed around their lives, or the lives of the women most at risk.
And that’s the heartbreaking part: the women who stand to benefit most from early diagnosis are often the ones who never get the chance
Not a nice-to-have
We know that GDM testing in pregnancy matters. That is why the NHS does it in the first place. Screening for gestational diabetes isn’t a nice-to-have; it’s one of the few tools we have to catch a condition that can cause real harm if left untreated. But testing only protects women when it’s done accurately. When the process breaks down, when blood samples are delayed, when appointments are hard to access, when results aren’t reliable, the system gives women false reassurance.
And that’s where the real danger lies. Because when no one is looking for the risk, it stays hidden. GDM is a condition we can manage safely when we know about it. The real harm comes from the cases we never catch.
The consequences of missed GDM aren’t small or abstract. And even after pregnancy ends, the effects can linger. Women with GDM have a significantly higher chance of developing type 2 diabetes later on yet the National GDM Audit found that only 57% receive the recommended postnatal check and only 4.5% of affected women enter the Diabetes Prevention Programme. Their children also face higher risks of diabetes and obesity later in life.
Despite this, and the fact that some estimates show around 1 in 5 are affected, GDM rarely makes headlines. Unlike other maternity issues that spark national discussion, this one sits quietly in the background hidden behind technical language, outdated processes and fragmented responsibility. Maternity teams focus on births, diabetes teams focus on treatment after diagnosis, labs focus on processing, and no single part of the system owns the question of whether the test actually works.
And that’s the heart of the problem. When everyone owns a slice of an issue, no one feels responsible for solving it.
A cultural shift is needed
So what needs to change?
Women deserve clearer explanations about GDM, its risks, and why testing matters. Screening pathways need to be easier to access, and above all, we need a cultural shift that treats GDM as a core women’s health issue, not a footnote.
There’s also a warning for the future. Current data already shows that when GDM testing is pushed out into community settings without the right safeguards, even more cases are missed. And as the NHS shifts more care into the community in line with its 10-Year Plan, that risk will only increase unless the testing pathway itself changes. Without action, the gaps we see today won’t just continue, they’ll grow.
The good news is that innovation is happening, even if the system has been slow to embrace it. One of the unspoken reasons is fear: fear that better testing will uncover more cases, increase clinical workload and stretch already pressured services. But avoiding diagnosis doesn’t reduce the problem; it just leaves women at risk. New approaches, including at-home testing models developed by organisations like Digostics, are emerging specifically to reduce missed diagnoses and make screening easier to access. They show what becomes possible when women’s health is taken seriously and when technology is designed around real lives, not service pressures.
Because the real danger isn’t the diagnosis. It’s the women who never get one, because no one ever told them they were at risk.