Posted on: 21 May 2026
Hello my name is Eleanor
Gestational diabetes mellitus (GDM) affects between 10-20% of pregnancies in the UK, yet until now, there has been no systematic, national picture of how well we are identifying, managing, and supporting women through this condition. That has just changed.
Together with NHS England, I’ve established the first National Audit of Gestational Diabetes, part of the mandatory National Diabetes Audit programme - a landmark step toward ensuring that every woman, regardless of where she lives or which trust manages her care, receives consistently high-quality support from diagnosis through to the postnatal period and beyond.
Why does this matter?
GDM carries real risks: for the baby, there is an increased likelihood of being born too big, birth complications, and a higher lifetime risk of obesity and type 2 diabetes. For the mother, the risks during pregnancy include pre-eclampsia and unplanned caesarean section and up to 50% will go on to develop type 2 diabetes within a decade of their pregnancy. Furthermore, these women are also at increased risk of cardiovascular disease. These are not small numbers. They represent tens of thousands of women and families each year.
Despite NICE guidance providing a clear framework for care for gestational diabetes, audits of local services have repeatedly shown significant variation in practice particularly in postnatal follow-up. Without a national dataset, we have been largely unable to quantify the variation nor drive meaningful improvement at scale.
What does the audit do?
The national GDM audit collects standardised data from all NHS trusts and GP practices across England. It allows us, for the first time, to benchmark care, identify outliers, understand what good looks like; and importantly, share the learning across integrated care systems and nationally. Crucially, the audit shines a light on inequalities. We know that GDM disproportionately affects women from South Asian, Black, and mixed-heritage backgrounds. A national audit gives us the evidence base to ask hard questions of ourselves and others about whether these women are being reached equitably.
What have we learned from the audit?
Determining how common GDM is, remains tricky, largely because coding across care settings is still incomplete. How we capture the coding needs work and should improve going forward.
Encouragingly, pregnancy outcomes for women who receive treatment for GDM appear broadly comparable to those without the condition - suggesting that once GDM is diagnosed, women are being managed effectively in pregnancy. However, this sits alongside clear and persistent inequalities, particularly linked to socioeconomic status and ethnicity.
Beyond pregnancy however, there’s a noticeable drop-off: postnatal follow-up and support to optimise engagement with diabetes prevention services remain sub-optimal. This is important to appreciate and worrying. It highlights the need for more consistent referral pathways and a more proactive, joined-up approach to postnatal care to prevent type 2 diabetes and cardiovascular disease in these women. The alignment of new 2026/27 Quality Outcomes Framework (QOF) points for doing annual HbA1c in all women who have had GDM is a major step towards this. It helps make sure women with GDM are:
- accurately coded in primary care
- flagged as being at risk of type 2 diabetes
- enabled access to focussed care to prevent diabetes and cardiovascular disease
A foundation for better care
This audit is not the solution to improve outcomes for those with a history of GDM in itself; however, it is an instrumental starting point. The audit will now be run annually and the data it generates each year will inform commissioning decisions, clinical guideline optimisation and ultimately, the conversations we have with patients. For women navigating gestational diabetes, the benefit is that care will not just be guideline-compliant on paper, but genuinely responsive to their needs.
To note: for the avoidance of doubt, services commissioned by NHS West Yorkshire Integrated Care Board are trans-inclusive. Transgender people who require these services will be accommodated and supported in line with person centred care and relevant equality duties.
Thanks for reading.
Eleanor
Useful links
National Gestational Diabetes Mellitus Audit - NHS England Digital