By James Jackson, CEO at Digostics

Gestational diabetes (GDM) is one of the most under-recognised challenges in maternity care today.

Despite affecting around one in five pregnancies in the UK, GDM remains a blind spot in policy and practice, with devastating consequences for women and their children.

New research continues to expose the scale of the problem.

A recent NIHR-funded study published in Diabetic Medicine found that standard NHS testing methods miss over 50 per cent of cases.

Put simply: thousands of women each year go undiagnosed, untreated, and exposed to avoidable risks.

For a condition we know how to diagnose and manage, this represents a serious failure in women’s healthcare.

The human cost of missed diagnosis

When gestational diabetes is not picked up, the consequences are immediate and long-term.

During pregnancy, women face higher risks of preeclampsia, larger babies, emergency C-sections, and stillbirth. Babies are more likely to need neonatal intensive care due to breathing difficulties or low blood sugar.

The risks don’t end at birth.

Mothers who have had GDM are up to 50 per cent more likely to develop type 2 diabetes within 5–10 years. Their children also face an increased lifetime risk of obesity and diabetes.

These outcomes are not rare, nor are they inevitable. They are the product of a testing system that is not fit for purpose.

An unequal system

Current UK pathways rely on risk-factor–based screening rather than universal testing.

         James Jackson

This already puts women at a disadvantage compared with countries such as Spain, Italy, and many others, where all pregnant women are routinely screened.

But even within this narrower approach, the NHS faces a further problem: in-clinic oral glucose tolerance tests (OGTTs), used to test for GDM, are prone to delays in blood sample processing, leading to false negatives.

Research shows that when samples are processed correctly  diagnoses increase from 9 per cent to 22 per cent — more than double.

The burden of this diagnostic failure falls hardest on women from disadvantaged backgrounds.

Attending early-morning, hospital-based tests is more difficult for women juggling shift work, childcare, or long travel times.

Women from ethnic minority groups, who already face higher rates of maternal complications, are also more likely to be missed. In this way, testing failures are not just a clinical problem but a driver of health inequalities.

The case for innovation

This is where innovation can play a transformative role.

We have seen in other areas of healthcare — from remote monitoring to home blood pressure checks — how new approaches can increase accuracy, improve access, and reduce inequalities.

Gestational diabetes testing should be no different. Technologies such as at-home oral glucose tolerance tests (OGTTs) are designed to meet the same clinical standards as hospital testing, while overcoming the practical barriers of travel, fasting, and sample degradation.

By enabling women to test from home, results can be processed immediately and shared directly with care teams, reducing missed cases and ensuring timely diagnosis.

Early work with NHS Trusts has already shown that this model not only identifies more cases but also improves access for diverse patient groups, including those typically underserved.

From evidence to action

Despite clear data, progress has been slow. Part of the challenge is that more accurate testing uncovers more cases — and more cases mean more workload for already stretched maternity services.

But failing to diagnose does not make the problem go away; it only delays care and worsens outcomes.

In the long run, undiagnosed gestational diabetes costs the NHS more through emergency interventions, neonatal intensive care, later-life type 2 diabetes, and the ongoing workload and cost pressures this creates for primary care.

The evidence is clear. Now it must translate into policy. That means:

• Recognising underdiagnosis as a patient safety issue on par with other maternity scandals.
• Guaranteeing that all women offered testing receive accurate, reliable results, rather than being failed by flawed processes.
• Supporting innovation that improves accuracy and equity, whether in the clinic or at home.
• Embedding the patient voice in service design, especially from women in disadvantaged and minority communities most affected by current failures.

A call to prioritise women’s health

Gestational diabetes is not a niche concern; it is a mainstream women’s health issue with lifelong consequences.

Every undiagnosed case represents not just a missed number, but a mother at risk of preeclampsia or birth trauma, a baby at risk of intensive care, or a family facing preventable illness later in life.

As maternity services undergo yet another review, it is striking that the diagnostic gap in GDM remains so little discussed.

We cannot claim to be serious about women’s health while ignoring one of the most widespread and preventable sources of harm in pregnancy.

Innovation has a role to play — but innovation must be matched by policy will.

If we are to modernise maternity care, we must start by ensuring that every woman has access to accurate, timely, and equitable testing for gestational diabetes.

Because every mother deserves certainty. And every baby deserves the best start in life.