News
Why gestational diabetes underdiagnosis is a women’s health crisis
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.
A new study is the first to systematically examine how severe menstrual symptoms affect working life, exposing a major research gap and the need for more inclusive policies.
Researchers analysed global studies to identify common themes and to map the challenges women face at work.
The work, led by the University of Portsmouth, highlights how little research exists on workplace menstrual health despite evidence that 25 per cent of women experience severe symptoms.
These include cramps, breast tenderness, mood changes, headaches, fatigue and back pain, alongside heavy bleeding, painful periods, anaemia (low red blood cells), irregular cycles, fibroids (non-cancerous growths) and endometriosis (tissue similar to the womb lining growing outside the uterus).
Lead author Amtullah Oluwakanyinsola Adegoke said: “We need to recognise that women and girls menstruate – it’s a natural part of life.
“As members of society, their needs should be acknowledged as part of the life cycle.
“While menopause awareness has grown, menstrual health and endometriosis are still not widely understood.”
While analysing previous data, the researchers found a survey of more than 42,000 women aged 15 to 45 which revealed that one in three experienced symptoms severe enough to interfere with daily activities, including work.
Researchers identified three themes: impact on women’s workplace wellbeing and quality of life; presenteeism and absenteeism linked to symptoms; and organisational practices, policies and menstrual health inclusion programmes.
The study found that supported employees are more productive, take fewer sick days, stay in their roles longer and engage more.
Poor menstrual health support can lead to depression, poor concentration, reduced performance and an overall negative effect on wellbeing.
Only 18 per cent of organisations include some form of menstrual health support within their wellbeing initiatives, and just 12 per cent provide dedicated support.
Professor Karen Johnston from the University of Portsmouth said: “Menstrual health remains a largely neglected area of research.
“The majority of existing studies in medical journals focus on clinical aspects, highlighting the need to use menopause research to support the argument for menstruation. Although other topics have received increased attention in the UK, menstrual health continues to be underexplored.
“It shouldn’t be a taboo topic – it should be part of an organisation’s health and wellbeing agenda.
“Alongside training, organisations should explore flexible working and ways to support employees experiencing severe menstrual problems.”
The study emphasised the importance of creating more inclusive workplaces through supportive measures such as menstrual leave, flexible working, access to hygiene products and encouraging open conversations.
In the UK, there is no legal requirement for paid menstrual leave, so employees typically use standard sick leave.
An overlooked fat-derived hormone may drive higher breast cancer death risk in postmenopausal women with obesity, an analysis suggests.
The review identifies oestrone, a form of oestrogen produced in fat tissue, as a major driver of oestrogen receptor positive (ER+) breast cancer, the most common and deadly form of the disease in postmenopausal women.
ER+ means the cancer grows in response to oestrogen. It also raises the possibility that treatment could be improved with the addition of weight-loss drugs known as GLP-1 receptor agonists.
The analysis was led by Joyce Slingerland, who co-leads the Cancer Host Interaction Program at Georgetown University’s Lombardi Comprehensive Cancer Center in the US.
She said postmenopausal women with obesity are more likely to be diagnosed with ER+ breast cancer and are two to three times more likely to die from it.
Slingerland said: “That’s particularly concerning because it’s estimated that obesity will affect nearly half of women in the United States by the end of the decade.”
Before menopause, the most abundant oestrogen in women is 17β-oestradiol, produced primarily by the ovaries.
After menopause, its levels fall dramatically and oestrone becomes the most abundant form circulating in the blood.
Despite their similar chemical structure, the research suggests these two forms of oestrogen behave very differently.
While 17β-oestradiol turns on genes that reduce inflammation, oestrone does the opposite, activating genes that trigger intense inflammatory activity.
In the context of obesity, levels of oestrone are two to four times higher in fat, breast and other tissues.
The analysis suggests these elevated levels set off a cascade that causes precancerous changes and activates cancer-fuelling genes.
Previous research by the team showed that oestrone-fuelled inflammation activates genes involved in a process that promotes cancer spread.
When researchers treated obese mice with ER+ breast cancer with oestrone, their tumours grew faster and rapidly spread throughout the body compared with mice treated with 17β-oestradiol.
Slingerland said: “Our work has provided some of the causal links between oestrone and the worse outcomes seen in postmenopausal women with ER-positive breast cancer who are obese.
“Simply put, these two oestrogens are not equal to each other.”
The author argues that clinical studies of GLP-1 drugs in women with ER+ breast cancer who have obesity are a logical next step.
Slingerland said: “The GLP-1 drugs have revolutionised weight loss.
“Because of oestrone’s powerful inflammatory effects in fat, there’s real potential that, by inducing weight loss, GLP-1 drugs can pump the brakes on oestrone’s cancer-fuelling behaviour.”
Older women with both insomnia and sleep apnoea show worse verbal memory than those with sleep apnoea alone, a new study has found.
The research revealed that older adults with comorbid insomnia and sleep apnoea, often referred to as COMISA, demonstrated worse memory performance than those with sleep apnoea alone. Sleep apnoea is a condition where breathing repeatedly stops and starts during sleep.
However, when analysed by sex, the association was only significant in women, not men.
The study, conducted by researchers at UC San Diego School of Medicine, involved 110 older adults aged 65 to 83 diagnosed with obstructive sleep apnoea.
Participants completed an overnight sleep study and cognitive testing. COMISA was present in 37 per cent of participants.
Lead author Breanna Holloway, a postdoctoral researcher at UC San Diego School of Medicine, said: “We expected that having both insomnia and sleep apnoea would worsen memory for everyone, but only older women showed this vulnerability.
“That was striking, especially because women typically outperform men on verbal memory tasks.
“The fact that COMISA seemed to offset that advantage hints at a hidden sleep-related pathway to cognitive decline in women.
“Prior studies have shown increased incidence of Alzheimer’s disease in women with untreated sleep apnoea.”
The researchers suggest sex differences in sleep architecture may explain the vulnerability observed in women.
Post hoc analyses revealed that women with COMISA had reduced rapid eye movement (REM) sleep, the stage associated with dreaming and memory consolidation, and more slow wave (deep) sleep compared with men.
Holloway said: “These results point to an overlooked risk in women with both insomnia and sleep apnoea.”
“Because women are more likely to have insomnia and often go undiagnosed for sleep apnoea, recognising and treating COMISA early could help protect memory and reduce dementia risk.”
The researchers noted that the findings support sex-specific screening and treatment strategies.
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