Exploring what influences gestational diabetes risk

A new study, published in the International Journal of Environmental Research and Public Health, examined risk factor, demographic and clinical characteristics variation among pregnant women at risk of gestational diabetes, across four international study sites. This cross-sectional study utilised baseline data from the Bump2Baby and Me multi-centre randomised controlled trial. The study revealed substantial variations in risk factors and characteristics across different patient cohorts, highlighting the importance of developing context-sensitive approaches to gestational diabetes and chronic disease prevention.

Background to the study

Gestational diabetes is a growing health concern affecting one in seven pregnancies globally.  Prevalence varies significantly across populations and is influenced by factors such as ethnicity, age, body mass index (BMI) and family history of diabetes. Gestational diabetes is associated with an increased risk of several adverse maternal and offspring outcomes, including induction of labour, perinatal death and type 2 diabetes and obesity development. Given these risks, understanding the characteristics of women at risk of gestational diabetes is crucial for developing effective prevention strategies, particularly those relating to modifiable risk factors, such as body weight, diet and physical activity.

Varying population risk profiles

Women were screened for gestational diabetes risk at their first antenatal visit (typically 10–16 weeks’ gestation) by trained midwives and researchers, and their gestational diabetes risk scores calculated. 865 women were enrolled in the trial across four clinical sites: the National Maternity Hospital, Dublin (Ireland); North Bristol NHS Trust, Bristol (UK); Clinical University Hospital San Cecilio, Granada (Spain); and Monash Medical Centre, Melbourne (Australia).

The study examined baseline characteristics including demographic, clinical and lifestyle data such as age, ethnicity, height, weight, BMI, blood pressure, food intake, physical activity, health literacy, living situation, education and employment status.

The results found substantial variety in gestational diabetes risk factors and characteristics among the women who had been identified as at-risk, despite using a standardised gestational diabetes screening tool.

Significant differences were found across populations for clinical risk factors, health behaviours and health literacy – challenging the notion of a uniform “at-risk” profile for gestational diabetes.

Key study findings

The risk factors that varied across the four sites included:

• Body Mass Index
• Age
• Physical activity
• Dietary intake
• Sleep scores
• Health literacy

Almost 3 in 4 of all women reported poor sleep scores, with scores differing between sites.  The high prevalence of poor sleep quality, combined with varying health literacy levels, suggests that gestational diabetes prevention strategies need to address multiple domains beyond traditional clinical and behavioural risk factors.

These findings provide additional evidence that women at risk of gestational diabetes represent a diverse population with distinct demographic, clinical and behavioural characteristics, shaped by ecosocial drivers and their cultural and healthcare contexts.  This highlights the importance of developing context-specific, culturally sensitive approaches to gestational diabetes prevention that account for local population characteristics.

Building on the findings

This study provides the first systematic international comparison of gestational diabetes risk profiles using a standardised risk assessment tool across four countries with different healthcare systems and population demographics. The findings highlight the need to move beyond one-size-fits-all approaches and instead focus on tailored strategies that reflect the diverse realities of women’s lives. This study lays the groundwork for future research into more targeted prevention and improved risk assessment tools that can better support women across different cultures and healthcare settings.

Paper

O’Reilly, S. L., et al., & on behalf of the IMPACT DIABETES BB Collaboration Group. (2025). Clinical and Behavioural Heterogeneity Among Women at Increased Risk for Gestational Diabetes: A Four-Country Analysis. International Journal of Environmental Research and Public Health, 22(7), 1022.