Does screening in different healthcare settings affect the diagnosis of gestational diabetes or diabetes in pregnancy?

Key messages

• Screening in a maternity healthcare setting may increase the extent to which screening and after-care guidelines are followed and may reduce the time taken to receive diabetes care during pregnancy, based on evidence from one study.

• More well-designed studies using reliable methods are needed to compare healthcare settings fairly and accurately.

What are gestational diabetes and diabetes in pregnancy?

Gestational diabetes develops during pregnancy when the body cannot produce enough insulin to maintain healthy blood sugar levels. It often resolves after birth but increases the risk of developing type 2 diabetes later in life.

'Diabetes in pregnancy' refers to diabetes identified during pregnancy that meets the criteria for diabetes outside pregnancy. It may have been present but undiagnosed before pregnancy and carries risks for expectant mothers and babies.

About 1 in 6 pregnancies worldwide are affected by high blood sugar (hyperglycaemia) during pregnancy. This includes gestational diabetes and diabetes present or diagnosed during pregnancy.

Why might healthcare setting matter in diagnosing these conditions?

Pregnancy care varies within and between countries. Maternity healthcare settings provide specialised care during pregnancy, birth, and after delivery, such as in midwife-led centres. Non-maternity settings, such as community health centres, provide general medical care without specialised pregnancy-related services.

Settings may influence access to and completion of screening tests, as well as women’s confidence and trust in the care they receive. It remains unclear whether maternity or non-maternity settings are better for screening and diagnosing these conditions.

What did we want to find out?

We wanted to find out if maternity settings were better than non-maternity settings at diagnosing gestational diabetes and diabetes in pregnancy. We planned to measure this by considering the effect of setting type on:

• health service factors such as the numbers of women tested and subsequently diagnosed for these conditions, the time taken to receive care, and the costs;

• the numbers of women who developed high blood pressure (pre-eclampsia) or high blood sugar problems, died, were hospitalised, or had other health problems;

• the number of stillbirths (when unborn babies die), and the numbers of newborn babies who died, were hospitalised, born too early, or had other health problems.

What did we do?

We searched for studies comparing diabetes screening in maternity and non-maternity healthcare settings, including different screening methods and tests. We planned to summarise the results and assess confidence in the evidence based on factors such as study methods and the number of women included.

What did we find?

We found only one study with 781 women: 390 were screened in a maternity healthcare setting and 391 in a non-maternity healthcare setting. The study was in Ireland, which has a publicly funded healthcare system. The average age of the women was around 33 years.

The researchers included all women when assessing whether screening and after-care guidelines were followed. For other aspects of the study, they grouped women according to where they actually had their screening. This resulted in two groups of very different sizes: 215 women screened in non-maternity settings and 475 screened in maternity settings.

The only study we found examined screening for gestational diabetes. We found no studies specifically examining screening for diabetes in pregnancy. Therefore, we do not know whether the findings apply to screening for this condition.

Main results

Health service results

Screening in a maternity healthcare setting:

• may increase the extent to which screening and after-care guidelines are followed;

• may reduce the time taken to receive diabetes care during pregnancy.

We do not know if screening in a maternity healthcare setting affects the diagnosis of gestational diabetes and the length of hospital stay for the baby. The study did not measure emergency department visits during pregnancy, maternal hospital stays, length of those stays, and costs.

Maternal results

We do not know if screening in a maternity healthcare setting increases or decreases high blood pressure during pregnancy (pre-eclampsia). The study did not measure other conditions we were interested in, including pregnancy-associated seizures (eclampsia), maternal death, intensive care needs, treatment for high blood sugar, infections, and issues with blood sugar after giving birth.

Child-related results

We do not know if screening in a maternity healthcare setting increases or decreases stillbirths or foetal death, newborn deaths, needing special care in a newborn unit, being born early or larger than average at birth, birth injuries, jaundice, breathing problems, and low blood sugar.

What are the limitations of the evidence?

The evidence is limited because it is based on a single study. We have little to no confidence in the evidence because the number of events or participants was too small, and the way results were recorded and reported was not appropriate. For most measures, the researchers grouped women according to where they actually received screening, rather than their original group. This resulted in groups of very different sizes, which may have affected the reliability of the comparisons between healthcare settings.

How up to date is the evidence?

The evidence is current to 12 April 2026.