Evaluation of the 2025 Australasian Diabetes in Pregnancy Society Gestational Diabetes Guideline: Clinical Impact on Prevalence and Neonatal Outcomes — ASN Events
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Evaluation of the 2025 Australasian Diabetes in Pregnancy Society Gestational Diabetes Guideline: Clinical Impact on Prevalence and Neonatal Outcomes (#120)

Beminate Lemma Seifu 1 , Zhong Lu 2 3 4 , Jenny Wong 5 , Emily Callander 1 , Yitayeh Mengistu 1 , Helena Teede 1 5 , Joanne Enticott 1 , Rebecca Goldstein 1 5
  1. Monash Centre for Health Research and Implementation, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
  2. Monash Health Pathology, Monash Health, Melbourne, Victoria, Australia
  3. Dorevitch Pathology, Melbourne, Victoria, Australia
  4. Department of Medicine , Monash University, Melbourne, Victoria, Australia
  5. Diabetes and Vascular Medicine Unit, Monash Health, Melbourne, Victoria, Australia

Background: The new Australian Diabetes in Pregnancy Society (ADIPS) Gestational Diabetes (GDM) criteria (2025) raise the diagnostic glucose threshold for GDM, potentially altering clinical and system-level outcomes.

Aim: To compare GDM prevalence, maternal and neonatal outcomes and cost-benefit analysis using ADIPS 2025 vs International Association of the Diabetes and Pregnancy Study Groups (IADPSG) diagnostic criteria.

Methods: A retrospective cohort study of 40,334 singleton births >20 weeks at Monash health, Melbourne, Australia (2016-2024). GDM was defined based on glucose (mmol/L) using IADPSG: fasting ≥5.1, ±1h ³10.0; ±2h ≥8.5; and 2025 ADIPS: fasting ≥5.3, ±1h ≥10.6, ±2h ≥9.0. Baseline characteristics were compared across groups: ADIPS-defined GDM and women meeting only IADPSG (mildly abnormal on outdated IADPSG criteria, i.e., fasting 5.1-5.2, 1h 10.1-10.5, 2h 8.6-8.9). Outcomes included: maternal (mode of delivery, blood loss, pre-eclampsia, gestational weight gain (GWG)) and neonatal (large for gestational age, small for gestational age, birthweight, NICU admission, Apgar, birth trauma, perinatal death). Binary and multinomial logistic regression models were employed according to outcome type. Adjusting for maternal demographic and clinical characteristics.  A prospective cost-benefit analysis is planned to identify the effectiveness of ADIPS 2025.

Results: GDM prevalence was 20.5% (95%CI: 20.0, 20.9) using IADPSG and 12.1% (95%CI: 11.8, 12.4) using ADIPS 2025, corresponding to a 41% relative reduction. Women meeting IADPSG criteria alone had statistically significant lower prevalence of obesity, overweight, prior GDM, and diabetes family history, were more likely to be Australian-born and have GWG within recommended ranges. Despite representing an additional 8% of the GDM cohort, this group did not have statistically significant adverse outcome risks. 

Conclusion: ADIPS 2025 substantially reduces GDM prevalence without evidence of increased short-term adverse outcomes among women re-classified as non-GDM. However, this study was based on a treated cohort of women and comparisons may be influenced by treatment effects, thus findings should be interpreted with caution. The adoption of ADIPS 2025 may reduce clinical and health system burden without compromising short-term adverse outcomes, however further evaluation of health economics and longer-term outcomes is warranted and is underway.