Aligning gestational diabetes guidelines with women’s lived experiences
Recent national consensus recommendations from the Australasian Diabetes in Pregnancy Society (ADIPS) move gestational diabetes (GDM) screening and diagnosis toward greater international consistency. They also highlight ongoing gaps in psychosocial support, risk communication, and stigma reduction. This article explores how the updated guidance aligns with women’s unmet needs, drawing on Australian qualitative studies that illuminate the lived experience of GDM and GDM-related stigma.
The emotional toll of GDM
“The health benefits of tracking the GDM were far outweighed by the negative consequences to my mental health.”
GDM affects about one in six pregnancies in Australia and can cause significant emotional distress, shaping the pregnancy experience and self-care behaviors. Recent qualitative work shows that for some women, a GDM diagnosis “stripped away any kind of enjoyment” of pregnancy. Many participants spoke of “the huge mental and emotional burden” often going unacknowledged, with little structured psychosocial support available.
The new guidance recognises the emotional impact and stigma linked to GDM, but it does not yet include systematic psychosocial screening or dedicated support pathways for women and training for health professionals to address these needs.
Screening and diagnosis: moving toward consistency
One participant described the inconsistency in diagnostic thresholds across hospitals: “At my hospital, I’ve got GDM, but if I was at your hospital, I wouldn’t… reinforcing that one day, it’s my fault and then the next day, I wouldn’t even have it.” Such experiences bred confusion and distrust about whether GDM would be diagnosed under different settings.
The updated recommendations push toward higher thresholds and more consistent international practice. This shift aims to reduce unnecessary labeling, thereby lessening emotional distress and stigma. However, for women who were diagnosed under older thresholds, the change can feel confronting. Careful, sensitive communication is essential so that women feel supported rather than invalidated.
Beyond thresholds: personalised care
GDM risk is not limited to those with obvious factors. While higher risk is more common among older age, obesity, family history, or certain ethnic backgrounds, the new guidance advocates risk-informed, personalised screening and a holistic approach to risk stratification within maternity care models.
Yet the very label of “high-risk” can be dehumanising. Some women feel reduced to statistics rather than individuals with agency over their care: “You’re a ‘high-risk’ patient…not a person, and that you need to be managed, not cared for.” The guidance’s emphasis on individualized care is a step forward, but it must be paired with clear risk-communication strategies and a respect for patient autonomy during decision-making.
The role of diabetes stigma
“The stigma that you receive from the medical profession as soon as you’re diagnosed… It’s like you’ve lost credibility.”
Stigma surrounding GDM can shape how women engage with care, manage glucose, and approach future health decisions. While the new guidance acknowledges stigma and its harms, it falls short of concrete actions to reduce stigma within healthcare settings.
Many women report ongoing feelings of shame, even after pregnancy. One participant summed it up: “I don’t think that shame completely goes away.” This stigma can erode engagement with follow-up care and post-GDM health checks, including future diabetes screening for both mother and child.
<h2 Toward stigma-free care
International consensus and health-professional pledges have highlighted that stigma is widespread and harmful. The Pledge to End Diabetes Stigma has gained traction across many countries, but translating commitments into practice remains critical. Research on lived experience consistently shows benefits from person-centred, empathic care and narrative-based learning tools. Initiatives like Amelia’s Story and materials from the Virtual Empathy Museum illustrate how healthcare can foster understanding and reduce stigma through informed empathy.
Conclusion
The updated GDM guidelines align with women’s lived experiences by clarifying diagnostic thresholds, supporting risk-informed screening, and recognising psychosocial impacts. Yet critical gaps persist in psychosocial support, sensitive risk communication, and stigma reduction—areas essential to truly meeting community needs. Addressing these gaps could improve not only wellbeing during pregnancy but also long-term health outcomes, including engagement with post-GDM risk reduction and type 2 diabetes screening.
Authorship: Elizabeth Holmes-Truscott, Dr Eloise Litterbach, and Professor Jane Speight with the Australian Centre for Behavioural Research in Diabetes (ACBRD). The authors emphasise that guideline statements reflect their view and not necessarily official policy of professional bodies unless stated.
