Using data to make pregnancy care safer and fairer for women with gestational diabetes

Gestational diabetes is a type of diabetes that develops during pregnancy. It affects around one in 20 pregnancies across England, but in North West London the number is much higher, closer to global estimates of one in seven.

It matters because it can lead to serious problems for both mother and baby, such as high blood pressure in pregnancy, the need for a Caesarean birth, babies needing special care after birth, and a greater chance of the mother developing type 2 diabetes later on. Because of these risks, these pregnancies need close monitoring and frequent check-ups. This puts pressure on already stretched NHS services.

Some check-ups happen in person, and some happen remotely by phone or video call. This research set out to understand a simple but important question: does remote care work well for these women, and does it work equally well for everyone?

What the research looked at

Sara Sousi studied the anonymised health records of 18,000 women and their babies in North West London. She also reviewed 45 earlier studies from around the world, covering more than 26,000 women, to see what was already known.

What it found

Remote care can help. Across the strongest studies, women receiving remote care were less likely to need an emergency Caesarean and their babies less likely to need intensive care. Other benefits included healthier weight gain in pregnancy and better blood sugar control after birth.

But the benefits were not shared equally. Women facing barriers to using phones or video, often those from more deprived areas or ethnic minority backgrounds, tended to miss out.

The research also found that gestational diabetes is rising sharply in North West London, and that some groups are affected more than others. The risk for Asian women was more than three times that of White women, and women in more deprived areas were at higher risk.

One of the most striking findings was how women engaged with their care. The team identified four patterns: ‘standard care’, ‘high use’, ‘disengaged’ and ‘virtual care’. For example, women in the disengaged group – often those facing the greatest disadvantage – who struggled to attend appointments had a higher risk of stillbirth. This shows that staying connected to care is a vital part of keeping mothers and babies safe, just as managing blood sugar levels is.

Why it matters

This research helps the NHS understand who benefits from remote care, who might be harmed by it, and what needs to change so that no one is left behind. The goal is straightforward: pregnancy care that is safer and fairer for every mother and baby.