Managing gestational diabetes in Australia's post-COVID clinical landscape

When the pandemic disrupted routine hospital workflows in 2020, antenatal services across Sydney, Melbourne and regional Queensland had to rethink how women with hyperglycaemia in pregnancy were monitored. Three years on, the temporary telehealth models introduced under expanded Medicare rebates have matured into a permanent hybrid model of care. Clinicians now juggle in-person visits with remote glucose reviews, and women diagnosed with gestational diabetes mellitus (GDM) navigate a system that blends hospital-based oversight with home-based digital tracking. This shift has altered the lived experience of GDM management and reshaped clinical expectations for both patients and providers.

The post-COVID clinical landscape also brought renewed attention to service gaps that pre-existed in remote and Indigenous communities, particularly across the Northern Territory and Western Australia's Kimberley region. With virtual consultations now reimbursable and continuous glucose monitors increasingly affordable through the National Diabetes Services Scheme, Australian maternity teams have a broader toolkit than ever before. Understanding which tools work, which thresholds matter, and how to integrate them into a culturally responsive care plan has become essential for every practitioner who manages pregnant patients with GDM.

Telehealth becomes standard in antenatal diabetes care

Before 2020, a diagnosis of GDM in a public hospital typically meant weekly or fortnightly clinic visits for glucose review, dietary counselling and foetal growth assessment. Today, many of those touchpoints occur through secure video platforms funded by Medicare's permanent telehealth items. A woman in Hobart or Geelong can upload a week of finger-prick readings through a patient portal, receive dietician feedback by phone, and attend her next obstetric review from her workplace carpark. The reduced travel burden has been especially welcome for women in rural New South Wales and the Pilbara, where the nearest tertiary centre may be a six-hour drive away.

For clinicians, however, telehealth introduces new clinical judgment calls. Blood pressure checks, fundal height measurements and cardiotocography still require physical presence, so antenatal teams have learned to triage which visits can safely move online. The article on high-risk pregnancy management describes how several Australian units designed alternating schedules that preserved essential bedside assessments while protecting women from unnecessary exposure to crowded waiting rooms.

Hybrid models also depend on reliable internet connectivity and patient confidence with digital tools. Where connectivity falters, telephone consultations remain a Medicare-rebillable fallback, and community health workers in places like Cairns and Darwin have stepped in to support women who lack smartphones. This pragmatic flexibility, born of necessity, is now codified in updated RANZCOG COVID-era guidance that recognises telehealth as a legitimate, not a lesser, mode of antenatal review.

Updated diagnostic thresholds and screening pathways

Pandemic-related delays in attending pathology centres prompted professional bodies to clarify when and how GDM screening should occur. The Australasian Diabetes in Pregnancy Society (ADIPS) 2022 consensus reaffirms a one-step 75 g oral glucose tolerance test (OGTT) at 24–28 weeks, but it also supports earlier testing at booking for women with risk factors such as a prior macrosomic baby, BMI above 30 kg/m², or a first-degree relative with type 2 diabetes. Clinicians in Adelaide and Brisbane report that earlier identification has compressed the window for lifestyle intervention, making the first post-diagnosis review more time-critical than before.

The shift to earlier universal screening in some services has also surfaced questions about resource allocation. Pathology labs in Perth experienced backlogs during 2021–2022 as deferred non-urgent work returned to the system, and some women waited up to three weeks for OGTT results. In response, several hospital networks adopted point-of-care HbA1c at the booking visit as a triage tool, with formal OGTT reserved for those whose initial results fall in an indeterminate range.

Shared electronic maternity records now used in Victoria, Queensland and Western Australia make these revised pathways easier to coordinate. A positive OGTT in regional Warrnambool can trigger an automatic referral to the closest tertiary diabetes-in-pregnancy clinic, with diabetologist input delivered by telehealth within seventy-two hours. The result is a tighter, more responsive diagnostic journey for women who would once have waited weeks for their first specialist review.

Nutrition, movement and self-monitoring at home

Dietary advice remains the cornerstone of GDM management, and the post-COVID period has seen a quiet revolution in how that advice is delivered. Group education sessions once held in hospital meeting rooms have migrated to online platforms, with cooking demonstrations and label-reading tutorials recorded by dieticians and made available on demand. Localised content now features Australian staples: carb counts for a bowl of basmati rice, a serving of Weet-Bix with yoghurt, a standard meat-pie portion, and a piece of damper. Women can apply the guidance to what they actually eat rather than to unfamiliar food examples.

Continuous glucose monitoring (CGM) has moved from a tool reserved for type 1 diabetes to an accepted adjunct in GDM care, particularly for women on insulin. Subsidised access through the NDSS in 2023 widened eligibility, and devices such as the FreeStyle Libre are now used selectively in public clinics from Penrith to Fremantle. The data streams help dieticians identify post-prandial spikes a woman might not notice with finger-prick checks alone, enabling more precise carbohydrate adjustment.

Daily habits that fit Australian routines

• Spreading carbohydrate intake across three small meals and two planned snacks to smooth the glucose curve
• A ten-minute walk after dinner, often built into evening routines in suburban neighbourhoods where footpaths are plentiful
• Keeping a simple photo food diary on a phone, which clinicians can review during telehealth consultations
• Scheduling weekly weigh-ins and blood pressure checks at the local pharmacy or GP to reduce travel

Pharmacotherapy and insulin strategies in a hybrid era

Despite best efforts with diet and movement, roughly one in three Australian women with GDM will eventually require pharmacotherapy. Metformin use in pregnancy has grown steadily since the MiG trial follow-up data, and it is now an accepted first-line option when lifestyle measures alone are insufficient, particularly for women with a BMI above 35 kg/m². Insulin remains the gold standard when glucose targets cannot be met within two weeks of metformin initiation, and basal-bolus regimens are commonly titrated through a combination of clinic visits and remote dose reviews.

Remote insulin titration relies on clear communication channels. Maternity services in Canberra and the Gold Coast have adopted standardised text-based dose-adjustment protocols, where women send fasting and pre-dinner readings each morning and receive revised doses by lunchtime. This rhythm mimics the cadence of frequent face-to-face reviews without requiring the woman to leave home or take unpaid time off work, a meaningful consideration in cost-of-living-pressured households.

Clinicians should also remember that neonatal outcomes depend on tight glycaemic control in the final weeks of pregnancy. The updated neonatal hypoglycaemia guidelines reinforce the need for pre-feed blood glucose checks in the first twenty-four hours after birth for infants of mothers with GDM, particularly when maternal glucose was labile in the third trimester or when birth weight exceeded 4.5 kg.

Postnatal follow-up and long-term cardiometabolic health

The postnatal period has historically been a weak link in GDM care, with completion rates for the recommended 6–12 week oral glucose tolerance test sitting between thirty and fifty per cent in Australian audits. COVID-era disruption worsened the problem temporarily, but the shift to automated SMS recalls through general practice software has lifted follow-up rates by an average of fifteen percentage points in services that adopted the approach. Women now receive a single text linking to a booking form, with reminders sent to the GP if the test is not completed within eight weeks.

Long-term, the post-COVID clinical environment has strengthened the connection between maternity services and primary care. Women with prior GDM are routinely offered enrolment in lifestyle programs such as the Life! program in Victoria, the Get Healthy Service in New South Wales, or equivalent telephone coaching schemes funded by state health departments. These programs address the elevated lifetime risk of type 2 diabetes and cardiovascular disease, conditions that disproportionately affect women from culturally and linguistically diverse backgrounds and Aboriginal and Torres Strait Islander communities.

Building blocks of high-quality postnatal care

• A documented plan at hospital discharge that names the responsible GP and the date for the postnatal OGTT
• Brief intervention on breastfeeding, which improves maternal glucose metabolism and lowers infant risk
• Annual HbA1c or fasting glucose checks for at least five years postpartum, aligned with the Australian Diabetes Society position statement
• Preconception counselling before any subsequent pregnancy, including a medication review and weight-optimisation plan

Looking ahead, Australian maternity services have a rare opportunity to keep the best of the pandemic-era innovations while closing the gaps that widened during 2020 and 2021. Practitioners who embrace hybrid models, advocate for equitable CGM access, and reinforce postnatal follow-up systems will be the ones who translate the post-COVID clinical landscape into better long-term outcomes for women with GDM and their children. Explore further resources on perinatal medicine in the Asia-Oceania region through FAOPS 2020, and subscribe to your state health department's clinical updates to stay informed as guidelines continue to evolve.