As a midwife, one of the questions I hear most often from pregnant people is:

“If I have gestational diabetes, should I be induced early?”

This concern is understandable. Gestational diabetes (GDM) is often presented as a risk factor that might justify early induction. But what does the evidence actually say?

Understanding Gestational Diabetes

First, it’s important to clarify what it means to be diagnosed with GDM. I often use the phrase “said to have” because the diagnosis is not always straightforward. Guidelines, tests, and cut-off values vary between countries, and even between hospitals. This inconsistency can be confusing and stressful for expectant parents.

For example, in Australia, changes to glucose thresholds in 2014 led to a sharp increase in GDM diagnoses. Yet studies show these stricter thresholds did not improve outcomes for babies but did increase the use of medications (Peters et al., 2025; Montalto et al., 2025).

So being told you have GDM does not automatically mean your pregnancy is high-risk individual factors matter far more than the label.

Why Induction is Often Suggested

Many obstetric teams recommend induction for women with GDM. Sometimes this is the only reason. Other times, induction is suggested alongside additional concerns, such as:
• Suspected large baby
• Maternal age
• Previous pregnancy complications

From my experience, women are often presented with multiple “risk factors” sequentially, which can feel coercive. It’s important to remember that adding up risk factors does not automatically justify intervention.

Risk Factors vs. Actual Problems

A key distinction to understand is the difference between being at risk and having an actual problem:
• At risk: Statistical probability of complications. Most people flagged as “high risk” experience no issues.
• Actual problem: Conditions like pre-eclampsia or abnormal fetal growth may justify intervention but decisions should always rest with the person carrying the baby.

Multiple risk factors do not create evidence where none exists. The pregnant person has the right to define what is “justified” for their body and pregnancy.

The “Big Baby” Concern

One common worry with GDM is that the baby might grow larger than average. This is often used as a reason for induction. But evidence shows:
• Ultrasound estimates of fetal weight are often inaccurate only 40–42% of babies suspected to be large actually are.
• The Big Baby Trial found no significant differences in shoulder dystocia, NICU admission, or other neonatal complications between induced and spontaneous births.

So using suspected fetal size alone to justify induction is not evidence-based.

What the Research Shows

Here’s the bottom line:

There is no evidence that induction benefits women with GDM without complications.
• Cochrane Review (Biesty et al., 2018): Only one small study compared induction with waiting for spontaneous labour. Outcomes for mothers and babies were the same.
• Australian Population Study (Seimon et al., 2022): Induction at 38–40 weeks for women with GDM increased the risk of cesarean without improving neonatal outcomes.

Research in this area is limited, and larger, high-quality studies are needed. Until then, routine induction for GDM alone is not supported.

Guidance from Health Authorities
• WHO (2018): Induction should not be offered for GDM unless there are clear abnormalities, such as poorly controlled blood sugar.
• NICE (UK): Elective induction or cesarean should generally not happen before 40+6 weeks unless complications are present.

The Midwife’s Role

As a midwife, I strongly advocate for informed, person-centred decision-making:
• Ask why an intervention is recommended.
• Request clear evidence for your individual situation.
• Consider consulting a consultant midwife for a detailed discussion.

Your choices shape your birth experience, health, and well-being for both you and your baby.

Key Takeaways
1. Induction for GDM without complications is not evidence-based.
2. Many women with GDM safely have spontaneous births at home, in midwifery-led units, or in hospital.
3. You have the right to refuse unnecessary interventions and make informed choices about your birth.

References
• Berger H & Melamed N (2014). Timing of delivery in women with diabetes in pregnancy. Obstet Med, 7(1):8-16.
• Biesty LM, Egan AM, Dunne F et al (2018). Planned birth at or near term for improving health outcomes for pregnant women with gestational diabetes. Cochrane Database Syst Rev, Issue 1.
• Jabak S & Hameed A (2020). Continuous intrapartum fetal monitoring in gestational diabetes, where is the evidence? J Matern Fetal Neonatal Med.
• Seimon RV, Natasha N, Schneuer FJ et al (2022). Maternal and neonatal outcomes of women with gestational diabetes. Aust N Z J Obstet Gynaecol.
• Peters et al., 2025; Montalto et al., 2025.
• Wickham S (2018). Inducing Labour: Making Informed Decisions. Avebury: Birthmoon Creations.