Gestational diabetes mellitus in Italian diabetes clinics: clinical characteristics, screening practices and management from the amd annals registry.

backgroundGestational diabetes mellitus (GDM) is one of the most common complications of pregnancy and is associated with adverse maternal and neonatal outcomes. Nationwide real-world data describing characteristics , screening practices, clinical management, and quality of care of women with GDM attending diabetes clinics in Italy are limited.

methodsWe conducted a retrospective observational study using data from the AMD Annals Initiative, a well-established large quality-of-care monitoring program. Anonymized clinical data from women with GDM attending participating centers during 2025 were analyzed. Study measures included demographic characteristics, risk factors, oral glucose tolerance test (OGTT) timing and results, therapeutic management, intermediate outcomes, and available maternal and neonatal outcomes.The analysis was descriptive.

resultsA total of 13,487 women with GDM were included. The mean age was 33.6±5.4 years, and 41.1% were aged ≥35 years. Pre-pregnancy overweight and obesity were reported in 28.1% and 24.9% of women, respectively. Overall, 20.3% of women met criteria for early OGTT screening based on established risk factors; however, only 15.2% of eligible women underwent testing within the recommended 16-18-week gestational window. Standard OGTT screening between 24 and 28 weeks was performed in 51.5% of cases. Women tested at 16-18 weeks showed higher fasting glucose levels but lower post-load glucose values than those screened at 24-28 weeks. Mean HbA1c at diagnosis was 5.2±0.7%, and only 0.9% of women had HbA1c ≥6.5%. Dietary treatment alone was used in 63.9% of women, while 33.1% required insulin therapy and 5.6% received metformin. Among women with available delivery data (n=2,288), mean gestational age at delivery was 38.8±1.4 weeks, with cesarean section and labor induction rates of 30.0% and 33.6%, respectively. Neonatal outcomes were recorded for 1,384 of these women, whereas postpartum glucose assessment was available for only 3.1% of the entire cohort.

conclusionsThis large real-world analysis provides a first nationwide snapshot of the characteristics and quality of care of GDM in Italy. Although management and perinatal outcomes appear broadly consistent with international standards, substantial gaps remain in adherence to recommended screening pathways, particularly the implementation of early OGTT testing in high-risk women. Improving the completeness and standardization of structured data collection, including maternal and neonatal outcomes, will further strengthen the ability of the AMD Annals to monitor and support continuous improvement in GDM care.