Perioperative blood glucose and energy management in gestational diabetes mellitus: a survey of obstetric staff from selected regions in China

Abstract

Background

Gestational diabetes mellitus (GDM) is a common pregnancy-related complication and has been associated with an increased risk of caesarean sections. By surveying obstetric healthcare professionals across Chinese tertiary hospitals, this study examined the current state of blood glucose and energy management during the perioperative period of women with GDM scheduled for caesarean section. The purpose of this study was to identify gaps in current clinical practice and provide evidence for the development of standardized strategies in clinical management.

Methods

A questionnaire-based survey was conducted from December 2024 to January 2025, where electronic questionnaires were distributed to obstetric healthcare professionals from 44 tertiary hospitals across 16 provinces, municipalities, and autonomous regions in China. Descriptive statistics were used to summarize the perceptions and current practices among obstetric healthcare professionals. The chi-square test or Fisher’s exact test was used to compare reported practices and perceptions among obstetric healthcare professionals.

Results

A total of 819 questionnaires were distributed, and 779 valid questionnaires were returned, yielding a valid return rate of 95%. The respondents were from six regions, including South China, Southwest China, and East China, and 80.9% of participants were affiliated with Class A tertiary hospitals. Obstetric healthcare professionals with different educational backgrounds, disciplines, job titles, and years of obstetric experience reported varying perceptions. Reported practices also varied across disciplines, professional titles, and academic qualifications.

Conclusions

Obstetric healthcare professionals from diverse backgrounds reported varying perceptions and practice preferences regarding perioperative management of caesarean section in women with GDM. It indicates potential issues, such as heterogeneity in self-reported practices and gaps in alignment with guideline recommendations. It may be considered to support improvements in overall care quality and coordination by strengthening clinical research, developing detailed clinical protocols, and providing targeted training.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-026-08974-w.

Background

The 11th Edition of the International Diabetes Federation (IDF) Diabetes Atlas released by the IDF estimates that 19.7% of women with live births in 2024 experienced some form of hyperglycaemia during pregnancy, with 79.2% of these cases being attributed to gestational diabetes mellitus (GDM) [1]. GDM is defined as glucose intolerance initially identified during pregnancy in euglycemic women who were previously euglycemic [2] and is one of the most prevalent pregnancy-related complications. GDM is associated with increased risks such as spontaneous abortion, fetal malformation, preeclampsia, caesarean section, macrosomia, neonatal hypoglycemia, and neonatal respiratory distress syndrome [3, 4]. The number of caesarean sections performed worldwide continues to increase. Eastern Asia (44.9%) showed the largest increase in caesarean section rates since 1990 among all observed regions, followed by Western Asia (34.7%). The World Health Organization has projected that by 2030, the global caesarean section rate will approach 30% [5]. China’s caesarean section rate stood at 45% in 2022, higher than the global average [6]. This poses challenges for maternal and neonatal health as well as for healthcare resource allocation. Glycaemic control is considered the cornerstone of the comprehensive management of GDM [7], while perioperative management serves as a key component of quality control in caesarean Sect [8]. During this process, evidence-based blood glucose regulation [9] and energy management can effectively reduce the risk of intraoperative and postoperative complications, improve neonatal outcomes, and play a vital role in ensuring the perioperative safety of both mothers and newborns. This study aimed to describe current strategies and practices among obstetric healthcare professionals in the management of women with GDM undergoing elective caesarean section and to identify potential gaps.

Methods

Study population

This is a descriptive, cross-sectional survey of self-reported practices. In the obstetrics departments of 44 tertiary institutions spread over 16 provinces (including municipalities and autonomous areas) in China, a convenience sampling method was conducted from December 2024 to January 2025. The inclusion criteria were as follows: (1) registered nurses and physicians working in obstetrics; (2) at least 6 months of continuous employment in the current obstetrics department; (3) voluntary participation in the study. Visiting or resident physicians and aspiring nurses were excluded.

Research tools

A thorough literature review served as the foundation for the creation of a self-designed questionnaire. Twelve obstetric healthcare professionals participated in a pilot test of the first draft, and feedback was collected. Content validity was systematically evaluated by eight experts in relevant fields. Items with an item-level content validity index (I-CVI) < 0.78 were removed or revised accordingly. Next, the questionnaire was finalized after being amended in light of group discussions. The final scale-level content validity index based on the averaging method (S-CVI/Ave) was 0.97, and the scale-level universal agreement index (S-CVI/UA) was 0.81. The final questionnaire consisted of the following three sections and 30 items: (1) general demographic information of participants, including sex, age, professional title, and specialization; (2) assessment of perceptions regarding perioperative blood glucose and energy management for patients with GDM undergoing caesarean section; (3) assessment of reported practices related to perioperative blood glucose and energy management in the same population. This questionnaire was not designed as a psychometric scale but comprised heterogeneous items rather than a single latent construct; therefore, internal consistency (e.g., Cronbach’s alpha) was not calculated. Accordingly, this heterogeneity limits the interpretation of composite or aggregated comparisons across subgroups.

Data collection and analysis

Data was collected using the “Questionnaire Star” online platform. Every question was marked as required; those that did not pertain to a respondent’s area of expertise were automatically omitted. Only questionnaires that were completely filled out were accepted. Submissions with response times < 180 s or those with glaring errors were not accepted. A total of 819 questionnaires were distributed, and 779 valid questionnaires were returned, yielding a valid return rate of 95%. In this study, the operational definition of the “perioperative period” included two phases: the preoperative phase, beginning at the initiation of fasting (NPO), and the postoperative recovery phase, from when the patient leaves the operating room until discharge.“Energy management” is defined as the provision of energy through either oral intake or intravenous infusion. This definition was selected to standardize responses within the survey context and may not fully align with perioperative care definitions used in all institutions. Data were analyzed using SPSS version 23.0. Categorical variables are presented as frequencies and percentages. The chi-square test or Fisher’s exact test was applied, and multiple pairwise comparisons were adjusted using the Bonferroni correction method, and P < 0.05 was considered significant.

Results

General information

The general demographic characteristics of the 779 respondents are presented in Table 1. This survey covered 44 tertiary hospitals across 16 provinces, including municipalities and autonomous regions, across six regions, i.e., South China, Southwest China, and East China. Among the respondents, 630 (80.9%) were from Class A tertiary hospitals. The average age of participants was 35.08 ± 7.05 years. Most participants had 5 to 10 years of obstetrics experience (32.30%) and intermediate professional titles (47.60%). A majority (82.20%) reported regularly attending GDM-related trainings, and 70.70% had attended training on perioperative blood glucose and energy management in GDM in the previous 3 years.

Table 1.

General characteristics of the survey participants (n = 779)

Variable	Frequency (n)	Percentage (%)
Region
South China—Guangdong Province	354	45.4
Guangxi Zhuang AR	43	5.5
Hainan Province	28	3.6
East China—Jiangxi Province	36	4.6
Shandong Province	4	0.5
Zhejiang Province	36	4.6
Fujian Province	8	1.0
Southwest China—Sichuan Province	21	2.7
Yunnan Province	55	7.1
Guizhou Province	34	4.4
Chongqing Municipality	38	4.9
Central China—Henan Province	25	3.2
Hunan Province	38	4.9
Northwest China—Qinghai Province	30	3.9
Gansu Province	17	2.2
Northeast China—Heilongjiang Province	12	1.5
Sex
Male	18	2.3
Female	761	97.7
Age
20–30	227	29.1
31–40	399	51.2
41–50	134	17.2
51–60	19	2.4
Education level
Diploma	68	8.7
Bachelor’s degree	630	80.9
Master’s degree	78	10.0
Doctorate or above	3	0.4
Professional title
Junior	296	38.0
Intermediate	371	47.6
Associate senior	84	10.8
Senior	28	3.6
Professional category
Nurse	575	73.8
Physician	204	26.2
Years in obstetric practice
≤ 5 years	118	15.1
5–10 years (inclusive of 10 years)	252	32.3
10–15 years	208	26.7
≥ 15 years	201	25.8
Attended regular GDM training
Yes	640	82.2
No	139	17.8
Received perioperative GDM training in the past three years
Yes	551	70.7
No	228	29.3

Perceptions and current practices among obstetric healthcare professionals

Descriptive analysis indicated that 38.4% of respondents considered the target perioperative fasting glucose range to be 6–10 mmol/L. Intravenous insulin infusion during fasting was recommended by 58.5%. Frequent glucose monitoring was widely supported: 68.8% favored monitoring every 1–2 h preoperatively and 80.9% postoperatively, while 46.0% believed monitoring should continue for at least 24 h after surgery. Most participants supported glucose administration during fasting, with 64.2% permitting glucose-containing fluids if anesthesia protocols allowed and 85.8% advocating routine intravenous glucose supplementation. In addition, 91.5% agreed that glycaemic management should continue up to 42 days postpartum (Table 2).

Table 2.

Current status of healthcare professionals’ perceptions

Item	N	Frequency (n)	Percentage (%)
The target range for blood glucose control during perioperative fasting and fluid restriction is 6–10 mmol/L	779	299	38.4
Belief that intravenous insulin should be used during perioperative fasting	779	456	58.5
Frequency of blood glucose monitoring during preoperative fasting: every 1–2 h	779	536	68.8
Frequency of blood glucose monitoring during postoperative fasting: every 1–2 h	779	630	80.9
Belief that blood glucose should be monitored for at least 24 h post-caesarean	779	358	46.0
Belief that oral intake of glucose-containing fluids is permissible if anesthesia allows	779	500	64.2
Belief that routine intravenous glucose supplementation is appropriate during fasting	779	668	85.8
Belief that blood glucose should continue to be controlled within 42 days postpartum	779	713	91.5

During preoperative fasting, 62.1% of respondents monitored blood glucose every 1–2 h, compared with 48.0% postoperatively; 51.0% continued monitoring for at least 24 h after surgery. Fasting duration differed between liquids and solids. A liquid fasting time of ≥ 4–6 h was reported by 35.7%, whereas 65.1% reported ≥ 6–8 h for solids. Insulin was not routinely added to intravenous fluids by 70.8% during preoperative fasting and by 62.8% postoperatively. Regarding energy management, 30.5% used a 5% glucose solution during preoperative fasting, and 69.6% initiated intravenous fluid administration on the morning of surgery. Postoperatively, 35.9% preferred a 5% glucose solution, and 78.9% initiated energy supplementation immediately upon return to the ward. When blood glucose reached ≥ 11.1 mmol/L, insulin was the most commonly selected intervention both preoperatively (45.2%) and postoperatively (43.9%) (Table 3).

Table 3.

Current reported practices of obstetric healthcare professionals

Item	N	Frequency (n)	Percentage (%)
Frequency of blood glucose monitoring during preoperative fasting: every 1–2 h	779	484	62.1
Frequency of blood glucose monitoring during postoperative fasting: every 1–2 h	779	374	48.0
Minimum duration of postoperative glucose monitoring: at least 24 h	779	397	51.0
Usual preoperative fasting duration for liquids: at least 4–6 h	779	278	35.7
Usual preoperative fasting duration for solids: at least 6–8 h	779	507	65.1
Routine addition of insulin to intravenous fluids during preoperative fasting: No	473	335	70.8
Routine addition of insulin to intravenous fluids during postoperative fasting: No	779	489	62.8
Preferred method of energy supplementation during preoperative fasting: IV infusion of 5% glucose (5% GS)	1749	534	30.5
Usual timing of initiation of IV fluids: morning of surgery	473	329	69.6
Preferred method of energy supplementation during postoperative fasting: IV infusion of 5% glucose	1618	581	35.9
Usual timing of postoperative energy supplementation: immediately after returning to ward	779	615	78.9
Threshold for insulin administration during preoperative fasting: blood glucose ≥ 11.1 mmol/L	473	214	45.2
Insulin is typically administered to control blood glucose when the postoperative random blood glucose level is ≥ 11.1 mmol/L	779	342	43.9

Comparison of perceptions across obstetric healthcare professionals

Differences were observed across several perception items among subgroups of obstetric healthcare professionals (Supplementary Table 1; see Supplementary Tables for details). Perceptions of the target blood glucose range during preoperative fasting differed by professional title (P < 0.017). Perceptions regarding insulin use during perioperative fasting differed by education level and professional title (both P < 0.0083), as well as by specialization and years of obstetric experience (both P < 0.05). Differences by specialization were also observed in the reported frequency of blood glucose monitoring during both preoperative and postoperative fasting (both P < 0.05), and in the duration of postoperative blood glucose monitoring (P < 0.05). Views on whether glucose-containing drinks were permissible when allowed by the anaesthesia protocol differed by professional title (P < 0.0083) and specialization (P < 0.05). In addition, reported use of intravenous glucose during preoperative fasting differed by professional title (P < 0.0083).

Comparison of reported practices across obstetric healthcare professionals

Differences in reported practice patterns were observed across several items among obstetric healthcare professionals in tertiary hospitals (Supplementary Table 2; see Supplementary Tables for details). The reported frequency of blood glucose monitoring during preoperative fasting for women with GDM undergoing caesarean section differed across professional disciplines (P < 0.05). Differences by professional discipline were also observed for the reported frequency of blood glucose monitoring during postoperative fasting (P < 0.05) and for the minimum duration of postoperative blood glucose monitoring (P < 0.05). In addition, the required minimum preoperative fasting duration for fluids differed by education level (P < 0.017), professional title (P < 0.0083), and professional discipline (P < 0.05). Finally, reported routine addition of insulin to intravenous fluids during postoperative fasting in women with GDM differed by professional discipline (P < 0.05).

Discussion

Previous studies have demonstrated that GDM disrupts placental development [10], and that even mild hyperglycaemia may affect placental structure [11]. According to the American Diabetes Association guidelines [12], glycaemic targets during pregnancy are more stringent than those for nonpregnant individuals. These targets are typically achieved through a combination of insulin therapy and medical nutrition. Surgery inherently triggers a metabolic stress response, which impairs insulin sensitivity [13]. Insulin therapy often requires careful regulation before and after caesarean delivery [14]. This survey of obstetric healthcare professionals from 44 tertiary hospitals across China primarily focused on the phase during which normal oral intake is disrupted or restricted. This phase represents a core clinical challenge in peri-caesarean management. Respondents’reported practices may differ from their actual clinical behavior, potentially leading to “idealized"responses. Since respondents were mainly from tertiary centers in Guangdong Province, which have more specialized teams and standardized protocols, and some responses may reflect institutional rather than individual practices, the findings may not fully represent nationwide patterns, and the observed variability may underestimate heterogeneity in lower-level institutions. Nevertheless, the reported perceptions and practices regarding perioperative blood glucose and energy management in women with GDM indicate that there is scope for improving clinical workflows.

Current status of blood glucose management

According to the China Guidelines for Joint Maternal and Fetal Management of Gestational Diabetes Mellitus (2024 Edition, hereinafter the “2024 China GDM Guidelines”), women with GDM should aim for an intrapartum blood glucose range of 4.0–7.0 mmol/L, with a more flexible target range of 5.0–8.0 mmol/L [15]. Meanwhile, the 2024 China Guidelines for the Prevention and Treatment of Diabetes (hereinafter the “2024 China Diabetes Guidelines”) recommend a perioperative blood glucose control range of 5.6–10.0 mmol/L for most hospitalized patients with diabetes [16]. According to the International Federation of Gynecology and Obstetrics (FIGO) guidelines, the recommended glycaemic target range is 4.0–7.0 mmol/L [17]. In this study, most obstetric healthcare professionals with intermediate or senior titles reported a perioperative glycaemic target of 6.0–10.0 mmol/L. This target differs from several GDM guideline recommendations but is more consistent with the 2024 China Diabetes Guidelines, potentially reflecting real-world clinical flexibility. The underlying reasons for this discrepancy could not be fully explained by the questionnaire data alone. Previous evidence suggests that maternal blood glucose levels within 2 h before delivery play an important role in the development of neonatal hypoglycaemia [18]. A study among laboring individuals with diabetes demonstrated that permissive maternal glucose management (target 3.9–10 mmol/L) resulted in similar initial neonatal blood glucose levels compared with usual care (target 3.9–6.1 mmol/L), without significant differences in maternal or neonatal outcomes. Usual care was associated with increased resource utilization and a higher risk of maternal hypoglycemia [19]. Given the limited and heterogeneous evidence currently available, the optimal perioperative glycaemic target range for women with GDM remains controversial and warrants further prospective clinical validation.

According to the 2024 China GDM Guidelines, fingertip blood glucose should be checked every 1–2 h during the perioperative fasting period. In our survey, 62.1% of obstetric healthcare professionals reported monitoring at this frequency preoperatively, compared with 48.0% postoperatively, suggesting more intensive blood glucose monitoring before surgery. This discrepancy may reflect heavy workloads and limited staffing, which require clinicians to prioritise tasks between pre- and postoperative care [20]. Continuous glucose monitoring (CGM) may help address these challenges, and recent studies support its integration into the management of women with gestational diabetes [21].

Current status of insulin use

Insulin is the first-line treatment for hyperglycaemia during pregnancy [22]. Current guidelines recommend using intravenous insulin instead of subcutaneous insulin during the perioperative period. In this study, only 58.5% of obstetric healthcare professionals reported that intravenous insulin should be used during the perioperative fasting period. This may be because most respondents were nurses, who may be less familiar with insulin pharmacology in obstetrics.

The 2024 China GDM Guidelines recommend administering insulin together with glucose at a 1:6–1:4 ratio for proactive prevention of hyperglycaemia, rather than as a remedial measure. However, in our survey, over half of respondents reported that insulin was not routinely added to intravenous fluids during the perioperative period, which may reflect safety concerns or institutional protocols and highlights acceptable clinical flexibility in real-world practice. Most obstetric healthcare professionals used a blood glucose threshold of 11.1 mmol/L to initiate insulin therapy, consistent with ACOG recommendations [23]. In a randomized controlled trial, a tight maternal glucose management protocol in labor (insulin if > 2 glucose values > 5.56 mmol/L) resulted in lower mean neonatal blood glucose in the first 24 h compared with a liberalized protocol (insulin if persistent glucose > 11.1 mmol/L) [24]. The optimal timing for initiating insulin therapy remains uncertain and warrants further prospective investigation.

Queensland Health advises that insulin infusion for women with GDM during labour should be administered via an infusion pump [25]. This survey did not assess the use of intravenous infusion pumps in obstetric practice. Future studies should explore this issue in greater depth and incorporate endocrinology-related considerations within a multidisciplinary approach. The changing landscape of maternal care in China is also reshaping the role of obstetricians, and improving the overall quality of obstetric care may increasingly depend on multidisciplinary integration [26].

Current status of energy management

Appropriate energy management may enhance pregnant women’s tolerance to surgical trauma, contribute to stable blood glucose levels, and help prevent uterine atony caused by inadequate energy supply, which in turn can increase the risk of postpartum haemorrhage [27]. Furthermore, it helps meet basal metabolic requirements and stress-related energy demands [28], thereby addressing the specific physiological needs of women during labour.

In our survey, most healthcare professionals reported following traditional fasting protocols, with preoperative fasting from fluids and food lasting at least 4–6 h and 6–8 h, respectively. In addition, energy supplementation practices varied, and the lack of detailed guideline recommendations for perioperative energy management may be relevant. Intravenous infusion of 5% glucose solution (GS) was the most commonly used option, with approximately 30% of respondents reporting its use for women with GDM.

In contrast, the timing of energy supplementation was relatively consistent: 69.6% of obstetric healthcare professionals reported initiating energy supplementation on the morning of surgery; 78.9% reported administering it immediately after returning to the ward postoperatively. This approach may provide timely energy, reduce hunger, help prevent maternal hypoglycaemia, and facilitate postoperative recovery. Intravenous glucose supplementation is feasible and may help balance energy requirements while maintaining an adequate preoperative fasting interval. However, given the recommended minimum daily carbohydrate intake of 175 g during pregnancy [29], it is difficult to meet this target through intravenous supplementation alone. Enhanced Recovery After Surgery (ERAS) guidelines recommend consuming up to 400 mL of a 12.5% carbohydrate solution within 2 h before surgery [30]. A retrospective cohort study [31] found that compared with traditional management, oral intake of 42.6 g of a carbohydrate beverage before surgery did not result in clinically significant increases in maternal glucose levels and was not associated with increased glucose-related maternal or neonatal perioperative complications. Integrating ERAS principles with intravenous rehydration may help optimise energy-supplementation strategies and promote recovery after caesarean section.

Perceptions and reported practices across professional backgrounds

One study reported notably high overall and primary caesarean section rates of 55.0% and 24.1%, respectively, in a tertiary care setting [32]. Obstetric healthcare professionals must continually improve their skills and expertise, as they play a key role in implementing perioperative management. A study [33] evaluating resident physicians’ understanding of inpatient glycaemic management found that “system issues,” such as incorrect dietary components and insulin dosing that were not aligned with meal timing, were the most frequent source of confusion regarding glycaemic control. Only 34.1% of respondents were aware of the appropriate preprandial glycaemic targets for non-critically ill patients.

This survey suggested that obstetric healthcare professionals with different educational backgrounds, professional categories, professional titles, and years of obstetric experience reported differences in perceptions regarding perioperative blood glucose and energy management for women with GDM undergoing caesarean section. Similarly, reported practices appeared to vary across professional categories, professional titles, and educational levels. These findings indicate variability and limited consensus among obstetric healthcare professionals from diverse professional backgrounds. The relative scarcity of research on intrapartum GDM management, compared with the antenatal period, may limit the evidence available to guide clinical decision-making.

As shown in Supplementary Tables 1 and Supplementary Table 2, healthcare professionals from different professional backgrounds reported differing practices with respect to standardised insulin use, adherence to blood glucose monitoring protocols, and perioperative energy supplementation strategies. Inappropriate liquid and energy management may increase the risk of dehydration and hypoglycaemia, trigger ketosis and catabolic states, or cause hypotension during anaesthetic induction [34].

Based on descriptive, self-reported data from tertiary hospitals, further primary research in these areas may help better inform future clinical guideline updates. Targeted training in these areas may also help enhance healthcare professionals’ understanding and implementation of perioperative management for women with gestational diabetes. Given the increasingly important role of artificial intelligence (AI) in medicine [35], AI could also be incorporated into the education and training of future healthcare professionals. Through a specialty alliance model led by tertiary hospitals [36], structured methodological workshops, interprofessional simulation-based training, and joint capacity-building programmes could be delivered. These initiatives aim to develop standardised clinical pathways, enhance staff competencies, and promote consistency in clinical practice across participating institutions. Collectively, these approaches may help healthcare professionals provide more professional and evidence-based care for women with GDM.

Strengths and Limitations

A strength of this study is its exploratory focus on perioperative blood glucose and energy management in women with GDM, an area that has received limited attention in existing research.

In terms of sampling, this study used a cross-sectional design with convenience sampling. The non-random sampling approach may have reduced the representativeness of the study population. In addition, most respondents were from Guangdong Province, and more than 70% were nurses, resulting in an imbalanced professional composition. Therefore, the findings may not fully reflect the current status of GDM management among obstetric healthcare professionals nationwide, limiting generalizability. The sample size was also moderate, as only obstetric staff from 44 tertiary hospitals were included. Furthermore, because the study focused exclusively on tertiary hospitals, it did not capture potential staffing differences between general hospitals and obstetrics/gynecology hospitals, nor did it include healthcare institutions at other administrative levels. Moreover, endocrinology healthcare providers were not included, which limited multidisciplinary perspectives. From an analytical standpoint, given the highly granular questionnaire items, multivariable analyses were not considered applicable. Thus, unadjusted subgroup comparisons may reflect overlapping demographic characteristics rather than independent associations. Although Bonferroni correction was applied, the subgroup analyses remain exploratory; therefore, the findings should be interpreted with caution, regarded as descriptive and hypothesis-generating, and not used to draw causal inferences regarding patient outcomes. Collectively, these factors may have introduced sampling bias and limited the representativeness of the study population. Future studies should consider random or stratified sampling across China, a larger sample size [37], and inclusion of endocrinology providers and institutions at multiple healthcare levels. These refinements would improve generalizability and provide a more comprehensive understanding of practice patterns and associated factors in GDM management across obstetric healthcare professionals.

Conclusions

Regarding the current state of perioperative care for caesarean sections in women with GDM and strategies to improve perioperative blood glucose and energy levels during this period, the survey findings can serve as a resource for obstetric healthcare professionals and offer insights into improving medical and nursing workflows. This survey objectively reflects the current state of perioperative management for caesarean deliveries in women with GDM across Chinese tertiary hospitals. It indicates potential issues, such as heterogeneity in self-reported practices and gaps in alignment with guideline recommendations. It indicates potential issues, such as heterogeneity in self-reported practices and gaps in alignment with guideline recommendations. Enhancing clinical research through larger-scale studies could represent a key measure for deeper improvement. Obstetric department administrators may consider addressing these gaps by implementing measures to strengthen the professional competence of the obstetric team. In addition, enhanced multidisciplinary collaboration with anaesthesiology and endocrinology to develop unified clinical standards and standardised workflows could help junior and less-experienced healthcare personnel understand and apply these protocols more consistently. Finally, these initiatives will enhance the overall quality and coordination of medical services and ensure the safety of expectant mothers and newborns.

Abbreviations

GDM

gestational diabetes mellitus

GS

glucose solution

IDF

International Diabetes Federation

IV

Intravenous

FBG

Fasting Blood Glucose

2h PBG

2 h Postprandial Blood Glucose

RBG

Random Blood Glucose

Postop

Post-operative

The 2024 China GDM Guidelines

China Guidelines for Joint Maternal and Fetal Management of Gestational Diabetes Mellitus (2024 Edition)

FIGO

International Federation of Gynecology and Obstetrics

AI

Artificial intelligence

CGM

Continuous glucose monitoring

Authors’ contributions

XT X and LZ Z are co-first authors.Study Design: XT X, LZ Z, WZ W. Data Collection: LZ Z, X L, WZ W. Data Analysis and Interpretation: XT X, ZF L. Data Verification and Table Preparation: ZF L, LZ Z. Manuscript Drafting and Revision: XT X, Y G W, XY Z, WZ W. All authors have approved the final manuscript.

Funding

This study was supported by the Guangdong Provincial Medical Science and Technology Research Fund (Project Number: B2024002), and the grant was awarded to Wu Weizhen.

Data availability

Data can be obtained from the corresponding author upon reasonable request and approval by the research team.

Declarations

Ethics approval and consent to participate

The Declaration of Helsinki was followed in the conduct of the research. This study was approved by the Clinical Research and Application Ethics Committee of the Third Affiliated Hospital of Guangzhou Medical University (permission number: IIT[2025] No.007). All research participants participated voluntarily and were informed of the study’s purpose, methods, and potential risks before taking part. The act of participants selecting to start answering the questionnaire is deemed as the expression of informed consent.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.