Gestational diabetes mellitus (GDM) affects around 10-20% of pregnancies1 in the United Kingdom, making it one of the most common metabolic complications of pregnancy. Early detection is essential because untreated GDM increases the risk of complications such as pre-eclampsia, macrosomia, and stillbirth, and significantly raises the mother’s and child’s long-term risk of developing type 2 diabetes.
The oral glucose tolerance test (OGTT) requires fasting overnight, travelling to a clinic, getting two blood draws and sitting still for 2 hours in the hospital wating room. Many women have to take time of work and find childcare for their children. Due to the inconvenience or rigid clinic appointments that can take a whole morning, screening for GDM is not simply a clinical question - it is also a question of access.
Health equity in maternity care is often discussed in terms of access, but in practice it is defined by something more fundamental. It is defined by whether patients can realistically complete the care pathway offered to them, which is particularly clear in gestational diabetes screening.
A study by E. H. Lachmann and colleagues2 highlighted a critical issue. Even when women are identified as being at risk and invited for testing, a meaningful proportion do not complete the oral glucose tolerance test. In their cohort of over 1,900 women, 12.7 percent did not complete at least one test, and nearly a third of those never completed it at all.
Another finding was that non completion was not evenly distributed. Women who were younger, from minority ethnic backgrounds, or from lower socio economic groups were significantly less likely to complete testing. These are the very populations already at higher risk of adverse pregnancy outcomes.
The reasons for not attending were practical and human. Women reported difficulty tolerating the test due to nausea and fasting. Many faced competing demands on their time, including work and caring responsibilities. Others experienced challenges related to mental health or social circumstances. Logistical barriers such as transport and childcare also played a role.
This points to an important conclusion - the design of the testing pathway itself can create inequality.
The findings are important because they also point towards a solution. The authors concluded that improving completion rates requires testing methods that are easier to schedule and tolerate, alongside better support for vulnerable groups.
This is where GTT@home represents a meaningful shift.
Across real world implementation, we have observed no difference in successful test completion based on Index of Multiple Deprivation or language preference. This is a striking contrast to traditional clinic based pathways, where socio economic status and language barriers are often linked to lower engagement.
This matters because it shows that when structural barriers are removed, much of the inequality disappears with them. Fixed appointments, travel requirements, time spent in clinical settings, and rigid protocols all create friction. When that friction is reduced, participation becomes more consistent across different groups.
Traditional healthcare models often attempt to compensate for inequality by adding layers of support such as reminders, education, or follow up. While these approaches are valuable, they do not address the underlying issue. They do not change the structure of the pathway itself.
GTT@home takes a different approach by redesigning the pathway. Testing can be completed at a time that fits around daily life. Instructions are accessible and supported, including in multiple languages. There is no requirement to travel or wait in a clinic, and no need to take time away from work or family responsibilities. The process fits into the patient’s environment rather than requiring the patient to adapt to it.
As a result, engagement becomes less dependent on external factors such as income, language, or available support.
Health equity is often framed as ensuring equal access to care. However, access alone is not enough if the pathway cannot be completed. The findings from Lachmann and colleagues make this clear. The oral glucose tolerance test, as traditionally delivered, can act as a barrier, and that barrier disproportionately affects those already at risk.
By contrast, the consistency of completion seen with GTT@home suggests a different principle. When care pathways are designed around real lives, participation becomes more equitable.
Addressing health inequality does not always require complex solutions. In some cases, it requires rethinking how care is delivered. In gestational diabetes screening, the evidence shows that the current model introduces avoidable barriers, and those barriers affect vulnerable populations the most. Redesigning the pathway offers a practical way to reduce these disparities and improve outcomes.
1 https://www.diabetes.org.uk/about-diabetes/gestational-diabetes/causes
2 https://pubmed.ncbi.nlm.nih.gov/32144795/