When O&G Magazine last devoted an issue to diabetes in 2018, the incidence in pregnancy was already high and rising. In 2026, across Australia and Aotearoa New Zealand, increasing rates of type 2 diabetes in women of reproductive age, higher maternal body mass index, delayed childbearing, and widening health inequities mean that diabetes in pregnancy is no longer a subspecialty concern – it is core business for the profession.
Over the past decade, understanding has evolved, and diagnostic criteria have been refined. Gestational diabetes mellitus (GDM) is now recognised not simply as a short-term obstetric complication, but as a marker of underlying metabolic vulnerability and long-term cardiovascular risk – for women and their children. The intergenerational impact of diabetes is no longer theoretical; it is visible in clinics from Brisbane to Broome and from South Auckland to Southland.
This issue deliberately broadens its scope beyond diagnostic thresholds and treatment algorithms. Alongside clinical case studies and updates, we have included nutrition-focused articles that revisit a key aspect of diabetes care and explore the gut microbiota and its potential role in diabetes. We also feature articles that confront cultural bias, centre lived experience and examine equity and discrimination in diabetes care.
Across both countries, the burden of GDM and type 2 diabetes falls disproportionately on Aboriginal and Torres Strait Islander women in Australia and on Māori and Pacific peoples in Aotearoa New Zealand, as well as on women from culturally and linguistically diverse communities and those experiencing socioeconomic disadvantage. These disparities are not explained by biology alone. They reflect colonisation, structural racism, food insecurity, barriers to culturally safe services, and health systems that have not consistently met the needs of the communities they serve.
The articles exploring equity and discrimination challenge us to move beyond describing disparities to interrogating their roots. How do our models of care accommodate – or fail to accommodate – cultural context? How does implicit bias shape the way we frame risk, discuss weight, or escalate treatment? How often do we attribute “non-compliance” to individual behaviour rather than examining accessibility, health literacy, continuity of care, or trust?
Equally powerful is the contribution centred on lived experience. For many women, a diagnosis of GDM carries anxiety, guilt, and stigma. Dietary advice may conflict with cultural food practices. Frequent glucose monitoring can feel intrusive. Listening to lived experience is a reminder that what appears straightforward within a guideline can feel complex and overwhelming in daily life.
Finally, this issue includes a reflection on expert opinion and the tyranny of hindsight. While not confined to diabetes, its message resonates strongly in this field. Diabetes in pregnancy is an area of evolving evidence. As diagnostic thresholds shift and management algorithms change, we must guard against retrospective simplification. Clinical judgement occurs in real time, under uncertainty. The law may seek determinacy; medicine operates in gradients.
Reflecting on the years since our 2018 issue, the field has progressed in science, technology, and pharmacotherapy. But progress must also be measured in fairness, trust, and respect. Diabetes in pregnancy in 2026 is not only about glucose values or treatment thresholds. It is about life-course health. It is about intergenerational prevention. It is about confronting cultural bias and structural inequity within our own services. And it is about listening – to evidence, to experts, dietitians and multidisciplinary colleagues, and to the women and whānau at the centre of our care.
We hope this issue stimulates not only clinical reflection, but also critical self-examination. As obstetricians and gynaecologists across Australia and Aotearoa New Zealand, we play a pivotal role in shaping outcomes that extend far beyond pregnancy. Ensuring those outcomes are equitable, culturally safe, and grounded in lived experience is one of the most important tasks before us.
