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We assessed the effect of enhanced pre\u2010analytical glucose processing upon glucose concentrations, gestational diabetes diagnosis, health equity and pregnancy outcomes, and if HbA1c was a suitable alternative.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We recruited pregnant women with \u22651 risk factor to a prospective observational cohort study of pregnancy hyperglycaemia, endocrine causes, lipids, insulin and autoimmunity (OPHELIA), from nine UK centres. During a 75\u2009g antenatal OGTT (National Institute of Health and Care Excellence criteria), standard glucose processing was compared to enhanced glucose processing (storage on ice, rapid centrifugation, aliquoting and freezing &lt;2.5\u2009h).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We recruited 1308 participants of mean (SD) age 31.5\u2009years (5.0) and BMI 33.0\u2009kg\/m<jats:sup>2<\/jats:sup> (6.8) of 82.5% white ethnicity, representative of the UK population. Enhanced glucose processing resulted in glucose levels ~0.6\u2009mmol\/L higher than standard glucose processing, increasing gestational diabetes diagnosis from 9% to 22%. Women with gestational diabetes on enhanced but not standard glucose processing (<jats:italic>n<\/jats:italic>\u2009=\u2009165) were younger (31.9 vs. 33.2\u2009years, <jats:italic>p<\/jats:italic>\u2009=\u20090.035), with a higher BMI (36.5 vs. 33.9\u2009kg\/m<jats:sup>2<\/jats:sup>; <jats:italic>p<\/jats:italic>\u2009=\u20090.003), different ethnic distribution (<jats:italic>p<\/jats:italic>\u2009=\u20090.025) and delivered more large\u2010for\u2010gestational age infants (37.0% vs. 22.3%; <jats:italic>p<\/jats:italic>\u2009=\u20090.006) compared to women with gestational diabetes on standard processing alone. HbA1c was not a suitable alternative predictor of gestational diabetes diagnosis (Area under receiver operator curve 0.74; 95% CI 0.68\u20130.79).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>An OGTT with enhanced glucose processing would support more accurate, equitable diagnosis of gestational diabetes, but with increased diagnosis rates.<\/jats:p><\/jats:sec>","DOI":"10.1111\/dme.15476","type":"journal-article","created":{"date-parts":[[2024,12,17]],"date-time":"2024-12-17T09:49:03Z","timestamp":1734428943000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Enhanced glucose processing in gestational diabetes diagnosis: Effects on health equity and clinical outcomes"],"prefix":"10.1111","volume":"42","author":[{"given":"Danielle L.","family":"Jones","sequence":"first","affiliation":[{"name":"Institute of Metabolic Science \u2013 Medical Research Laboratories, University of Cambridge  Cambridge UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura C.","family":"Kusinski","sequence":"additional","affiliation":[{"name":"Institute of Metabolic Science \u2013 Medical Research Laboratories, University of Cambridge  Cambridge UK"},{"name":"Leicester Diabetes Centre, University Hospitals Leicester &amp; University of Leicester  Leicester UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Barker","sequence":"additional","affiliation":[{"name":"Institute of Metabolic Science \u2013 Medical Research Laboratories, University of Cambridge  Cambridge UK"},{"name":"Cambridge Universities NHS Foundation Trust  Cambridge UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keith","family":"Burling","sequence":"additional","affiliation":[{"name":"Institute of Metabolic Science \u2013 Medical Research Laboratories, University of Cambridge  Cambridge UK"},{"name":"Cambridge Universities NHS Foundation Trust  Cambridge UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ian","family":"Halsall","sequence":"additional","affiliation":[{"name":"Institute of Metabolic Science \u2013 Medical Research Laboratories, University of Cambridge  Cambridge UK"},{"name":"Cambridge Universities NHS Foundation Trust  Cambridge UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth","family":"Turner","sequence":"additional","affiliation":[{"name":"Norfolk and Norwich University Hospitals NHS Foundation Trust  Norwich UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Coralie","family":"Glenn\u2010Sansum","sequence":"additional","affiliation":[{"name":"North West Anglia NHS Foundation Trust Peterborough City Hospital  Peterborough UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abby","family":"Rand","sequence":"additional","affiliation":[{"name":"Salisbury NHS Foundation Trust Salisbury District Hospital  Salisbury UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jenny","family":"Finch","sequence":"additional","affiliation":[{"name":"East Suffolk and North Essex Foundation Trust Ipswich Hospital, Ipswich  Colchester UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Genessa","family":"Peters","sequence":"additional","affiliation":[{"name":"East Suffolk and North Essex Foundation Trust Ipswich Hospital, Ipswich  Colchester UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Geraldine","family":"Upson","sequence":"additional","affiliation":[{"name":"Croydon Health Services NHS Trust Croydon University Hospital  Croydon UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edward","family":"Mullins","sequence":"additional","affiliation":[{"name":"Imperial College London and the George Institute for Global Health  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4176-8329","authenticated-orcid":false,"given":"Claire L.","family":"Meek","sequence":"additional","affiliation":[{"name":"Institute of Metabolic Science \u2013 Medical Research Laboratories, University of Cambridge  Cambridge UK"},{"name":"Leicester Diabetes Centre, University Hospitals Leicester &amp; University of Leicester  Leicester UK"},{"name":"Cambridge Universities NHS Foundation Trust  Cambridge UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,12,17]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41572-019-0098-8"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm11030564"},{"key":"e_1_2_11_4_1","unstructured":"Diabetes in pregnancy: management of diabetes and its complications from preconception to the postnatal period. 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