The analysis, covering nearly all first live singleton births in the country during that period, also revealed that GD increased across every racial and ethnic group, though the rise was not uniform.
Researchers pointed to a combination of factors fueling the increase, including the growing prevalence of overweight and obesity prior to pregnancy, older maternal age at first birth, and higher rates of metabolic risk factors. The COVID-19 pandemic may have amplified these trends through disruptions to routine preventive care, reduced physical activity, higher psychosocial stress, and weight gain, according to Emily L. Lam, a medical student at Northwestern University and first author of the study.
“Primary care clinicians are uniquely positioned to intervene upstream of pregnancy,” Lam said. “Optimizing cardiometabolic health before pregnancy—through counseling on weight, nutrition, and physical activity—can help reduce the likelihood of developing gestational diabetes and promote long-term cardiometabolic health.”
The study included 12,617,106 mothers who gave birth between January 1, 2016, and December 31, 2024. The average maternal age at delivery was 27 years. Just over half (52.7%) of the participants were White, 22.8% Hispanic, 13% Black, 7.4% Asian, 0.6% American Indian or Alaska Native, and 0.2% Native Hawaiian or other Pacific Islander.
Over the study period, the age-standardized GD rate increased from 58.2 per 1,000 live births in 2016 to 79.3 per 1,000 in 2024, reflecting an annual growth rate of 3.8%. The highest rates were observed among American Indian or Alaska Native mothers, rising from 113.2 per 1,000 in 2016 to 136.7 per 1,000 in 2024. Native Hawaiian and other Pacific Islander mothers also experienced high rates, increasing from 93.8 to 126 per 1,000 over the same period. Both groups saw the fastest annual increases, at 4.1%. White mothers consistently had the lowest rates, though these still rose from 51.2 to 70.7 per 1,000 births.
Lam described the overall increase as striking. “We anticipated some rise in gestational diabetes given broader metabolic trends in the U.S., but the magnitude and consistency across almost all racial and ethnic groups were remarkable,” she said.
The researchers noted that differences in absolute rates between racial and ethnic groups are likely linked to variation in risk factor burden, health behaviors, access to care, and social exposures.
Gestational diabetes is considered an early warning sign of future cardiometabolic disease for both the birthing parent and their child. Lam emphasized the importance of follow-up care after pregnancy complicated by GD. “Primary care clinicians play a critical role in optimizing long-term cardiometabolic health and mitigating future risks,” she said.
The findings were published online on December 29, 2025, in JAMA Internal Medicine.