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Background: Gestational diabetes mellitus (GDM) is the fastest growing type of diabetes in Australia with rates trebling over the past decades partially explained by rising obesity rates and maternal age among childbearing women. Percentage of GDM attributable to obesity has been documented, mostly focusing on metropolitan populations. In parts of regional (areas outside capital cities) and rural Australia where overweight, obesity and morbid obesity are more prevalent, intertwined with socioeconomic disadvantage and higher migrant communities, trends over time in adjusted percentages of GDM attributed to obesity are unknown., Methods: In this population-based retrospective panel study, women, without pre-existing diabetes, delivering singletons between 2010 and 2017 in a tertiary regional hospital that serves 26% of Victoria's 6.5 million Australian population were eligible for inclusion. Secular trends in GDM by body mass index (BMI) and age were evaluated. The percentage of GDM that would have been prevented each year with the elimination of overweight or obesity was estimated using risk-adjusted regression-based population attributable fractions (AFp). Trends in the AFp over time were tested using the augmented Dickey-Fuller test., Results: Overall 7348 women, contributing to 10,028 births were included. The age of expecting mothers, their BMI, proportion of women born overseas, and GDM incidence significantly rose over time with GDM rising from 3.5% in 2010 to 13.7% in 2017, p <  0.001, increasing in all BMI categories. The incidence was consistently highest among women with obesity (13.8%) and morbid obesity (21.6%). However, the highest relative increase was among women with BMI < 25 kg/m 2 , rising from 1.4% in 2010 to 7.0% in 2017. Adjusting for age, country of birth, socioeconomic status, comorbidities, antenatal and intrapartum factors, an estimated 8.6% (confidence interval (CI) 6.1-11.0%), 15.6% (95% CI 12.2-19.0%), and 19.5% (95% CI 15.3-23.6%) of GDM would have been prevented by eliminating maternal overweight, obesity, and morbid obesity, respectively. However, despite the rise in obesity over time, percentages of GDM attributable to overweight, obesity, and morbid obesity significantly dropped over time. Scenario analyses supported these findings., Conclusions: Besides increasing prevalence of obesity over time, this study suggests that GDM risk factors, other than obesity, are also increasing over time., (© 2022. The Author(s).)

Introduction: Women in rural and regional areas encounter challenges when accessing care for gestational diabetes mellitus (GDM). A telehealth initiative for GDM care in an urban setting demonstrated positive effects on achieving glycaemic targets without compromising quality of care, but consumer and health service staff perspectives have not been explored. This research aimed to identify the profiles of women accessing care for GDM in a large regional hospital with a rural catchment in Victoria, Australia as well as gain insight into the views of the women with GDM, clinicians and IT staff on the acceptability and feasibility of a GDM telehealth in this setting., Methods: Clinical and demographic characteristics of women accessing the GDM service between October 2016 and October 2017 were audited. Semi-structured interviews were completed with nine patients, three clinical staff and two IT service staff. Quantitative and qualitative data were analysed descriptively and thematically, respectively., Results: Telehealth was viewed favourably by women and staff, with many perceived benefits identified around mitigating challenges of accessing care, and service capacity and provision. Concerns were raised around potential costs incurred by women and health services in accessing telehealth initiatives. Staff highlighted that moderation of workloads and coordination of telehealth services would be essential to the success of a future telehealth initiative., Conclusion: This article contributes important knowledge around GDM care in rural and regional settings and the perspectives of women with GDM, clinicians and technical support staff. Women and health services staff consider telehealth a feasible and acceptable alternative to current GDM care and address many of the barriers and impacts of attending care in person. Perceived benefits to patients and health services need to be balanced against the concerns around the work and costs to deliver GDM telehealth services.