Optimal screening practices for gestational diabetes in those with risk factors for gestational diabetes are unknown. Some experts recommend early (under 20 weeks gestation) screening plus repeat screening at the standard 24-28 week timeframe if not diagnosed via early screening. More recent data has called this recommendation into question, citing more costs than benefits of early screening. Kaiser Permanente Northern California initiated a recommendation against early screening in April 2020, the effects of which have yet to be studied. The goals of this study are to determine whether the decrease in the proportion of women screened for gestational diabetes before 24 weeks of gestation was safe in relation to maternal and newborn health outcomes that are common gestational diabetes-related complications. This evaluation will inform whether this practice change is safe enough to evolve into a permanent care delivery strategy. We also will compare resource utilization with this new practice compared to the historic strategy.