OBJECTIVES: To compare the cost-effectiveness of GDM screening in mainland China using the guidelines from the Textbook of Obstetrics and Gynaecology of China, 7th version (Textbook, original guideline used in China) and the American Diabetes Association (ADA) 2011 (IADPSG) criteria. METHODS: A decision-tree model was used to estimate the cost-effectiveness of two strategies used to diagnosis GDM: the guidelines from the Textbook and the ADA 2011 guidelines. All probabilities, costs, and utilities were derived from the two major regional university-based hospital (The First Affiliated Hospital of Jinan University, The First Affiliated Hospital of Sun Yat-sen University) and literature. The primary outcome measure was the incremental cost per quality-adjusted life year (QALY). A base-case analysis, a one-way sensitivity analysis, and a Monte Carlo simulation were performed. RESULTS: When screening for GDM using ADA 2011 criteria, 23.1% of pregnant women were diagnosed with GDM, an increase of 350% when compared with the guidelines from the Textbook. ADA 2011 criteria were more expensive but more effective, and the cost-effective increment ratio was RMB$318,823.3/QALY in 2017. A sensitivity analysis showed that the top three factors influencing the ICERs were the prevalence of GDM, cesarean section rate, and the incident rate of preeclampsia. A Monte Carlo analysis showed only 9.5% probability that screening with ADA 2011 was cost-effective.CONCLUSIONS: ADA 2011 could improve the clinical outcomes of GDM. However, it’s not cost-effective for most provinces in China. It is estimated that it could be accepted by more than 50% of the provinces by 2029 if economic growth in China continues at a rate of 6.76%. Although the research does not indicate that it is a cost-effective strategy in China, we suggest that, with additional.