Hyperglycaemia in pregnancy includes gestational diabetes (GDM) and pre-existing type 1 or type 2 diabetes in pregnancy. Rates of these conditions continue to increase, particularly that of GDM and type 2 diabetes in pregnancy; with increased prevalence relating to increasing maternal age and obesity, high risk population groups and changes in screening and diagnostic criteria. The International Association of Diabetes in Pregnancy Study Group GDM diagnostic criteria have been recommended by the Australasian Diabetes in Pregnancy Society and the World Health Organisation and have been implemented by many, but not all, centres in Australia, with variable uptake internationally. Clinical guidelines and practice also vary within Australia and internationally for topics including early pregnancy GDM diagnosis, treatment targets and use of metformin. There are several recent and current clinical trials in Australia and internationally addressing some key evidence gaps in hyperglycaemia in pregnancy. Our current clinical research program includes the Northern Territory and Far North Queensland Diabetes in Pregnancy Partnership, a partnership between researchers, policy makers and health service providers to improve systems, services and outcomes for women with hyperglycaemia in pregnancy and their children, particularly the high risk population of Aboriginal and Torres Strait Islander peoples.