Background: There is limited data reporting the adherence to screening protocol for gestational diabetes mellitus (GDM) in real-life settings. Aim: To evaluate the implementation of the screening tests for gestational diabetes suggested by the 2018 SID-AMD guidelines in clinical practice. Methods: Data from 189 women with GDM attending the Diabetes and pregnancy Outpatient Clinic at Federico II Hospital from 2021 to 2023 were analyzed. Pregestational risk for GDM was defined according to 2018 SID-AMD guidelines. Results: The mean age was 34±4 years, with a high prevalence of pregestational overweight and obesity (60%). Diagnosis of GDM was obtained with fasting hyperglycemia (n=10) or abnormal OGTT – oral glucose tolerance test (n=179). Out of 179 women with impaired OGTT, 112 had the T0 sample diagnostic. Among women who underwent screening with OGTT, 71 were classified as at very high pre-pregnancy risk, 86 were at high risk for GDM and 22 were low-risk women. Only 45% of the very high-risk women underwent OGTT screening between 16-18 weeks, as recommended. On the contrary, 16% of women at high risk performed the early OGTT. In women at low risk, OGTT screening was prescribed for reasons such as glycosuria (30%), borderline fasting blood glucose (30%), fetal growth abnormalities (20%), and polyhydramnios (33%). Conclusions: In clinical practice, GDM screening by OGTT in very high-risk women is performed later than guideline recommendations. Other clinical parameters help physicians in identifying women at high risk for GDM.