INTRODUCTION: Gestational diabetes is one of the most common medical conditions women encounter during pregnancy and is the leading cause of maternal morbidity and mortality, perinatal and neonatal morbidity, and long-term consequences for both mother and baby. The percentage of pregnant women with gestational diabetes increased by 56% in the last ten years in the United States. Maternal obesity is a significant risk factor for gestational diabetes. In 2020, the Kansas obesity rate was 30-35%, which is expected to rise to more than 55% by 2030. Additionally, maternal and child health disparities are experienced to a greater extent in rural areas including obesity, in which rates are higher in rural counties than in large urban counties. It is hypothesized most rural counties in Kansas will have a higher prevalence of gestational diabetes. PURPOSE: Analyze the prevalence of gestational diabetes in rural and urban counties in Kansas. METHODS: Kansas Department of Health and Environment (KDHE) was used to gather diabetes and pre-pregnancy BMI data from 2005 to 2019. The data was analyzed by creating trend graphs and examining the prevalence in categorized peer groups. RESULTS: There is an increasing trend in rates and number of cases of gestational onset diabetes and pre-pregnancy BMI classified as overweight and obese. Urban counties have a higher prevalence of gestational diabetes, however rural counties have a higher prevalence of pre-pregnancy BMI overweight and obese cases. Rural counties have experienced a growing increase over the years in the prevalence of gestational diabetes. CONCLUSION: Similar national studies from the Centers for Disease Control and Prevention have reported an increased prevalence of gestational diabetes from 3.7% in 2012 to 5.8% in 2016. In Kansas gestational diabetes increased from 5.8% in 2012 to 6.4% in 2016. Observed increases in the prevalence of gestational diabetes could be reflective of recent increases in the prevalence of pre-pregnancy obesity that is experienced to a greater extent in rural communities. Future efforts to address this growing health disparity are needed.