In 2013, the Society for Maternal-Fetal Medicine (SMFM) Publications Committee adopted the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system for evaluating and rating scientific evidence and practice recommendations for SMFM Clinical Guidelines and Consults.1 This decision to adopt the GRADE system was 2-fold: to achieve a singular classification system to improve consistency with other organizations that create guidelines and address some of the limitations of previous classification systems. Since the initial adoption of the GRADE system, the SMFM Publications Committee has continued to refine its guideline development process to provide additional benefit to clinicians and policymakers and improve the quality of care for our patients. This document serves to update our process for creating evidence-based practice recommendations and describe the GRADE process as it is currently implemented in the SMFM Consult and Guidelines series.