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Prior to the hyperglycemia and adverse pregnancy outcome (HAPO) study, the guidelines for GDM diagnosis were formulated in the 4th and 5th international workshops [3, 4]. Screening for GDM may be universal (all pregnant women) or selective (depending upon risk factors). As history-based risk factors identify only 50% of women with GDM [5], the screening procedure is often accompanied by a 50 g glucose challenge test (GCT) [6]. The cutoff for a positive screening test is typically set at 130–140 mg/dL (7.2–7.8 mmol/L), at which 14–23% of women will be screen positive. If screening is positive, a diagnostic OGTT is preformed, measuring glucose following on overnight fast and 1, 2, and 3 h after 100 g glucose were ingested. At least 2 of the 4 OGTT values should be abnormal in order to diagnose GDM using the modifications of O’Sullivan’s work, as made by the National Diabetes Data Group [7] and later by the thresholds of Carpenter and Coustan [8].

Table 2. Diagnostic thresholds for the OGTT

Alternatively, the World Health Organization (WHO) [9] adopted somewhat different criteria, derived from classification of impaired glucose tolerance in a nonpregnant population. WHO recommended a universal 75 g OGTT in which only fasting and 2-h measurements are used.