CRITERIA FOR GESTATIONAL DIABETES - A CAUTIONARY TALE

The diagnosis of gestational diabetes was developed to predict neonata l outcome (particularly perinatal mortality, macrosomia and hypoglycae mia) and future maternal diabetes. A variety of criteria for this diag nosis have evolved over time, assessed predominantly among European wo men. We describe a Pacific Islands woman with multiple risk factors fo r future diabetes yet a borderline 100 g glucose tolerance test result , who delivered a stillborn macrosomic baby weighing 6.7 kg at 38 week s' gestation. Six weeks postpartum, diabetes was diagnosed by 75 g ora l glucose tolerance test. This case highlights the need for caution wh en interpreting the glucose tolerance test in pregnancy and suggests t hat closer fetal monitoring and involvement of the diabetes team may b e necessary among women with a borderline glucose tolerance test in th e presence of additional risk factors for future diabetes (eg obesity, ethnic group).