IADPSG and WHO 2013 Gestational Diabetes Mellitus Criteria Identify Obese Women With Marked Insulin Resistance in Early Pregnancy

Implementation of the International Association of Diabetes and Pregnancy Study Groups (IADPSG) and the World Health Organization 2013 (WHO 2013) recommendations leads to an increased prevalence of gestational diabetes mellitus (GDM) due to more stringent criteria and early screening of women at high risk for diabetes in pregnancy (DIP) (1,2).IADPSG members now recommend that their GDM criteria should not be used in early pregnancy but have not provided alternative criteria (3).We have compared the characteristics of overweight/obese women early in pregnancy, with and without GDM using the new criteria, to assess whether those testing positive are metabolically distinct.Pregnant women with a BMI $29.0 kg/m 2 underwent a 75-g oral glucose tolerance test in early pregnancy as part of enrollment into the DALI (Vitamin D And Lifestyle Intervention for GDM prevention) pilot and lifestyle Pan-European multicenter trials (4).GDM and DIP were diagnosed using WHO 2013 criteria.A high rate of GDM (237/1,035 or 22.9%: DIP 0.5%; total hyperglycemia in early pregnancy 23.4%) was found at a mean of 15.2 6 3.0 gestational weeks (interquartile range 13.4-16.8).A fasting glucose alone identied 190/242 (78.5%) women.The other 52 women (21.5%) were diagnosed with elevated