Clinical Diagnosis of Gestational DiabetesRYAN, EDMOND A. MDClinical Obstetrics & Gynecology: December 2013 - Volume 56 - Issue 4 - p 774–787 doi: 10.1097/GRF.0b013e3182a8e029 Gestational Diabetes Mellitus Abstract Author Information Abstract Gestational diabetes mellitus (GDM) diagnosis remains controversial. ACOG criteria are based on the long-term risk of maternal diabetes. ADA recently suggested diagnosing GDM with 1 elevated value on an oral glucose tolerance test based on a 1.75-fold risk of large-for-gestational age infants resulting in a 17.8% rate of GDM. Given the lack of neonatal-based outcomes for the traditional position and problems of reproducibility and benefit/harm balance of the ADA approach, an alternative is presented herein based on a 2-fold risk of a large-for-gestational age baby, requiring 2 separate abnormalities to reduce false positives giving a more balanced benefit/harm ratio (10% GDM rate). Author Information Division of Endocrinology and Metabolism, Heritage Medical Research Centre, Alberta Diabetes Institute, University of Alberta, Edmonton, Alberta, Canada The author declares that there is nothing to disclose. Correspondence: Edmond A. Ryan, MD, Division of Endocrinology and Metabolism, Heritage Medical Research Centre, Alberta Diabetes Institute, University of Alberta, Edmonton, AB, Canada. E-mail: firstname.lastname@example.org © 2013 by Lippincott Williams & Wilkins.