Clinical Diagnosis of Gestational DiabetesRYAN, EDMOND A. MDClinical Obstetrics and Gynecology: December 2013 - Volume 56 - Issue 4 - p 774–787 doi: 10.1097/GRF.0b013e3182a8e029 Gestational Diabetes Mellitus Abstract Author Information 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). 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.