Gestational Diabetes: Seeing Both the Forest and the Trees

Gestational diabetes is a heterogeneous disorder. Various metabolic etiologies underpin the diagnosis and influence perinatal outcomes as well as an individual’s propensity for the subsequent development of diabetes. Recent landmark studies have driven a review of the diagnostic criteria for gestational diabetes, with an emergent category, “overt diabetes during pregnancy,” recognizing the increased surveillance required for some women. As we strive for consensus in diagnosis at a global level, consideration for its application to local populations, with different ethnicities, genetics, and immunological make-up, is essential to optimize obstetric care and neonatal outcomes. An individualized approach must remain the mainstay of management.