Recent Italian guidelines exclude women <35 years old, without risk factors for gestational diabetes mellitus (GDM), from screening for GDM. To determine the effectiveness of these measures with respect to the International Association of the Diabetes and Pregnancy Study Groups (IADPSG) criteria, we evaluated 2,448 pregnant women retrospectively enrolled in Calabria, southern Italy. GDM was diagnosed following the IADPSG 2010 criteria. Among 538 women <35 years old, without risk factors, who would have not been tested according to the Italian guidelines, we diagnosed GDM in 171 (31.8%) pregnants (7.0% of total pregnants). Diagnosis was made at baseline (55.6%), 1 hour (39.8%), or 2 hours (4.7%) during OGTT. Despite of appropriate treatment, GDM represented a risk factor for cesarean section, polyhydramnios, increased birth weight, admission to neonatal intensive care units, and large for gestational age. These outcomes were similar to those observed in GDM women at high risk for GDM. In conclusion, Italian recommendations failed to identify 7.0% of women with GDM, when compared to IADPSG criteria. The risk for adverse hyperglycaemic-related outcomes is similar in low-risk and high-risk pregnants with GDM. To limit costs of GDM screening, our data suggest to restrict OGTT to two steps (baseline and 1 hour). 1. Introduction Gestational diabetes mellitus (GDM) is defined as any degree of glucose intolerance with onset or first recognition during pregnancy [1]. Incidence of GDM is increasing worldwide for recent trends in obesity and advancing maternal age, with huge healthcare and economic costs [2, 3]. Women exposed to GDM are at high risk for pregnancy complications [4–6], future type 2 diabetes mellitus (DM), and cardiovascular disease [7–9]. In particular, several lines of evidence indicate a continuum of risk for adverse pregnancy outcomes for mothers and their offsprings related to increasing maternal glucose levels [10, 11], whereas treatment to reduce maternal glucose levels reduces this risk [12–14]. Based on these evidences, to identify women at risk for adverse pregnancy outcomes and improve prognosis through evidence-based interventions, recent tight diagnostic criteria for GDM have been introduced by the International Association of the Diabetes and Pregnancy Study Groups (IADPSG) [15]. Diagnosis requires a 75？g oral glucose tolerance test (OGTT) carried out between 24 and 28 weeks of gestation in all women not previously found to have overt diabetes or GDM, considering glycaemia of 92？mg/dL at baseline, 180？mg/dL at 1？h, and 153？mg/dL at 2？h
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