Background
The Oral Glucose Tolerance Test is considered to be the Gold standard for the diagnosis of Gestational diabetes. However this test has many drawbacks such as being time consuming and unpleasant to execute. We took a snap shot of our patient experience with the Oral glucose tolerance test over a two week period in 2016. 221 pregnant women were requested to do the OGTT of which only 133 turned up for the test. Of these 11 had to abort the procedure after drink the glucose solution due to nausea and vomiting. Thus we felt we should look for other options. A literature search revealed that Fasting plasma glucose might be a viable option.  

Aim
To test whether Fasting Plasma Glucose might be used as a screening tool for Gestational Diabetes thus circumventing the OGTT in a numer of patients. 

Method
Prospective Observational Study from 1st January 2016 to 31st December 2016. Universal screening with a 75 gram 2 hour OGTT was requested for all women between 24 to 32 weeks gestation who did not have pre existing diabetes or early onset Gestational Diabetes by the IADPSG criteria.
If the Fasting Glucose was reported as equal to or more than 5.1 mmol/L the patient was declared to have Gestational Diabetes and was not required to drink the glucose solution.
If the fasting glucose was less than 5.1 mmol/L the woman went on to have the full 2 hour OGTT. 

Results
During the study period 6,790 women registered a new pregnancy in Corniche Hospital. 546 had pre existing diabetes and whereas 1,781 were diagnosed as GDM prior to 20 weeks gestation . 5,889 women were requested to have an OGTT of which 3,375 actually had the test. It was abnormal in  791 women. The Fasting Glucose was abnormal in 443 women , the one hour reading was abnormal in 171 and the 2 hour in 177 patients. Thus by halting the OGTT after an abnormal Fasting Glucose result 56% of these women were able to  avoid having a full OGTT. 

Discussion
Following the IADPSG recommendation that any one of three readings on the 75 gram 2 hour OGTT  being abnormal leads to a diagnosis of Gestational diabetes. An Abnormal Fasting glucose in itself may be diagnostic of Gestational Diabetes. Thus avoiding the OGTT in 56% of women is both patient friendly and cost effective.

Fasting glucose as a screening tool for gestational diabetes