What criteria should I use to determine whether to refer a pregnant patient with gestational diabetes to a specialist?

Refer a pregnant patient with gestational diabetes to a specialist if:

• They have been diagnosed with gestational diabetes based on fasting plasma glucose ≥5.6 mmol/l or 2-hour plasma glucose ≥7.8 mmol/l, requiring specialist joint diabetes and antenatal clinic review within 1 week of diagnosis.
• They have a history of previous gestational diabetes, warranting early self-monitoring or early OGTT and specialist input.
• They have risk factors such as BMI >30 kg/m2, previous macrosomic baby ≥4.5 kg, family history of diabetes, or ethnicity with high diabetes prevalence, which prompt testing and possible referral.
• They require blood glucose-lowering therapy beyond diet and exercise, including oral agents or insulin, necessitating specialist management.
• They have fasting plasma glucose levels ≥7 mmol/l at diagnosis, indicating need for more intensive management.
• They experience unstable blood glucose levels or problematic severe hypoglycaemia despite efforts to optimise control, requiring specialist diabetes team input.
• They need education on self-monitoring, diet, exercise, and medication management, which is best provided by a specialist multidisciplinary team including dietitians.

Referral should be to a joint diabetes and antenatal clinic to ensure coordinated care and monitoring throughout pregnancy and delivery ¹.