Waiting for HAPO.

The recent global increase in gestational diabetes has paralleled the increased prevalence of obesity and type 2 diabetes. The Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study is an attempt to establish gestational diabetes diagnostic criteria as well as to clarify the accurate glucose threshold for the relationship between maternal hyperglycaemia and adverse perinatal outcomes. Although five international workshops have convened to address the importance of gestational diabetes, a resolution towards a general consensus for diagnosis and clinical management of gestational diabetes has not been achieved. Such a resolution may never appear, much like the outcome in the play Waiting for Godot, a character who in the end never arrives, and may not even exist. The accompanying article by Mathiesen and Vaz highlights the fetal, neonatal and maternal risks that accompany inadequate glycaemic control during pregnancies complicated by diabetes, even in the presence of only mild maternal hyperglycaemia. Diet, exercise and an optimised treatment regimen based on regular pre- and postprandial monitoring of blood glucose are essential throughout pregnancy. Pivotal to this goal is the recognition that insulin requirements in pregnancy are distinct from those of the prepregnancy state, and that these requirements change throughout gestation, labour and lactation.