Only 40% of pregnant women with fasting glucose ≥ 5.10 mmol/L at the first obstetric examination were diagnosed with gestational diabetes mellitus in China Professor Yang Huixia et al. of the First Hospital of Peking University reported that fasting glucose (FPG) levels ≥ 5.10 mmol/L at the first obstetric examination could not confirm the diagnosis of gestational diabetes mellitus (GDM). If 6.10 mmol/L ≤ FPG level at the first obstetric examination <7.00 mmol/L, GDM should be considered and nutrition and exercise interventions should be given; when the FPG level is 5.10-6.09 mmol/L, nutrition and exercise can also be strengthened appropriately and an oral glucose tolerance test (OGTT) can be performed at 24-28 weeks of gestation to exclude GDM ( The International Academy of Diabetes and Pregnancy Study Group (IADPSG) and the American Diabetes Association (ADA) have different views on the use of initial FPG levels at delivery to diagnose GDM. The IADPSG recommends that GDM can be diagnosed if the FPG level is ≥ 5.10 mmol/L at the initial delivery and throughout pregnancy; the ADA recommends that the FP level at the initial delivery can only be used to diagnose overt diabetes (≥ 7.00 mmol/L) and that an OGTT is required to screen for GDM at 24 to 28 weeks of gestation. "The standards are similar to the ADA recommendations. The standard recommends that pregnant women should have an FPG test during the first obstetric examination to screen for preconceptional diabetes, and a 75 g OGTT at 24-28 weeks of gestation to exclude GDM. According to the criteria, GDM is classified into 2 levels: 1. Al level, i.e. GDM can be controlled in the normal range by diet alone; 2. A2 level: GDM can be controlled in the normal range by insulin treatment. Professor Yang et al. enrolled 17,186 pregnant women from 13 hospitals in China, and examined the first antenatal checkup and the 75g OGTT at 24-28 weeks of gestation. The results of 75g OGTT one-step screening for GDM at 24-28 weeks of gestation were analyzed. The results showed that the median FPG level at the initial examination was 4.58 mmol/L. The FPG level decreased as the gestational cycle increased. The FPG level at the initial examination was strongly correlated with GDM at 24-28 weeks of gestation. In pregnant women with FPG levels >4.10 mmol/L at the initial examination, the rate of GDM diagnosis at 24-28 weeks of gestation increased with each 0.50 mmol/L increase in FPG level. In pregnant women with FPG levels of 5.10-5.59 mmol/L, 5.60-6.09 mmol/L, and 6.10-6.99 mmol/L at the first obstetric examination, the GDM diagnosis rate was 37.0%, 52.7%, and 66.2%, respectively (Table 1). The study found that only 1 in 3 pregnant women with FPG levels ≥5.10 mmol/L at the time of the initial examination maintained their FPG levels at 24-28 weeks of gestation. The OGTT diagnostic criteria at 24-28 weeks of gestation were used as the gold standard, with a specificity of 99% and a reasonable range of positive and negative predictive values when the FPG level was close to 5.60 mmol/L at the time of the first obstetric examination, and a specificity of 100% when the FPG level was close to 6.10 mmol/L. This study suggests that the FPG level at the first obstetric examination can be used to diagnose GDM at 24-28 weeks of gestation, but PFG levels ≥ 5.10 mmol/L are not suitable for confirming GDM. 2/3 of pregnant women with FPG levels ≥ 6.10 mmol/L at the first obstetric examination are likely to progress to GDM, and therefore, it is recommended that these women be treated as having GDM and given nutritional and exercise advice. Half of the pregnant women with FPG levels of 5.60-6.09 mmol/L at the first obstetric examination are likely to progress to GDM and should be considered as a high-risk group for GDM, with appropriate nutritional and exercise interventions.