The next 5 years will be crucial for addressing and answering many of the key research questions which have been highlighted in this manuscript. In particular, RCTs will be carried out to assess the effects of treating women diagnosed as having GDM according to the new IADPSG criteria. Only then will we be able to determine which (if any) interventions (e.g., diet, exercise, drugs) are more effective to reduce the adverse outcomes reported in the HAPO study. RCTs will also be crucial to assess the benefits and harms of universal screening for GDM, including the patient's perspectives as well as the economic implications of different screening strategies.
The lowering of the diagnostic threshold to identify and treat GDM, in combination with the obesity epidemic, would dramatically increase the prevalence of the disease, putting enormous pressure on tertiary health centers and specialized health professionals (endocrinologists, dietitians, diabetes nurses and educators). In this context, primary healthcare professionals will need to be trained to care for these cases. Consequently, research to assess the effect on maternal and perinatal outcomes of delegating the care of mild GDM patients to these professionals, compared with care by more specialized professionals, on significant maternal and perinatal outcomes will be essential.