There remains some controversy on the criteria for diagnosing and aggressively treating gestational diabetes. There have been calls for a reduction in the threshold for diagnosis and treatment (which would result in the the diagnosis being made in many more women) as well as in the targets for treatment (which would result in much more aggressive interventions. This study supports the argument that even mild elevations in blood sugars leads to several maternal and fetal abnormalities - including large babies, hypertension etc. Treating more aggressively led to a better outcome in terms of birth weight , neonatal fat mass (, the frequency of large-for-gestational-age infants , shoulder dystocia, and cesarean delivery. More aggressive treatment of gestational diabetes mellitus, as compared with usual care, was also associated with reduced rates of preeclampsia and gestational hypertension. It is likely that this data will add to calls for changes in current diagnostic criteria and treatment guidelines. Vivian Fonseca, MD