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based on the finding of this study was presented at Annual Academic Sessions of Sri Lanka Medical Association in 2015 (29). Identification of mid trimester excess gestational weight gain is important as it is associated with higher risk of GDM. It would also provide an opportunity for intervention early in pregnancy. Even though most women with excessive GWG had traditional risk factors for GDM in our study, excessive GWG without traditional risk factors also had higher odds of having GDM. Therefore, it can be used as a predictor of GDM in our setting. Summary & conclusions From the series of clinical research on diagnostic tests and methods, author of this oration would like to draw following conclusions and would also like to argue against some of the existing management of GDM in Sri Lanka. 1. Results of our first study clearly indicated that the current GDM screening practices at tertiary care setting is far below the standard practice. Therefore, educating the health care professionals on GDM screening is an urgent need to improve maternal and child health services in Sri Lanka. 2. The second study revealed that the non-fasting GCT had a poor sensitivity (40.6%) and poor specificity when compared to GTT with IAPDSG criteria. Therefore, the current recommendation of Nirogi Lanka-diabetes prevention task force and Sri Lankan College of Obstetricians & Gynaecologists on GDM screening using a single-step non-fasting GTT with 2h cutoff of 140 mg/dL as a screening and diagnostic test for GDM may need to be revisited. 3. Instead we would suggest a single-step 75g GTT using the IADPSG criteria over GCT as the most appropriate method for GDM screening for our settings. 4. As for the most appropriate method for GDM screening, we would recommend universal screening as the best strategy at tertiary care settings. However, if the facilities are limited, selective risk factor based screening also can be used with success in community clinics where women are less likely to have multiple risk factors for GDM. 5. Booking visit BMI and mid trimester excessive gestational weight gain can be used to predict GDM. We recommend to calculate BMI at booking visit and look for excessive gestational weight gain in mid trimester and intensive look 2 for GDM in women with BMI ≥25 kg/m or/ and mid trimester excessive gestational weight gain.

Gestational diabetes mellitus: In search of better screening and diagnostic pathway for Sri Lankan women