What criteria should I use to determine whether to refer a pregnant pa

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

Refer a pregnant patient with gestational diabetes to a specialist if:

They have been diagnosed with gestational diabetes based on fasting plasma glucose ≥5.6 mmol/l or 2-hour plasma glucose ≥7.8 mmol/l, requiring specialist joint diabetes and antenatal clinic review within 1 week of diagnosis.
They have a history of previous gestational diabetes, warranting early self-monitoring or early OGTT and specialist input.
They have risk factors such as BMI >30 kg/m2, previous macrosomic baby ≥4.5 kg, family history of diabetes, or ethnicity with high diabetes prevalence, which prompt testing and possible referral.
They require blood glucose-lowering therapy beyond diet and exercise, including oral agents or insulin, necessitating specialist management.
They have fasting plasma glucose levels ≥7 mmol/l at diagnosis, indicating need for more intensive management.
They experience unstable blood glucose levels or problematic severe hypoglycaemia despite efforts to optimise control, requiring specialist diabetes team input.
They need education on self-monitoring, diet, exercise, and medication management, which is best provided by a specialist multidisciplinary team including dietitians.

Referral should be to a joint diabetes and antenatal clinic to ensure coordinated care and monitoring throughout pregnancy and delivery .

What criteria should I use to determine whether to refer a pregnant patient with gestational diabetes to a specialist?