Blood glucose monitoring. Women are instructed to carry out self monitoring of blood glucose (SMBG) 4 times a day, fasting glucose (upon awakening), and one or 2 hour post-meals (after the first bite of a meal). In GDM, monitoring of blood glucose after meals is preferred over pre-meal testing as the risk of macrosomia increases with increased maternal glucose levels post-meals.33 This was illustrated in a randomized clinical trial,34 which compared preprandial glucose monitoring to one hour post-prandial (PP) testing, and found macrosomia, cesarean deliveries, and neonatal hypoglycemia were significantly less frequent in women who monitor their glucose post-meals. However, it is not known whether a one hour, or 2-hour PP testing is the ideal goal for the prevention of fetal risks. Therefore, patients can monitor their glucose levels at one or 2 hours post-meal, whatever is convenient, or at the estimated peak blood glucose is most likely to occur post prandial, for example, choosing the time at which glucose was elevated during OGTT.