which the incidence
of large-for-gestational-age infants was 20%.Comparison
of the incidence of large-for-gestational-age infants with
eligible women who declined participation was precluded
because those with available birthweight data had a
signifi cantly lower BMI than did the group as a whole.
Our study highlights the need for randomised
controlled trials in women with obesity that do universal
testing and formally compare IADPSG and older
diagnostic criteria for gestational diabetes. In the UK,
comparison should be made with the most recent NICE
criteria, which do not align with IADPSG.11
More infants born to mothers in the intervention group
developed neonatal hypoglycaemia than did those in the
standard care group, but statistical power for this outcome
was low. This fi nding contrasts with that of a metaanalysis
of smaller lifestyle intervention studies, which
showed no eff ect.6 Ten infants in the intervention group
with hypoglycaemia were fed formula milk from birth,
compared with two in the standard care group (37% vs
16%; p=0·04). Since early introduction of formula feeding
has been associated with neonatal hypo glycaemia,29 this
factor could be contributory. The rates of exclusive
breastfeeding (p=0·73) or formula feeding (p=0·63) did
not diff er at neonatal discharge between the two study
groups; therefore, this fi nding is likely to be attributable
to chance