Abstract
<title>Abstract</title> <p>Oral glucose tolerance test (OGTT) is universally recommended for screening and diagnosis of gestational diabetes (GDM). This pure glucocentric approach is inadequate as other risk factors contribute to adverse perinatal outcomes. Our study tested the performance of a population-specific composite risk score-based risk stratification on perinatal outcomes. This was carried out in three prospective early pregnancy cohorts in the UK, India and Kenya and was externally validated in two real-world datasets. Our analysis illustrated clear differences in risk factors and rates of perinatal outcomes across the populations, highlighting the need for a population-specific approach. Our data also showed that rates of perinatal outcomes increased with increasing risk categories. Incorporation of key maternal risk factors that contribute to adverse perinatal outcomes with HbA1c offers a move away from an OGTT-based approach to GDM screening and a pragmatic solution for settings with limited health infrastructure where OGTT is difficult to perform.</p>