In 2017, ACOG adopted the NIDDK / ADA guidance on early screening for GDM before 24-28 weeks which takes in to account not only previous pregnancy history but also risk factors associated with GDM/type 2 diabetes. A recent presentation at the ACOG annual clinical meeting (ACM 2021) stated that despite these recommendations, the majority of women who meet early screening criteria are not tested early for gestational diabetes. Does early screening for gestational diabetes lead to reduced adverse outcomes? Is that evidence-based? In this episode we will review the ACOG ACM presentation and contrast that to the May 2020 AJOG RCT (ABOG MOC article) which investigated whether early screening and treatment for GDM actually resulted in better clinical outcomes or not.