The Treatment of Booking Gestational Diabetes Mellitus (TOBOGM) RCT was a well conducted trial demonstrating that early (before 20 weeks’ gestation) diagnosis and treatment of gestational diabetes (GDM) among women with risk factors is associated with reduced neonatal complications, reduced length of stay in the neonatal nursery, increased quality of life, increased breastfeeding and overall cost savings1-3. The trial is based upon sound pathophysiological principles as part of a shift in the GDM paradigm from a pregnancy-alone focus to a pregnancy-as-part-of-a-lifecourse approach4. TOBOGM suggested the use of higher diagnostic criteria in early pregnancy and the need to be able to step-down care to address GDM regression5. While several hospitals around Australia already apply a TOBOGM approach (early oral glucose tolerance test (OGTT) for those with risk factors and then universal 24-28 week OGTT), using current ADIPS diagnostic criteria, the early risk factors chosen, and wider management aspects vary. This presentation will discuss some of the options for implementing higher glycaemic OGTT thresholds thereby minimising the impact on women while maximising the number of women who may benefit from having their pregnancy and future type 2 diabetes risks identified.