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The increased obstetrical risk associated with diabetes first recognized in pregnancy, i.e., gestational diabetes, was first described in the postwar period by Dr. J. P. Hoet in a paper written in French and translated into English by Dr. F.D.W. Lukens for publication in Diabetes in 1954 (1). Not long after that the National Institutes of Health developed a program in the epidemiology of chronic disease, and a field center was established in Boston, Massachusetts, under Hugh Wilkerson (2). Dr. John B. O'Sullivan, having grown up in Ireland and graduated from the Royal College of Physicians and Surgeons in 1951, found his way to America and joined this program in the mid-late 1950s.
At the time there was a great controversy about how to diagnose gestational diabetes. Using oral glucose tolerance test (OGTT) criteria for nonpregnant subjects, the incidence of diabetes was as much as one-third of the entire pregnancy population. To address this question, O'Sullivan performed 100-g OGTTs in 752 mainly second- and third-trimester pregnant women and published the first, second, and third standard deviation upper limits for these glucose values (3). These were the first statistically based criteria for assessing the upper limit of glycemic normality in pregnancy. These criteria differed from those in normal individuals by having higher upper-limit values at the 2nd and 3rd hours, consistent with an impaired glucose tolerance in pregnant compared with nonpregnant individuals. This result was consistent with the earlier observation of higher glucose values after oral glucose administration in pregnant women published by Hurwitz and Jensen in the New England Journal of Medicine in 1946 (4). The O'Sullivan criteria, published with statistician Claire Mahan, were the standard for diabetes detection in pregnancy for the next 40 years (3).
In the ensuing years, O'Sullivan and Mahan used the criteria to detect gestational diabetes and then to determine whether insulin therapy could ameliorate the condition. In this work, they found that insulin could reduce infant macrosomia incidence, a leading indicator of the...