Inclusion Criteria:

• * pregnancy complicated by GDM as diagnosed with traditional two step testing in the third trimester according to Carpenter-Coustan Criteria
• * receiving prenatal care at UMASS Memorial and plans to deliver at UMASS Memorial
• * able and willing to provide informed consent
• * English or Spanish speaking
• * ability to complete immediate in hospital postpartum glucose testing
• * have evidence of impaired glucose metabolism defined as fasting glucose value of ≥126 mg/dL or 2-hour glucose value of ≥200 mg/dL

Exclusion Criteria:

• * known diagnosis of pre-existing pre-gestational diabetes in pregnancy
• * inability to complete oral glucose tolerance test (e.g. gastric bypass surgery history, gastric dumping syndrome history, vomiting of oral glucose tolerance test) in pregnancy or immediately postpartum
• * systemic steroid use