Sleep disordered breathing (SDB) in pregnancy is a known risk factor for gestational diabetes, which is commonly diagnosed in the second or third trimester of pregnancy. A new study suggests that insulin resistance, which is the precursor to gestational diabetes, may be found as early as the first trimester of pregnancy in women with risk factors for obstructive sleep apnea, such as being overweight and having recurrent snoring when sleeping. This study demonstrates that the changes associated with gestational diabetes are seen much earlier in pregnancy.This study outlines the possible utility of screening for obstructive sleep apnea or sleep disordered breathing in pregnant patients who are overweight and have excessive snoring and increased daytime sleepiness. Waiting until mid-pregnancy to screen these women for obstructive sleep apnea is too late to make significant changes in their care.Experts in this field say that, ideally, screening for sleep disordered breathing should occur prior to pregnancy, taking into account the so-called body mass index of the patient (BMI) and a history of snoring loud enough to wake their partner. It may be too early to say that an intervention with CPAP will prevent the insulin resistance seen is gestational diabetes. We need to keep in mind that some of the findings and symptoms of obstructive sleep apnea and sleep disordered breathing are common in pregnancy, specifically an increase in the BMI and some daytime sleepiness. Obviously, more work needs to be done in this area, so stayed tuned.