We thank Dawood for his comments (1) concerning our letter (2), in which we reported the results of our two populations (from Japan and California). Our results underscore the need for a unique diagnosis for those women with moderate to severe hyperglycemia and/or other evidence of long-standing diabetes complications, and thus the label of gestational diabetes mellitus (GDM) is not adequate to identify the urgent need for more intensive surveillance and treatment than would otherwise be available for gestational diabetic women.
Dawood is correct; the American Diabetes Association (ADA) would not label our cohorts as having “type 2 diabetes” because their blood glucose concentrations did not reach the criteria of the ADA guidelines or position statements. The point is that regardless of whether these pregnant women are called type 2 diabetic women or, as Dawood suggests, “diabetic patients first discovered during pregnancy,” it is a matter of semantics. The bottom line is that these women would receive better care if they were not thought to have merely GDM. It is time to reconsider the definition of GDM.
Dawood’s second question was related to our lowest prevalence of GDM in the third trimester (first trimester: 33 of 250 [13.2%]; second trimester: 32 of 417 [7.7%]; and third trimester: 37 of 749 [4.9%]). In our Japanese cohort, our observation is based on the protocol that administers the oral glucose tolerance test in only those pregnant women with risk factors, not the population of pregnant women in general without risk factors for diabetes. The risk factors for diabetes have the highest likelihood of identifying those women who have diabetes already in the first trimester. The third-trimester increase in prevalence of GDM that Dawood questions only occurs in women without risk factors, when the pregnancy per se has the strongest impact on glucose intolerance, not age, obesity, history of glycosuria, glucose intolerance, hypertension, or delivery of a previous infant with macrosomia.