Articles by Reece and Moore and Visser and de Valk discuss the pros and cons of changing the diagnostic criteria for gestational diabetes mellitus (GDM). We highlight some additional concerns.

India shoulders the second largest global burden of diabetes. Twenty-eight million women conceive every year. With a prevalence of GDM of 14.3%, India has a potential population of 4 million who may develop GDM. Moreover, 50% of women with GDM are expected to develop type 2 diabetes within 5 years of the index pregnancy. An Indian study estimated that screening and treating gestational diabetes have an incremental cost-effectiveness of $1626 per disability-adjusted life year averted, considering adverse perinatal events and future diabetes.

The diagnostic criteria for GDM, however, need to be weighed not only in light of short term fetomaternal health outcomes but also long-term outcomes. Additional women diagnosed with International Association of Diabetes and Pregnancy Study Groups criteria may have mild GDM, without immediate adverse health consequences, but would certainly be at a higher risk for diabetes in the long term.

Considering primary prevention of diabetes as our aim, women with GDM constitute an ideal intervention group receptive to health care advice, especially if coupled to their offspring’s health.

It has been well proved in earlier studies that lifestyle interventions, when initiated at appropriate time, may prevent, or at least delay, the onset of diabetes. This window of opportunity is especially narrow in Asians, who have an early onset of diabetes, with more than one third developing diabetes before the age of 44 years. So encashing upon this opportunity is of vital importance if we want to reduce the future burden of disease.

The diagnosis of diabetes, however, is perceived as a psychosocial stress and social stigma, by many sections of society, especially in countries with a preexisting tradition of gender discrimination. The new criteria will generate a large pool of gestational diabetics, who may not need pharmacological therapy. An unwanted nocebo effect may be generated by the blanket advice to screen all persons for GDM. These factors argue against the revision of screening criteria to label more and more women as having GDM.

This negative yet valid impact, however, can be minimized by highlighting the fact that GDM can be managed by medical nutrition therapy in 80-90% of cases. It should also be explained that GDM is actually an opportunity in women’s lives to prevent future diabetes and should be viewed as such.