We thank Drs Kalra et al for expressing their concerns regarding changing the diagnostic criteria for gestational diabetes mellitus (GDM). We fully recognize that physicians in countries with a very high disease burden would want to pursue every opportunity to provide care at the earliest point possible in efforts to reduce long-term effects of diabetes. Therefore, we can appreciate the authors’ desire to encourage universal change in the GDM diagnostic threshold, thus allowing practitioners to intervene in the potential disease course at a time when otherwise no steps to prevent progression to diabetes would be taken. However, our article addressed whether adopting the International Association of Diabetes and Pregnancy Study Groups’ recommended criteria would improve outcomes in women in the United States. We and others are not convinced that change is better than the current approach.

This debate continued on a grander scale during the National Institutes of Health (NIH) Consensus Development Conference on Diagnosing Gestational Diabetes Mellitus. One of the key arguments against lowering the diagnostic threshold is that the incidence of GDM will increase significantly, adding strain to the current health care system and overburdened medical workforce, without clear evidence that changing the criteria improves maternal and fetal outcomes. The NIH panel conducted a rigorous review of the current state of the science, heard arguments on both sides of the debate from leading experts, but, ultimately, recommended to continue the current approach in the United States, based on a lack of data.

Additionally, the psychological impact of being diagnosed with GDM could greatly influence whether screening results in the successful mitigation of disease or progression to type 2 diabetes, a major concern and reason why lowering the diagnostic threshold is supported. Indeed, Drs Kalra et al cite psychosocial stress and social stigma as key factors against revising screening protocols. Because the primary reason to change is based on improving patient health and well-being, any potential shift in medical practice must take into account all the factors that health and well-being for a patient truly encompass.

Neither the NIH panel nor we were attempting to have the final word in this matter, or dictate policy for other countries or constituencies. Any high-risk country may see fit to adjust criteria to better serve its citizens. However, it would be unwise to apply such a change to the entire world, not knowing the full medical, sociological, and fiscal impact.