In my opinion, McIntyre and colleagues have misunderstood the primary point I raised in my earlier article in the Journal.1 My concern was not the increased number of women diagnosed with gestational diabetes mellitus (GDM), but the accuracy of the diagnostic thresholds. Although I suggested that many women in the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study with one elevated blood glucose level may not be at risk, I also stated that additional women with two or more blood glucose levels marginally below the new thresholds will be at risk. The authors' comment that an increased odds ratio has the same effect confirms that they misunderstood my concern.
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- 1. d'Emden MC. Reassessment of the new diagnostic thresholds for gestational diabetes mellitus: an opportunity for improvement. Med J Aust 2014; 201: 209-211. <MJA full text>
- 2. International Association of Diabetes and Pregnancy Study Groups Consensus Panel; Metzger BE, Gabbe SG, Persson B, et al. International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care 2010; 33: 676-682.
- 3. HAPO Study Cooperative Research Group; Metzger BE, Lowe LP, Dyer AR, et al. Hyperglycemia and adverse pregnancy outcomes. N Engl J Med 2008; 358: 1991-2002.
- 4. Metzger BE, Dyer AR. Comment on d'Emden. Do the new threshold levels for the diagnosis of gestational diabetes mellitus correctly identify women at risk? Diabetes Care 2014; 37: e43-e44.
- 5. D'Agostino Sr RB, Vasan RS, Pencina MJ, et al. General cardiovascular risk profile for use in primary care: the Framingham Heart Study. Circulation 2008; 117: 743-753.
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