Aisha Sheikh  ( Department of Medicine, Aga Khan University Hospital, Karachi. )
Lumaan Sheikh  ( Department of Obstetrics and Gynaecology, The Aga Khan University, Karachi. )

We are grateful for the valuable comments on our letter “Changing prevalence of Gestational Diabetes Mellitus (GDM) during pregnancy over more than a decade”.¹ In response to the first comment, we are sharing the exact numerator and denominator for this data from our institution in the table below,

which could not be added because of the limit of submission of 1 table/graph in the letter. The second comment is regarding the possibility of rise in prevalence of GDM due to increasing maternal age and thus the commenter has asked for ageadjusted data. Thanks for pointing that out, since, ours is a huge data set, our team is working on different risk factors and reasons of rising GDM prevalence and we will be publishing that as a separate paper. The exact reasons for this temporal change in trend can only be explained from prospective cohort studies. However, the probable contributing reasons for this rise in prevalence that we have mentioned are well-reported in medical literature. A recent article by Dr. Moshe Hod has thoroughly commented on all these reasons including increasing maternal age.² So, although advancing maternal age is one reason, it is not the sole cause of this rise in prevalence; lower diagnostic thresholds for GDM on oral glucose tolerance test (OGTT) in the International Association of Diabetes in Pregnancy study groups’ (IADPSG) criteria and requirement of only one single deranged glucose reading to make a diagnosis definitely leads to a rise in numbers. In addition, the increase in rates of obesity, prediabetes and diabetes in our population are contributing to the escalation of GDM in our pregnant women. The objective of our letter-toeditor was to show that the prevalence of GDM has gone up over all these years which further emphasize the need for concrete measures to screen and manage GDM to enhance maternal and fetal well being Lastly, we are thankful for the commenter to share their very informative data from year 2017³ which is showing comparable rates of GDM analogous to ours. The almost similar rates are justified by the fact that both the institutions (The Indus Health network and The Aga Khan University Hospital) are utilizing universal screening through IADPSG criteria for GDM screening which further corroborates with final comments of our letter to editor: “We need more data on GDM prevalence based upon the IADPSG criteria from different parts of Pakistan to know the exact burden of the disease”.

Disclaimer: None to declare.

Conflict of Interest: None to declare.

Funding Sources: None to declare.

References

1. Sheikh A, Sheikh L. Changing prevalence of Gestational Diabetes Mellitus during pregnancy over more than a decade. J Pak Med Assoc. 2020 Aug; 70:1477-1478.

2. Hod M, Kapur A, McIntyre HD. Prevention of early NCD Committee. Evidence in support of the International Association of Diabetes in Pregnancy study groups’ criteria for diagnosing gestational diabetes mellitus worldwide in 2019. Am J Obstet Gynecol 2019 Aug 1;221:109 16.

3. Wali AS, Rafique R, Iftikhar S, Ambreen R, Yakoob MY. High proportion of overt diabetes mellitus in pregnancy and missed opportunity for early detection of diabetes at a tertiary care centre in Pakistan. Pak J Med Sci. 2020 Jan; 36:S38-S43.