We thank Dr Ramya Chandrasekar, Mrs U Kiran and Mr ANA Weerakoddy for taking interest in our article.1 They recommend carrying out simple anthropometric measures in the long-term follow up of indigenous Asian women with previous gestational diabetes mellitus (GDM) to identify central obesity, a marker of the metabolic syndrome, which would be more cost-effective to institute secondary prevention measures than annual oral glucose tolerance testing (OGTT). We wish to emphasise that this is precisely what is carried out in our practice and published in the article. It is noteworthy that we did not carry out OGTT in the long-term follow up of these women.
The word ‘cohort’ in the abstract was not used in the context of the research design but to indicate a ‘cohort’ of women who had experienced abnormal glucose tolerance during their last pregnancy. This study was a comparative study to determine the prevalence of metabolic syndrome and polycystic ovary syndrome (PCOS) among cases and controls, where known women with GDM were compared with controls who had no GDM and had delivered in the same unit during the same period (please refer Table 1 of our study). We have indeed quantified the risks of GDM among Sri Lankan women as odds ratios and published elsewhere.2
The emphasis of this article was to highlight that GDM is not an isolated event that ‘ends with the pregnancy’ but a marker of the long-term metabolic syndrome, which results in premature cardiovascular deaths. No doubt our data support that obesity is an important factor to the development of GDM, PCOS and the metabolic syndrome. We are certain you would agree that these are different manifestations of the same metabolic disorder occurring at different times rather than GDM or obesity being the cause of the problem.