Oral glucose tolerance testing at gestational weeks <= 16 could predict or exclude subsequent gestational diabetes mellitus during the current pregnancy in high risk group
ABSTRACT An oral glucose tolerance test with a result that is negative but close to the diagnostic cut-off in early pregnancy was hypothesized to serve as a predictor of subsequent gestational diabetes in a high risk group. The aim of the study was to determine those cut-off values of OGTT at gestational weeks < or =16, which can predict or exclude subsequent onset of GDM in a high risk group.
Pregnant women at high risk of gestational diabetes (n = 163) underwent a 2-h, 75-g oral glucose tolerance test at gestational weeks < or =16 were analyzed in this study. In the event of a negative result, subsequent oral glucose tolerance tests were performed at gestational weeks 24-28 and 32-34. The sensitivity, the specificity, the positive and negative predictive values and the Odds ratio of the best cut-off values of fasting and postload glucose levels were calculated.
The best cut-off values to exclude subsequent GDM for fasting and postload glucose were 5.0 and 6.2 mmol/l, respectively. In combination, the best cut-off values were 5.3 mmol/l for fasting and 6.8 mmol/l for postload glucose, with negative predictive values of 0.97 and 0.71 and sensitivities of 96.9 and 86.3 at gestational weeks 24-28 and 32-34, respectively. Combination of these cut-off values with obesity proved to be very predictive for gestational diabetes by gestational weeks 32-34, with an Odds ratio of 6.0 [95% confidence interval: 1.7-21.0].
With regard to the very high negative predictive value of the method, pregnant women with glucose levels of < or =5.3 mmol/l at fasting and of < or = 6.8 mmol/l at postload in gestational weeks < or =16 should undergo subsequent oral glucose tolerance testing merely at gestational weeks 32-34. Approximately a quarter (24.5%) of the pregnant women at risk of gestational diabetes satisfied these criteria.
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ABSTRACT: Aim Consider the arguments for screening outside the classical period of 24–28 SA. Materials and Methods A literature search between 1990 and 2010 was performed using the Pubmed and Cochrane database. Foreign societies guidelines were also consulted. Results Screening for gestational diabetes is recommended between 24 and 28 weeks of pregnancy, when glucose tolerance deteriorates. However, for patients with certain risk factors, the increasing prevalence of type 2 diabetes in women of childbearing age requires earlier screening. Fasting blood glucose should be measured at the first visit during pregnancy for these patients. The diagnostics threshold is the same as for patients who are not pregnant, i.e. blood glucose > 1.26g/L. On the other hand, the interest of screening for gestational diabetes at the beginning of pregnancy in the case of certain risk factors is not supported by prospective studies. It is therefore not recommended to perform an OGTT in early pregnancy in order to diagnose gestational diabetes. The search for a gestational diabetes, regardless of screening policy recommended, has to be performed between 24 and 28 weeks gestational age. There are no reasons to consider a new search for gestational diabetes at later stages.Fuel and Energy Abstracts 12/2010; 39(8). DOI:10.1016/S0368-2315(10)70048-X
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ABSTRACT: Abstract Objective: This study aims to evaluate the value of increasing inflammation in predicting gestational diabetes mellitus (GDM). Materials and methods: Subjects in this cross-sectional study included 302 GDM and 310 normal pregnancies before 20 weeks. Sociodemographic and pregnancy characteristics as well as blood parameters were acquired by maternal health booklet, medical records and laboratory information systems. Blood cell parameters were compared between the two groups by independent sample t-tests. Multivariate logistic regression, χ2-test, receiver operator characteristic curve (ROC), and Fisher's linear discriminant were performed to analyze the screening effects of variables in developing GDM. Results: Women with GDM had significantly higher neutrophil (NEU), lymphocyte (LYM), platelet (PLT) and erythrocyte (RBC) counts, and were positively correlated with GDM. NEU (odds ratios, OR, 1.22) and LYM (OR, 2.01) were independently associated with the development of GDM (P<0.001). The OR of the mean platelet volume (MPV) and mean cell volume (MCV) were 0.84 and 0.92, respectively (P<0.01 for both). The efficiency of Fisher's equations in correctly classifying cases of GDM from 4 to 20 weeks of gestation was 70.06%. Conclusions: Maternal WBC, RBC, and PLT counts are important correlates of GDM. Increased volume of RBC and PLT might protect pregnant women from development of GDM.Journal of Perinatal Medicine 05/2014; 43(1). DOI:10.1515/jpm-2014-0007 · 1.43 Impact Factor
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ABSTRACT: Our aim was to evaluate and compare the diagnostic performance of three methods commonly used for GDM screening: fasting plasma glucose (FPG), two-step 50 g glucose challenge test (GCT), and 75 g glucose tolerance test (GTT) in a randomized study design to predict GDM in the first trimester and determine the best approach in predicting GDM. In a non-blind, parallel-group prospective randomized controlled study; 736 singleton pregnant women underwent FPG testing in the first trimester and randomly assigned to two groups; two-step 50 g GCT and 75 g GTT. GDM diagnosis was made according to Carpenter-Coustan or ADA (American Diabetes Association) criteria in two-step 50 g GCT and 75 g GTT groups, respectively. Subsequent testing was performed by two-step 50 g GCT at 24-28 weeks for screen negatives. After excluding the women who were lost to follow-up or withdrawn as a result of pregnancy loss, 486 pregnant women were recruited in the study. The FPG, two-step GCT, and one-step GTT methods identified GDM in 25/486 (5.1 %), 15/248 (6.0 %), and 27/238 (11.3 %) women, respectively. Area under ROC curves were 0.623, 0.708, and 0.792, respectively. Sensitivities were 47.17, 68.18, and 87.1 %, respectively. Specificities were 77.37, 100, and 100 %, respectively. Positive predictive values were 20.33, 100, and 100 %, respectively. Negative predictive values were 92.29, 97, and 98.1 %, respectively. Until superior screening alternatives become available, the 75 g GTT may be preferred for GDM screening in the first trimester.Endocrine 11/2013; 46(3). DOI:10.1007/s12020-013-0111-z · 3.53 Impact Factor