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: 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: To consider the arguments for screening outside the standard screening period of 24 to 28 weeks of gestation. A search of the literature between 1990 and 2010 was performed using the PubMed® and Cochrane® databases. Recommendations from learned societies in diabetology and obstetrics & gynaecology were consulted. Gestational diabetes mellitus screening is classically recommended between weeks 24 and 28 of pregnancy, the period during which glucose tolerance deteriorates. However, the increasing prevalence of type 2 diabetes in women of childbearing age with risk factors requires earlier screening. Fasting blood glucose should be measured at the fi rst visit during early pregnancy for these patients. The diagnostic threshold is the same as for patients who are not pregnant, i.e. blood glucose > 1.26 g/l. However, the benefit of screening for gestational diabetes during early pregnancy for women with risk factors has not been supported by prospective studies. Therefore oral glucose tolerance testing during early pregnancy is not currently recommended for the detection of gestational diabetes. Screening for gestational diabetes, regardless of the recommended screening policy, must be performed between weeks 24 and 28 of pregnancy. There are no reasons to consider subsequent screening for gestational diabetes at a later stage.Diabetes & Metabolism 12/2010; 36(6 Pt 2):652-7. DOI:10.1016/j.diabet.2010.11.015 · 2.85 Impact Factor
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ABSTRACT: To determine the relationship between the 75-g oral glucose tolerance test and pregnancy outcome after women's first IVF cycle. Prospective study. Infertility center at a private tertiary hospital in Taiwan. All 280 patients who went through their initial IVF cycle at the hospital between January 2004 and April 2005 were included in the study. Two hundred eighty patients underwent an oral glucose tolerance test before entering an IVF cycle; all pregnancy outcomes and pregnancy complications were recorded. The relationships between glycemic parameters and insulin resistance and IVF pregnancy outcome were determined. Linear regression between birth weight and levels of preconception fasting insulin, 2-hour glucose, and 2-hour insulin was performed. One hundred twenty patients conceived after their initial IVF cycle. Twenty-five of 89 ongoing pregnancies had various complications. The most common pregnancy complication was preterm birth (n = 11). These patients had higher body mass index (23.46 vs. 20.97 kg/m(2)); higher fasting glucose (107.36 vs. 95.14 mg/dL), fasting insulin (10.55 vs. 6.20 microIU/mL), and 2-hour glucose (120.55 vs. 99.97 mg/dL) levels; and higher homeostatic model assessment of insulin resistance (3.43 vs. 1.45) than did patients with full-term pregnancies. Linear regression between birth weight and the fasting glucose level and between birth weight and the homeostatic model assessment of insulin resistance had positive correlations. Before proceeding with IVF, preconception oral glucose tolerance testing is suggested, especially in patients with higher body mass index, to help identify groups who are at high risk for preterm birth.Fertility and sterility 12/2007; 90(3):613-8. DOI:10.1016/j.fertnstert.2007.07.1289 · 4.30 Impact Factor