Abstract
AimTo evaluate the diagnostic and prognostic performance of alternative diagnostic strategies to oral glucose tolerance tests, including random plasma glucose, fasting plasma glucose and HbA1c, during the COVID‐19 pandemic.MethodsRetrospective service data (Cambridge, UK; 17 736 consecutive singleton pregnancies, 2004–2008; 826 consecutive gestational diabetes pregnancies, 2014–2019) and 361 women with ≥1 gestational diabetes risk factor (OPHELIA prospective observational study, UK) were included. Pregnancy outcomes included gestational diabetes (National Institute of Health and Clinical Excellence or International Association of Diabetes and Pregnancy Study Groups criteria), diabetes in pregnancy (WHO criteria), Caesarean section, large‐for‐gestational age infant, neonatal hypoglycaemia and neonatal intensive care unit admission. Receiver‐operating characteristic curves and unadjusted logistic regression were used to compare random plasma glucose, fasting plasma glucose and HbA1c performance.ResultsGestational diabetes diagnosis was significantly associated with random plasma glucose at 12 weeks [area under the receiver‐operating characteristic curve for both criteria 0.81 (95% CI 0.79–0.83)], fasting plasma glucose [National Institute of Health and Clinical Excellence: area under the receiver‐operating characteristic curve 0.75 (95% CI 0.65–0.85); International Association of Diabetes and Pregnancy Study Groups: area under the receiver‐operating characteristic curve 0.92 (95% CI 0.85–0.98)] and HbA1c at 28 weeks' gestation [National Institute of Health and Clinical Excellence: 0.83 (95% CI 0.75–0.90); International Association of Diabetes and Pregnancy Study Groups: 0.84 (95% CI 0.77–0.91)]. Each measure predicts some, but not all, pregnancy outcomes studied. At 12 weeks, ~5% of women would be identified using random plasma glucose ≥8.5 mmol/l (sensitivity 42%; specificity 96%) and at 28 weeks using HbA1c ≥39 mmol/mol (sensitivity 26%; specificity 96%) or fasting plasma glucose ≥5.2–5.4 mmol/l (sensitivity 18–41%; specificity 97–98%).ConclusionsRandom plasma glucose at 12 weeks, and fasting plasma glucose or HbA1c at 28 weeks identify women with hyperglycaemia at risk of suboptimal pregnancy outcomes. These opportunistic laboratory tests perform adequately for risk stratification when oral glucose tolerance testing is not available.
Highlights
Gestational diabetes mellitus (GDM) affects approximately 5% of pregnant women in the UK and is associated with perinatal morbidity, including large-for-gestational-age (LGA) infants, complicated deliveries and neonatal hypoglycaemia [1]
Gestational diabetes diagnosis was significantly associated with random plasma glucose at 12 weeks [area under the receiver-operating characteristic curve for both criteria 0.81], fasting plasma glucose [National Institute of Health and Clinical Excellence: area under the receiver-operating characteristic curve 0.75; International Association of Diabetes and Pregnancy Study Groups: area under the receiver-operating characteristic curve 0.92] and HbA1c at 28 weeks' gestation [National Institute of Health and Clinical Excellence: 0.83; International Association of Diabetes and Pregnancy Study Groups: 0.84]
Prediction of gestational diabetes diagnosis and association with pregnancy outcomes All glucose measures were significantly associated with GDM diagnosis on receiveroperating characteristic (ROC) curves (Table 3 and Fig. 1)
Summary
Gestational diabetes mellitus (GDM) affects approximately 5% of pregnant women in the UK and is associated with perinatal morbidity, including large-for-gestational-age (LGA) infants, complicated deliveries and neonatal hypoglycaemia [1]. The oral glucose tolerance test (OGTT) is currently the recommended approach to the diagnosis of GDM in the UK and internationally [2,3]. In the UK, pregnant women have been advised to remain in self-isolation for at least 12 weeks except for essential excursions for food, healthcare and health reasons (including outdoor daily exercise), with similar restrictions internationally. This, alongside public transport limitations, especially during peak hours, social distancing and laboratory requirements, has made it challenging for healthcare providers to implement routine OGTTs. with staff shortages due to self-isolation, illness or redeployment, the clinical capacity for managing large numbers of pregnant women with milder forms of hyperglycaemia has been reduced. The alternative strategy recommends glucose testing during other hospital or community appointments to minimize additional clinical contacts [5]
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