Diagnostic Significance of Ultrasonographic Markers and Score in Detection of Gestational Diabetes Mellitus in the Indian Subcontinent

Abstract

In most countries, only high-risk women are screened for gestational diabetes mellitus (GDM). In addition, a onetime early screening test may miss GDM as it may be diagnosable between 24 and 28 weeks. Thus, it is preferable to have alternative tests to classify women as high risk for GDM and keep them under regular follow-up. A total of 120 women with singleton pregnancies and established maternal and/or pregnancy-related risk factors for GDM and who provided informed consent were subjected to an obstetric ultrasound scan at/or after 24 weeks' gestation followed by administration of a 2-hour 75-g oral glucose tolerance test. Various ultrasound markers were determined/measured. Each ultrasound GDM marker was assigned 1 point to create the ultrasound gestational diabetes screening (UGDS) score. All ultrasound GDM markers positively correlated to the disease (P < 0.0001). The strongest independent predictor of GDM was an immature appearance of placenta (relative risk, 49.09; 95% confidence interval, 7.04-342.28; P < 0.0001). Receiver operator characteristics showed an area under the curve of 96.9%, confirming good ability of the UGDS to discriminate between positive and negative oral glucose tolerance test. A UGDS score of 4, providing diagnostic efficiency of 92%, sensitivity of 93.2%, specificity of 92%, positive predictive value of 85.4%, and negative predictive value of 96.4%, is proposed by this study. This study suggests that ultrasound markers significantly vary in GDM compared with normal pregnancy women and that UGDS is a good predictor of GDM. The UGDS may be considered an adjunct to current screening tools for GDM.