Most Appropriate Gestational Age for OGTT amongst High-Risk Pregnant Patients? Need for RCT

Abstract

High risk for gestational diabetes mellitus includes mothers with certain ethnicities, increasing maternal age, mothers with history of high or low birth weights, rising parity, previous macrosomic baby, stillborn baby, a family history or first degree relative with gestational diabetes (GDM) and type 2 diabetes mellitus, history of glucose intolerance or GDM, polycystic ovarian syndrome and maternal obesity. Timely screening, hence intervention can prevent complications of GDM to fetus and mother. Studies investigating, when during pregnancy should this high-risk group be screened, have established that 24-28 weeks OGTT have missed a few early onset GDM cases and booking visit OGTT/12 weeks gestational age OGTT may miss late onset GDM cases. All these studies have either been retrospective or comparison groups have been mis-matched. To date there is no prospective direct comparisons, comparing early OGTT results (12 weeks gestation) and late OGTT results (24—28weeks gestations). Physiologically speaking, stress of pregnancy is higher with advancing age of gestation and 24-28 weeks gestational age OGTT seems appropriate however evidence suggests that a few early onset GDM cases are missed. There is a need for prospective comparison at two different time intervals in same group of these high risk patients to answer this question.