Simplifying the screening of gestational diabetes by maternal age plus fasting plasma glucose at first prenatal visit: A prospective cohort study.

Yi-Yun Tai,Kuan-Yu Chen,Ming-Wei Lin,Chun-Heng Kuo,Hung-Yuan Li,Shin-Yu Lin,Chien-Nan Lee,Clive J Petry

doi:10.1371/journal.pone.0237224

Yi-Yun Tai, Kuan-Yu Chen + Show 6 more

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https://doi.org/10.1371/journal.pone.0237224

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Abstract

The addition of maternal age to fasting plasma glucose (FPG) at 24-28 gestational weeks improves the performance of GDM screening as maternal age increases. However, this method delays the diagnosis of GDM. Since FPG at the first prenatal visit (FPV) is a screening option for pre-existing diabetes, we evaluated the performance of age plus FPG at the FPV to reduce the need for the OGTT. Pregnant women were recruited consecutively in 2013-2018 (the training cohort) and 2019 (the validation cohort). We excluded women with twin pregnancies, unavailable FPG at the FPV or OGTT data, pre-pregnancy diabetes, or a history of GDM. All participants underwent FPG and haemoglobin A1c (HbA1c) at the FPV and received 75-g OGTT at 24-28 gestational weeks if FPG at the FPV was <92 mg/dL. GDM was diagnosed by the IADPSG criteria. Two algorithms were developed with the cutoffs determined when the percentage requiring OGTT (OGTT%) was the lowest and the sensitivity was ≥90%. The incidence of GDM increased with age. The "FPG at the FPV" algorithm reduced OGTT% to 68.8% with the FPG cutoff at 79 mg/dl. The "age plus FPG at the FPV" algorithm, with the cutoff of 114, further reduced OGTT% to 58.3%, with the sensitivity of 90.7% (9.3% GDM missed) and the specificity of 100%. These findings were replicated in the validation cohort. Screening GDM by maternal age plus FPG at the FPV can reduce OGTT%, especially in populations with a significant proportion of pregnant women with advanced ages.

Highlights

For the diagnosis of gestational diabetes mellitus (GDM), the International Association of Diabetes and Pregnancy Study groups (IADPSG) and the World Health Organization (WHO) recommends the use of 75-g oral glucose tolerance test (OGTT) for all pregnant women at 24– 28 weeks of gestation, which is a diagnostic option suggested by the American Diabetes Association (ADA) in addition to the two-step method [1,2,3]
The IADPSG recommends the measurement of fasting plasma glucose (FPG) during early pregnancy to detect pre-existing diabetes and GDM [1, 9]; whereas the ADA suggests the screening of undiagnosed type 2 diabetes in the first prenatal visit (FPV) in women with risk factors by the standard criteria, such as FPG, hemoglobin A1c or even OGTT [3]
Since a higher first-trimester FPG level is associated with an increased risk of GDM diagnosed at 24–28 weeks [10], the FPG at the FPV may be a good predictor to be used in the screening of GDM

Summary

Introduction

For the diagnosis of gestational diabetes mellitus (GDM), the International Association of Diabetes and Pregnancy Study groups (IADPSG) and the World Health Organization (WHO) recommends the use of 75-g oral glucose tolerance test (OGTT) for all pregnant women at 24– 28 weeks of gestation, which is a diagnostic option suggested by the American Diabetes Association (ADA) in addition to the two-step method [1,2,3]. Some studies have reported fasting plasma glucose (FPG)based screening methods aimed at reducing the use of OGTTs [5,6,7]. These FPGbased screening methods have generally been targeted at 24–28 weeks of gestation instead of early pregnancy, and the use of an FPG-based method at 24–28 weeks essentially requires two steps to diagnose or exclude GDM [5,6,7,8]. Since a higher first-trimester FPG level is associated with an increased risk of GDM diagnosed at 24–28 weeks [10], the FPG at the FPV may be a good predictor to be used in the screening of GDM

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