50-g Glucose Challenge Test Research Articles

Risk of obstetric and neonatal morbidity in gestational diabetes in a single institution: A retrospective, observational study.

Gestational diabetes mellitus (GDM) is defined as a carbohydrate intolerance with onset or first recognition occurring during pregnancy and GDM could be risk factor for various maternal fetal complications. This study aimed to investigate risks of maternal and neonatal outcomes according to GDM and normal glucose tolerance. This retrospective, observational study included singleton pregnant women who had received a 50-g oral glucose challenge test in 2nd trimester of gestation and gave birth at National Health Insurance Service Ilsan Hospital. Maternal and neonatal complications were compared between GDM and non-GDM groups. Among the 682 women, 56 were diagnosed with GDM and 626 were non-GDM group. Maternal age was older and prepregnant body mass index was higher in GDM. The rate of cesarean delivery, preeclampsia, and transfusion was similar; however, the incidence of preterm birth was higher in GDM. Multivariate analysis, however, showed that GDM was independent risk factor only for preterm birth in <37 weeks (adjusted odds ratio, 2.25; 95% confidence interval, 1.16–4.36). Regarding neonatal morbidities, APGAR score <7 at 5 minutes and the rate of macrosomia were similar; however, the rates of neonatal intensive care unit (NICU) admission, large for gestational age (LGA), and intubation were higher in GDM. Multivariate analysis, however, showed that GDM was not independent risk factor for LGA, NICU admission, and intubation rate. Compared with the non-GDM group, GDM was associated with an increased likelihood of preterm birth <37 weeks, however, did not increase cesarean delivery, postpartum hemorrhage, LGA, and NICU admission rate. This study showed that the majority of women with GDM delivered with similar maternal and neonatal outcomes in non-GDM women.

Incidence of Gestational Diabetes Diagnosed on the 100-G Glucose Tolerance Test in Pregnancies with a 50-G Glucose Challenge Test Result of 200 mg/dL or Greater.

This study aimed to assess the positive predictive value (PPV) of a 1-hour, 50-g glucose challenge test (GCT) result ≥200 mg/dL for the diagnosis of gestational diabetes mellitus (GDM) on a 3-hour, 100-g glucose tolerance test (GTT). Pregnancies between 2008 and 2016 with a GCT result ≥200 mg/dL were identified retrospectively. GCT and GTT dates and results, demographics, and working due date (EDD) were extracted. Gestational age at testing was calculated from test date and EDD. As some clinicians presumptively diagnose GDM in such cases, if a GTT result was not available, clinic notes were reviewed to determine whether a GTT was ordered. Positive predictive values (PPV) were calculated at GCT cut-offs at and beyond 200 mg/dL. Subgroups were compared including early GCT (<16 weeks) versus routine GCT (24-28 weeks), GTT result normal versus GTT diagnostic of GDM, and GTT ordered versus GTT not ordered. Rates of use of medication for glycemic control were assessed among these groups. Of 236 pregnant women with a GCT result ≥200 mg/dL, 115 (48%) GTT was ordered for 115 (49%), whereas 123 (52%) were managed as presumed GDM. Of 100 (87%) who completed the test, 81 (81%) were diagnosed with GDM with a median intertest interval of 14 days. No statistically significant differences were found between groups stratified by GTT result. Use of rates of metformin, glyburide, and insulin were similar between those diagnosed with GDM by GTT and those diagnosed with GDM by GCT alone. A GCT result of ≥200 mg/dL has a PPV of 81% for diagnosis of GDM by GTT in a contemporary U.S. population, with a median intertest interval of 14 days between GCT and GTT. However, those diagnosed by GCT alone were as likely as those diagnosed by GTT to require medication for glycemic control, including insulin, suggesting that requiring a GTT may result in underdiagnosis and delayed treatment of GDM. · A 50-g GCT result of 200 mg/dL or greater has a PPV of 81% for GDM on the 100 g GTT.. · Patients diagnosed with GDM by GCT alone were as likely to require insulin as those diagnosed by GTT.. · 81% of patients diagnosed with GDM on the GTT completed their GTT at least 1 week after the GCT, thus requiring GTT in this population may lead to unnecessary delays in care..

Screening Accuracy of the 50 g-Glucose Challenge Test in Twin Compared With Singleton Pregnancies.

The optimal 50 g-glucose challenge test (GCT) cutoff for the diagnosis of gestational diabetes mellitus (GDM) in twin pregnancies is unknown. This work aimed to explore the screening accuracy of the 50 g-GCT and its correlation with the risk of large for gestational age (LGA) newborn in twin compared to singleton pregnancies. A population-based retrospective cohort study (2007-2017) was conducted in Ontario, Canada. Participants included patients with a singleton (n = 546 892 [98.4%]) or twin (n = 8832 [1.6%]) birth who underwent screening for GDM using the 50 g-GCT. We compared the screening accuracy, risk of GDM, and risk of LGA between twin and singleton pregnancies using various 50 g-GCT cutoffs. For any given 50 g-GCT result, the probability of GDM was higher (P = .0.007), whereas the probability of LGA was considerably lower in the twin compared with the singleton group, even when a twin-specific growth chart was used to diagnose LGA in the twin group (P < .001). The estimated false-positive rate (FPR) for GDM was higher in twin compared with singleton pregnancies irrespective of the 50 g-GCT cutoff used. The cutoff of 8.2 mmol/L (148 mg/dL) in twin pregnancies was associated with an estimated FPR (10.7%-11.1%) that was similar to the FPR associated with the cutoff of 7.8 mmol/L (140 mg/dL) in singleton pregnancies (10.8%). The screening performance of the 50 g-GCT for GDM and its correlation with LGA differ between twin and singleton pregnancies.

Clinical Updates on Screening and Diagnosis Criteria for Gestational Diabetes Mellitus Patients, as well as Therapeutic Management

The most prevalent metabolic and endocrine perinatal issue is gestational diabetes mellitus (GDM), which is an increasing health problem worldwide. It is a controversial entity, with conflicting guidelines and treatment protocols. In the United States, most doctors utilise a two-step strategy, first with a 50-g non fasting oral glucose challenge test at 24 to 28 weeks and then a 100-g fasting test for women who have a positive screening result. Alternatively, Clinicians take a one step Diabetes in Pregnancy Study Group India (DIPSI) method and perform simply a 75-g two hour fasting oral glucose tolerance test. The DIPSI approach of antenatal GDM screening has been demonstrated to be straightforward, cost effective, easy to use, patient friendly, and convenient. When comparing the findings to the gold standard of the International Association of Diabetes and Pregnancy Study Group (IADPSG), DIPSI shows high specificity and acceptable sensitivity. To maintain euglycemia, glucose monitoring, dietary changes, exercise, and, if necessary, medicines are used. Although insulin therapy is the most common treatment, glyburide and metformin may become more popular. Prenatal testing with nonstress tests and amniotic fluid indices, commencing in the third trimester, is commonly used to assess foetal well-being in women undergoing medication. The delivery technique and time are contentious. Women who have gestational diabetes are at a significant risk of developing type 2 diabetes later in life. As a result, along with routine diabetes screening, lifestyle adjustment should be recommended.

Glucose Intolerance in Pregnancy and Offspring Obesity in Late Adolescence.

Gestational hyperglycemia is associated with deleterious neonatal outcomes, but long-term risks for offspring obesity are less clear. We estimated the odds for offspring adolescent overweight and obesity among mothers with gestational glucose intolerance. In a mother-offspring historical cohort, the Israel military conscription data set was linked to a large health maintenance organization. Included were women who were evaluated at adolescence and underwent two-step gestational diabetes screening (mean age, 31 years) with a 50-g glucose challenge test (GCT), followed by a 100-g oral glucose tolerance test (OGTT) if the result was abnormal. Glucose tolerance categories included gestational normoglycemia, abnormal GCT with normal OGTT, impaired glucose tolerance (IGT; one abnormal OGTT value), and gestational diabetes. The primary outcome was offspring overweight/obesity (BMI ≥85th percentile) at adolescence, measured prior to military conscription. Logistic regression models were applied. Of 33,482 mother-offspring pairs, overweight and obesity were observed in 6,516 offspring. Across increasing categories of pregnancy glycemia, the proportions of offspring with adolescent overweight/obesity increased: normoglycemia, 19%; abnormal GCT with normal OGTT, 22%; gestational IGT, 24%; and gestational diabetes, 25% (P < 0.0001). Corresponding odds ratios after adjustment for the mother's late adolescent characteristics (sociodemographic confounders and BMI) and pregnancy age were 1.2 (95% CI 1.1-1.4), 1.3 (1.2-1.5), and 1.4 (1.3-1.6), respectively. Further adjustment for offspring birth weight percentile and sociodemographic variables did not materially change results. Associations were more pronounced with increasing obesity severity. Gestational glucose intolerance, including categories not meeting the gestational diabetes threshold, was associated with increased odds for offspring overweight/obesity at late adolescence.

The prognostic value of the oral glucose tolerance test for future type-2 diabetes in nulliparous pregnant women testing negative for gestational diabetes

AimTo determine the prognostic value of the antepartum 75g-oral glucose tolerance test (OGTT) for future type 2 diabetes mellitus (T2DM) in nulliparous pregnant women who tested negative for GDM. MethodsA population-based retrospective cohort study of nulliparous pregnant women who underwent testing for GDM using a 75g-OGTT in Ontario, Canada (2007-2017). The overwhelming majority of women in Ontario undergo screening using the preferred 2-step approach where the 75g-OGTT is performed following an abnormal non-fasting 1 h 50g-glucose challenge test. The relationship between the 75g-OGTT results in women who tested negative for GDM (defined as normal glucose at fasting, 1 and 2 h post 75g-glucose load) and future T2DM (as recorded in the Ontario Diabetes Database by the end date of follow up period) was explored. FindingsOf the 162,622 women who underwent 75g-OGTT during the study period, there were 41,507 (75.0%) who met the study criteria. In women without GDM, the adjusted hazard ratios (aHR) for T2DM were–At fasting 2.82 (95%-CI 2.18-3.64), at 1 h 1.26 (1.15-1.37), at 2 h 1.14 (1.04-1.25) for a 1 mmol/L increase in glucose. A model that combined all 3 OGTT values and clinical characteristics could detect 43% (42.6%-43.4%) of those who developed T2DM at 5-years post the index pregnancy for a false-positive rate of 20%. InterpretationThe results of the antepartum OGTT can be used to refine the future risk of T2DM even in nulliparous pregnant women who tested negative for GDM.

Early universal screening of gestational diabetes in a university hospital in Thailand

A total of 1016 pregnant women attending antenatal clinic before 20 weeks of gestation during September 2018 to February 2019 were included in a cohort study with repeated cross-sectional assessments. The study was aimed to determine prevalence and characteristics of gestational diabetes mellitus (GDM) and pregnancy outcomes by early universal screening approach. GDM screening was performed during first visit and repeated during 24–28 weeks of gestation, as necessary, using a 50-g glucose challenge test followed by a 100-g oral glucose tolerance test for GDM diagnosis. Overall prevalence of GDM was 18.6%. A significantly higher prevalence of GDM was observed among high-risk than low-risk women (21.3% vs. 13.1%, p = 0.002). GDM among low-risk women contributed to 23.3% of all GDM cases. The majority of GDM (76.2%) were diagnosed before 20 weeks of gestation, with 74.5% occurring in high-risk women and 81.8% occurring in low-risk women. When initial screening tests were normal, risk of GDM diagnosed during 24–28 weeks was 6.0% (7.5% among high-risk women and 3.1% among low-risk women). Compared to those without GDM, women with GDM significantly had lower gestational weight gain (p < 0.001), higher prevalence of preeclampsia (p = 0.001), large for gestational age (LGA) (p = 0.034) and macrosomia (p = 0.004). These outcomes were more pronounced among high-risk women with GDM. Impact Statement What is already known on this subject? Universal GDM screening is recommended during 24–28 weeks of gestation, either by 1- or 2-step approach. Some also recommend early GDM screening among high-risk women. Prevalence of early-onset GDM varies between studies and benefits of early diagnosis and treatment are still controversial. What do the results of this study add? Early universal GDM screening identified more women with GDM and majority could be diagnosed before 20 weeks of gestation. GDM among low-risk women contributed to 23.3% of all cases. Adverse pregnancy outcomes were more common among high-risk women with GDM. This approach could be useful and can be implemented in other settings, especially those that serve high-risk population or with high GDM prevalence. What are the implications of these findings for clinical practice and/or further research? Early universal GDM screening should be considered in settings with high prevalence of GDM and high-risk women. However, benefits of early detection and treatment of GDM should be determined in more details in the future, especially in terms of cost-effectiveness and improvement in pregnancy outcomes.

1048-P: Glucose Intolerance in Pregnancy and Offspring Obesity in Late Adolescence

Objective: Gestational hyperglycemia is associated with deleterious neonatal outcomes, but long-term risks for offspring obesity are less clear. We estimated the odds for offspring adolescent overweight and obesity among mothers with gestational glucose intolerance. Methods: In a mother-offspring, historical cohort, the Israel military conscription dataset was linked to a large health maintenance organization. Included were women who were evaluated at adolescence and performed two-step gestational diabetes screening (mean age, 31 years) with a 50-g glucose challenge test (GCT) , followed by a 100-g oral glucose tolerance test (OGTT) if abnormal. Glucose tolerance categories included gestational normoglycemia, abnormal GCT with normal OGTT, impaired glucose tolerance (IGT; one abnormal OGTT value) , and gestational diabetes. The primary outcome was offspring overweight/obesity (BMI≥85th percentile) at adolescence, measured prior to military conscription. Logistic regression models were applied. Results: Of 33,482 mother-offspring pairs, overweight and obesity were observed in 6,516 offspring. Across increasing categories of pregnancy glycemia, the proportions of offspring with adolescent overweight/obesity increased: normoglycemia, 19%; abnormal GCT with normal OGTT, 22%; gestational IGT, 24%; and gestational diabetes, 25%, P&amp;lt;0·0001. Corresponding odds ratios after adjustment for mother's late-adolescent characteristics (sociodemographic confounders and BMI) and pregnancy age were 1.2 (95%CI, 1.1-1.4) , 1.3 (95%CI, 1.2-1.5) , and 1.4 (95%CI, 1.3-1.6) , respectively. Further adjustment for offspring birth weight percentile and sociodemographic variables did not materially change results. Associations were more pronounced with increasing obesity severity. Conclusions: Gestational glucose intolerance, including categories not meeting the gestational diabetes threshold, were associated with increased odds for offspring overweight/obesity at late adolescence. Disclosure C.D.Bendor: None. Y.Lebenthal: Advisory Panel; Lilly, Novo Nordisk, Research Support; Novo Nordisk, Pfizer Inc., Speaker's Bureau; Pfizer Inc. A.Afek: None. G.Chodick: None. G.Twig: None. A.Bardugo: None. R.Rotem: None. E.Derazne: None. H.C.Gerstein: Advisory Panel; Abbott, Eli Lilly and Company, Hanmi Pharm. Co., Ltd., Novo Nordisk, Pfizer Inc., Sanofi, Viatris Inc., Consultant; Kowa Company, Ltd., Other Relationship; DKSH, Eli Lilly and Company, Sanofi, Zuellig Pharma Holdings Pte. Ltd., Research Support; AstraZeneca, Eli Lilly and Company, Merck &amp; Co., Inc., Novo Nordisk, Sanofi. D.Tzur: None. O.Pinhas-hamiel: Advisory Panel; Novo Nordisk, Speaker's Bureau; Pfizer Inc. A.M.Tsur: None. T.Cukierman-yaffe: Research Support; European Association for the Study of Diabetes, Medtronic, Merck Sharp &amp; Dohme Corp., Novo Nordisk, Speaker's Bureau; AstraZeneca, Eli Lilly and Company, Medtronic, Merck Sharp &amp; Dohme Corp., Novo Nordisk, Sanofi.

Clinical implications of the 100-g oral glucose tolerance test in the third trimester.

The clinical implications of gestational diabetes mellitus (GDM) diagnosed in the third trimester are not well established and controversy continues regarding the performance of diagnostic tests beyond 28-week gestation. This study aimed to evaluate the incidence of abnormal third trimester oral glucose tolerance test (OGTT) results in women at high risk and to compare the obstetric and neonatal outcomes with those of women with normal OGTT results. The study included 372 women who completed late (>29weeks) 100-g OGTT due to suspected fetal macrosomia, polyhydramnios or a personal risk factor for GDM, diagnosed according to the Carpenter & Coustan criteria. Women withonly one abnormal OGTT value were diagnosed with GDM by abnormal glucose follow-up and analyzed separately. Obstetric and neonatal outcomes were compared between the GDM and the non-GDM groups. GDM was diagnosed in 85/372 (22%) women, including 35 (59.3%) women with one abnormal OGTT value who were later diagnosed with GDM. Of 200 women who had a normal 1-h 50-g glucose challenge test at 24-28weeks, late GDM was diagnosed in 33 (16.5%). Seventy-six (89.5%) of those with GDM were treated by dietary therapy and 9 (10.5%) by pharmacological therapy. Among women with GDM, large-for-gestational-age fetuses, labor induction and elective cesarean section were more prevalent than for those without GDM. Significant differences were not found between the groups in macrosomia and neonatal outcomes. The performance of OGTT in women with risk factors during the third trimester should be considered following further prospective trials.

Accuracy of capillary blood glucose for 50-g glucose challenge test for gestational diabetes screening.

To assess the accuracy of capillary blood glucose (CBG) compared to conventional venous plasma glucose (VPG) testing for 50-g glucose challenge test (GCT) in gestational diabetes (GDM) screening. A total of 300 women were enrolled and 50-g GCT for GDM screening was offered. At 1h after glucose loading, CBG was evaluated by CONTOUR® PLUS glucose meter by well-trained nurses immediately after venipuncture for VPG. Results of CBG were compared with those from VPG to evaluate its accuracy. Women with venous plasma glucose > 140mg/dL were offered 100-g OGTT for GDM diagnosis. The mean age was 30.2years and the mean gestational age at testing was 21.8weeks. GDM was diagnosed in 34 women (11.3%). The mean VPG was 142.1 ± 32.9mg/dL and the mean CBG was 129.3 ± 33.5mg/dL. Mean difference was -12.3 ± 12.5mg/dL, corresponding to -8.8 ± 11.4%. CBG significantly correlated with VPG with correlation coefficient of 0.929, p < 0.001. In the detection of abnormal 50-g GCT results (VPG ≥ 140mg/dL), at 126mg/dL cutoff, CBG had sensitivity of 92.5%, specificity of 81.8%, and positive and negative predictive values of 82.8%and 92%. None of the GDM would have been missed if CBG was used. CBG by a certified glucose meter could be considered as an alternative to conventional VPG testing for 50-g GCT for GDM screening using 126mg/dL cutoff value.

Screening methods for gestational diabetes mellitus in Japan in 2018: a retrospective cohort study using a national surveillance questionnaire

This study aimed to investigate the relationship between gestational diabetes mellitus (GDM) screening methods and GDM incidences. In 2018, a national questionnaire was administered at 231 institutions (56.6%) of all 408 perinatal medical centers in Japan. Of 100,485 women, 2,982 (3.0%) were diagnosed with GDM during their first pregnancy period (FPP) and 7,289 (7.3%) were diagnosed with GDM during their middle pregnancy period (MPP). The proportion of women diagnosed with GDM during FPP and MPP using 95 mg/dL as the cutoff value (CV) for random plasma glucose (PG) at FPP (4.3% and 9.2%) was significantly higher than that of women diagnosed with GDM using 100 mg/dL as the CV for random PG (2.7% and 6.9%, p < 0.0001, respectively). Compared with women screened for GDM using "random PG and random PG," women who were screened for GDM using "random PG and 50-g glucose challenge test (GCT)" had a significantly higher incidence of GDM (6.6% versus 8.9%, p < 0.0001). Using random PG and 50-g GCT, the incidence of GDM among women diagnosed at MPP using a CV of 95 mg/dL at FPP was significantly higher than that of women diagnosed using a CV of 100 mg/dL (16.5% versus 7.8%: p < 0.0001). While, using "random PG and random PG," the incidences of GDM among women were similar between institutions using a CV of 100 mg/dL and those using a CV of 95 mg/dL at FPP (6.7% versus 6.9%: p = 0.3581). This study showed random PG as a first-step screening method in MPP may overlook women with GDM.

The impact of prenatal depression and diabetes management self-efficacy on postpartum stress and depression in women with gestational diabetes mellitus.

The study aimed to examine the impact of prenatal depression and diabetes management self-efficacy on postpartum stress and postpartum depression in women with gestational diabetes mellitus. Poor perinatal mental health is linked to various adverse pregnancy outcomes in women with gestational diabetes mellitus. A predictive study design and the guidelines forthe STROBE checklist were used for the study. A total of 119 pregnant women with a positive 75g-glucose challenge test were recruited at a medical centre. The Taiwanese depression questionnaire (TDQ), the diabetes management self-efficacy scale (DMSES) and the Hung postpartum stress scale (Hung PSS) were used for data collection at the 24th week of pregnancy and the first week after childbirth. Diabetes management self-efficacy was correlated with postpartum stress in women with gestational diabetes mellitus. Moreover, prenatal depression was a predictor of postpartum stress and postpartum depression, respectively, in women with gestational diabetes mellitus. Healthcare providers should assess those women's diabetes management self-efficacy and mood status during prenatal visits and offer the needed intervention to reduce the levels of postpartum stress and postpartum depression of those women after childbirth. A holistic care approach integrated diabetic care and mental health for women with gestational diabetes mellitus in a timely manner is warranted to promote perinatal mental health in women with gestational diabetes mellitus.

High Levels of 25-OH-Vitamin D and Copper in Pregnant Women with Abnormal Glucose Challenge Test.

Several hormones and elements are involved in the homeostasis of glucose metabolism during pregnancy. This present study determined the differences among the factors involved in glucose regulation for pregnant women with and without an abnormal glucose challenge test (GCT), but without gestational diabetes mellitus, during the second trimester of gestation and the postpartum period. One hundred and six pregnant women who had received routine prenatal and postpartum examinations at our hospital were recruited. Sugar-related tests and the levels of pregnancy-associated hormones and 25-OH-vitamin D were performed using a clinical autoanalyzer; six elements were assessed using graphite furnace atomic absorption spectrometry or inductively coupled plasma mass spectrometry. The women in the abnormal GCT group (n = 27) featured significantly higher levels of 25-OH-vitamin D (p = 0.006) and copper (p < 0.001) than those in the normal GCT group (n = 79). After adjusting for possible pregnancy factors, abnormal GCT remained the significant contributing factor for the elevated levels of 25-OH-vitamin D and copper during gestation (p = 0.046 and 0.002, respectively). Furthermore, significant positive correlations existed between 25-OH-vitamin D and glucose after a 50-g GCT (p = 0.001), 25-OH-vitamin D and HbA1C (p = 0.004), serum copper and glucose after a 50-g GCT (p = 0.003), and serum copper and HbA1C (p < 0.001). We conclude that blood 25-OH-vitamin D and copper are strongly correlated with glucose levels during gestation; these two factors are potential clinical predictors for maternal impaired glucose tolerance and, indirectly, for reducing perinatal risks and neonatal complications.

The screening performance of glucose challenge test for gestational diabetes in twin pregnancies: a systematic review and meta-analysis

Background The screening accuracy of the 50 g-glucose challenge test (50 g-GCT) for gestational diabetes (GDM) has been described in singleton pregnancies. Given the physiologic differences and greater increase in insulin resistance in twin compared with singleton pregnancies, the performance of the 50 g-GCT in twin pregnancies may differ. Objectives To perform a systematic review on the screening performance of the 50 g-GCT for gestational diabetes in twin pregnancies. Data sources Ovid Medline, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL). Study eligibility criteria, participants, and interventions We included randomized controlled trials or cohort studies that evaluated the screening accuracy of the 50 g-GCT for GDM in twin pregnancies using the two-step approach. The primary outcome was the positive predictive value of the 50 g-GCT for GDM using the 140 mg/dL (7.8 mmol/L) threshold. Study appraisal and synthesis methods Methodological quality of included studies was assessed using the QUADAS-2 tool. The positive predictive value (PPV) was pooled for studies that used similar test characteristics. Results From 2044 citations, 7 retrospective cohort studies with a total of 55,597 participants were included (6.5% twins and 93.5% singletons). The majority of studies evaluated a 50-g GCT cutoff point of 140 mg/dL. The pooled PPV for a threshold of 140 mg/dL (7.8 mmol/L) for twins was 22.58% (95% CI: 0.1912–0.2647, I2 =34.1%). The 50-g GCT screen positive rate in twin pregnancies was higher than that in singleton pregnancies. None of the studies performed routine OGTT. Conclusions and implications of key findings The PPV of 50 g-GCT for GDM in twin pregnancies when using a threshold of 140 mg/dL (7.8 mmol/L) is approximately 23%. There is currently no data on the sensitivity and specificity of the 50 g-GCT in twins.

An Update on Screening Strategies for Gestational Diabetes Mellitus: A Narrative Review.

Gestational diabetes mellitus (GDM) is a frequent medical complication during pregnancy. Screening and diagnostic practices for GDM are inconsistent across the world. This narrative review includes data from 87 observational studies and randomized controlled trials (RCTs), and aims to give an overview of the current evidence on screening strategies and diagnostic criteria for GDM. Screening in early pregnancy remains controversial and studies show conflicting results on the benefit of screening and treatment of GDM in early pregnancy. Implementing the one-step “International Association of Diabetes and Pregnancy Study Groups” (IADPSG) screening strategy at 24–28 weeks often leads to a substantial increase in the prevalence of GDM, without conclusive evidence regarding the benefits on pregnancy outcomes compared to a two-step screening strategy with a glucose challenge test (GCT). In addition, RCTs are needed to investigate the impact of treatment of GDM diagnosed with IADPSG criteria on long-term maternal and childhood outcomes. Selective screening using a risk-factor-based approach could be helpful in simplifying the screening algorithm but carries the risk of missing significant proportions of GDM cases. A two-step screening method with a 50g GCT and subsequently a 75g oral glucose tolerance test (OGTT) with IADPSG could be an alternative to reduce the need for an OGTT. However, to have an acceptable sensitivity to screen for GDM with the IADPSG criteria, the threshold of the GCT should be lowered from 7.8 to 7.2 mmol/L. A pragmatic approach to screen for GDM can be implemented during the COVID-19 pandemic, using fasting plasma glucose (FPG), HbA1c or even random plasma glucose (RPG) to reduce the number of OGTTs needed. However, usual guidelines and care should be resumed as soon as the COVID pandemic is controlled.

Diagnosis of Dysglycemia in Diabetic Patients in Primary Health Care

An early diagnosis of diabetes is a cornerstone for achieving the best prognostic outcomes. The potential complications take time to develop. For this reason, diabetic patients, especially type 2 are usually diagnosed with the disease after complications have been arisen. Dysglycemia is a term that has been used to describe the fluctuations in the plasma glucose levels, including the high (hyperglycemia) and low (hypoglycemia) levels, and can also refer to impaired glucose tolerance (IGT) or impaired fasting glucose (IFG). Many modalities have been developed to assess plasma glucose levels. Studies have shown that advantages and disadvantages are reported for each modality when assessing dysglycemia and screening for diabetes. The aim of this review is to discuss the previously reported diagnostic approaches of dysglycemia among diabetic patients according to the existing published studies in the literature. The study is related to the following: the 50-g oral glucose challenge test, HbA1c, fasting blood glucose, random blood sugar, and oral glucose tolerance tests in the assessment of the blood glucose fluctuating levels. Based on the findings, it is recommended that HbA1c levels assessment should be simultaneously conducted with the random and fasting blood glucose tests to decide which patients are required to perform an OGTT. Moreover, HbA1c tests might not be affordable in some healthcare settings although they are important indicators of long-term glycemic control.

Impact of gestational diabetes mellitus diagnosed during the third trimester on pregnancy outcomes: a case-control study

BackgroundIn 2010, the International Association of Diabetes and Pregnancy Study Group (IADPSG) proposed new criteria indicating that gestational diabetes mellitus (GDM) can be diagnosed if the fasting threshold of ≤92 mg/dL, 1-h threshold of ≤180 mg/dL, or 2-h threshold of ≤153 mg/dL are exceeded during the 75-g 2-h oral glucose tolerance test (OGTT) performed at 24–28 weeks of gestation. The World Health Organization (WHO) recommends using the proposed diagnostic threshold values of the IADPSG to diagnose GDM; however, it does not limit the timing of the 75-g OGTT. Since 2010 in Japan, GDM has been diagnosed using the same criteria as that proposed by the WHO. However, neither the JSOG nor the WHO has provided any evidence that it is appropriate to use a threshold beyond the range recommended by the IADPSG.MethodsThis was a single-centre retrospective study based on the medical records and delivery registry database of our centre. We included women who underwent a 50-g glucose challenge test (GCT) with results < 140 mg/dL at 24–28 weeks of gestation and subsequently underwent a 75-g OGTT after 29 weeks of gestation with abnormal glucose tolerance suspected based on clinical findings. The reference values for the 75-g OGTT followed the IADPSG criteria. Subjects were classified into the normal glucose tolerance (NGT) group and the GDM group. The type of delivery and neonatal outcomes of the two groups were compared. A multivariable analysis was performed to match the backgrounds of both groups.ResultsIn total, the NGT and GDM group comprised 189 and 49 women, respectively. Emergency caesarean delivery rates were similar in the GDM and NGT groups (10.6 and 12.2%, respectively; adjusted odds ratio [OR], 1.25; 95% confidence interval [CI], 0.43–3.64; p = 0.74); however, the elective caesarean delivery rate was higher in the GDM group than in the NGT group (16.3 and 5.3%, respectively, adjusted OR, 3.60; 95% CI, 1.27–10.19; p = 0.01). No significant differences were observed in other maternal and neonatal outcomes between both groups.ConclusionAlthough a diagnosis of GDM during the third trimester does not improve pregnancy outcomes, it increases the elective caesarean delivery rate.

Fetal Abdominal Obesity Detected At 24 to 28 Weeks of Gestation Persists Until Delivery Despite Management of Gestational Diabetes Mellitus.

BackgroundFetal abdominal obesity (FAO) has been reported to be affected at gestational diabetes mellitus (GDM) diagnosis at 24 to 28 weeks of gestation in older and/or obese women. This study investigated whether the management of GDM improves FAO in GDM subjects near term.MethodsMedical records of 7,099 singleton pregnant women delivering at CHA Gangnam Medical Center were reviewed retrospectively. GDM was diagnosed by 100-g oral glucose tolerance test after 50-g glucose challenge test based on Carpenter–Coustan criteria. GDM subjects were divided into four study groups according to maternal age and obesity. FAO was defined as ≥90th percentile of fetal abdominal overgrowth ratios (FAORs) of the ultrasonographically estimated gestational age (GA) of abdominal circumference per actual GA by the last menstruation period, biparietal diameter, or femur length, respectively.ResultsAs compared with normal glucose tolerance (NGT) subjects near term, FAORs and odds ratio for FAO were significantly higher in old and/or obese women with GDM but not in young and nonobese women with GDM. For fetuses of GDM subjects with FAO at the time of GDM diagnosis, the odds ratio for exhibiting FAO near term and being large for GA at birth were 7.87 (95% confidence interval [CI], 4.38 to 14.15) and 10.96 (95% CI, 5.58 to 20.53) compared with fetuses of NGT subjects without FAO at GDM diagnosis.ConclusionDespite treatment, FAO detected at the time of GDM diagnosis persisted until delivery. Early diagnosis and treatment might be necessary to prevent near term FAO in high-risk older and/or obese women.

Cord blood and maternal serum preptin and irisin concentrations are regulated independently in GDM.

The aim of this study is to examine the maternal serum and cord blood irisin and preptin levels in gestational diabetes mellitus (GDM) and correlate their levels with demographic and biochemical parameters. A total of 21 pregnant women with GDM and 21 BMI and age-matched pregnant women without GDM were included in the study. They underwent 50 g glucose challenge test (GCT) between 24-28th gestational weeks. Women with a GCT result higher than 140 mg/dl received 100 g oral glucose tolerance test (OGTT). Detection of one of the following criteria after OGTT was accepted as GDM: fasting plasma glucose level 92 mg/dL; 1-h plasma glucose level 180 mg/dL; and 2-h plasma glucose 153 mg/dL. Correlation between metabolic parameters and cord blood and maternal serum preptin and irisin levels in GDM and non-GDM subjects were analyzed. Maternal serum preptin values of GDM subjects were similar to the serum preptin values of non-GDM control subjects (123.12±34.3 pg/mL vs. 112.02±12.0 pg/mL, p<0.23). Cord blood preptin levels of GDM (64.3±1.09 pg/mL vs. 123.12±34.3 pg/mL, p<0.03) and non-GDM subjects (59.2±021 pg/mL vs. 112.02±12.0 pg/mL, p<0.02) were significantly lower than the maternal serum preptin values. Serum preptin levels of GDM group were positively correlated with HOMA-IR (r=0.33, p<0.04), but not with other parameters. Maternal serum irisin levels in the GDM group were lower than the non-GDM control group (5.32±0.44 µg/mL vs. 7.74±4.52 µg/mL, p<0.01). Cord blood irisin concentrations were found similar in women with GDM and non-GDM subjects (4.91±3.12 µg/mL vs. 5.01±2.14 µg/mL, p<0.14). Cord blood irisin levels of GDM subjects were similar to maternal serum irisin levels (4.91±3.12 µg/mL vs. 5.32±0.44 µg/mL, p<0.57). We found positive correlation between irisin concentration and fasting insulin, HOMA-IR, and BMI in women with GDM. In subgroup analysis of 6 patients using insulin treatment, serum and cord blood irisin and preptin levels were similar to those that did not use insulin. Maternal serum and cord blood preptin and irisin concentrations are regulated independently in women with GDM.

Gestational Diabetes Mellitus: Assessing the Reliability of Risk Factor-Based Screening in a Rural Nigerian Hospital

Implementation of the 2013WHO diagnostic criteria for Gestational Diabetes Mellitus (GDM), with lower threshold values required for the diagnosis of GDM, may be associated with further rise in the number of missed cases, especially among “low risk women”. This prospective study determined the proportions of women with GDM who were low risk. A hundred and seventeen pregnant women of gestational age 24-32weeks were screened with 50-g glucose challenge Test (GCT) and their GDM risk factor status noted. GCT positive women had 75-gOGTT, using 2013WHO GDM diagnostic criteria. The prevalence of GDM was 7.7% and about 55% of women with GDM had “low risk” status. There was no significant difference in the plasma glucose values of low risk and high risk women. With more than 50% of women with GDM being low risk, risk factor-based screening approach may be very unreliable in screening for GDM.