Elevated Glucose Challenge Test Research Articles

Prevalance of impaired glucose tolerance and its association with adverse perinatal outcomes in non-gestational diabetes pregnancies

Objective: Gestational diabetes mellitus (GDM) is characterized by glucose intolerance with onset during pregnancy and is one of the most common metabolic disorders complicating pregnancy. The aim of this study was to evaluate the risk of maternal and neonatal outcomes in non-gestational diabetes pregnancies with abnormal glucose challenge test (GCT) and abnormal glucose tolerance test (GTT) results.
 
 Methods: In this retrospective cohort study of 2982 singleton pregnancies, all patients underwent a non-fasting 50 g GCT at 24 to 28 weeks of gestation. A GCT cutoff of ≥ 140 mg/dl was selected. Women with an elevated GCT underwent prompt diagnostic testing with a 3-hour GTT. Subjects were divided into four groups according to GCT and GTT results.
 
 Results: There was an impaired glucose tolerance in 19.2 % of patients and 14.7 % of them had mild glucose intolerance and 4.5 % of them had moderate glucose intolerance. As expected, there was statistically significant difference in fetal macrosomia, neonatal hypoglicemia, PE, primary CS, and preterm birth between secreening negative and GDM patients (p < 0.0001). We also observed statistically significant difference in neonatal hypoglicemia (p = 0.0001) and PE (p = 0.0277) between screning negative and mild glucose intolerance group. Moreover, there was a significant difference in fetal macrosomia (p=0.0480) between mild glucose intolerance and moderate glucose intolerance groups.
 
 Conclusion: Compared with screening negative group, mild and moderate glucose intolerance are associated with increased adverse maternal and neonatal outcomes even in the absence of GDM.

Elevated Glucose Challenge Test in a Nondiabetic Index Pregnancy and Gestational Diabetes in a Subsequent Pregnancy

The aim of this study was to evaluate whether a 1-hour glucose challenge test (GCT) ≥140 mg/dL in a nondiabetic index pregnancy is associated with the development of gestational diabetes mellitus (GDM) in a subsequent pregnancy. We performed a retrospective cohort study from a single institution from June 2009 to December 2018. Women with a nondiabetic index singleton gestation who underwent a 1-hour GCT at 24 to 28 weeks and had a successive singleton delivery were included. GDM was defined by a 1-hour GCT of ≥ 200 mg/dL, ≥2 of 4 elevated values on a 3-hour GCT, or a diagnosis of GDM defined by International Classification of Disease codes in the electronic medical record. Univariable analyses were performed to evaluate the associations between an elevated 1-hour GCT result in the index pregnancy, maternal characteristics, and the development of GDM in the subsequent pregnancy. Variables found to be significant (p < 0.05) were included in multivariable analysis. A total of 2,423 women were included. Of these, 340 (14.0%) had an elevated 1-hour GCT in the index pregnancy. Women with an elevated 1-hour GCT in the index pregnancy compared with those without were significantly more likely to be older, married, privately insured, of Hispanic ethnicity or Asian race, chronically hypertensive, have a higher body mass index (BMI), have a shorter inter-pregnancy interval, and to develop GDM in the subsequent pregnancy (14.4 vs. 3.3%, p < 0.001). In multivariable analysis, an elevated 1-hour GCT (adjusted odds ratio [aOR]: 4.54, 95% confidence interval [CI]: 3.02-6.81), first-trimester BMI ≥30 kg/m2 in the index pregnancy (aOR: 3.10, 95% CI: 2.03-4.71), Asian race (aOR: 2.96, 95% CI: 1.70-5.12), Hispanic ethnicity (aOR: 2.11, 95% CI: 1.12-4.00), and increasing age (aOR: 1.07, 95% CI: 1.02-1.12) were significantly associated with an increased risk of GDM in the subsequent pregnancy. An elevated 1-hour GCT in a nondiabetic index pregnancy is associated with a fourfold increased risk of GDM in a subsequent pregnancy. · An abnormal 1 hour GCT in an index pregnancy is associated with GDM in a subsequent pregnancy.. · An abnormal 1 hour GCT may be an independent risk factor for GDM in a subsequent pregnancy.. · An abnormal 1 hour GCT is associated with a 4 fold increased risk of GDM in a subsequent pregnancy..

Fetomaternal outcome in elevated Glucose Challenge Test and gestational diabetes

Aims: To observe the maternal and fetal outcome among those having elevated Glucose Challenge Test (GCT) level and gestational diabetes mellitus (GDM).Methods: Medical record of 15,413 pregnant women booked and delivered between June 2012 and January 2018 were evaluated. GCT was performed by using 50gm glucose and diagnosis of gestational diabetes performed by using the Carpenter Coustan Criteria. Pregnancy outcomes were assessed by the antenatal events, gestation and mode of delivery. Similarly, neonatal outcomes assessed in terms of birth weights, Apgar score, congenital abnormalities, hyperbilirubinaemia, hypoglycaemia and respiratory distress syndrome.Results: The detected incidence of gestational diabetes was 2.35%. With the threshold plasma glucose level at 140 mg/ dl, 1843 women needed to undergo 100g oral glucose tolerance test and 363 women had gestational diabetes.Conclusions: It is very important to find out GDM in pregnancy as it has adverse outcomes which are preventable; it is worthwhile to detect GDM by screening in pregnancy. The 50g GCT is feasible and 100gm OGTT to find out GDM.

Comparison of Birth Outcomes by Gestational Diabetes Screening Criteria.

Objectives This study is to examine the association between different diagnostic criteria for gestational diabetes mellitus (GDM) and adverse birth outcomes. Study Design A retrospective cohort study of 5,937 women with a singleton pregnancy was conducted, who completed GDM screening between 24 to 32 weeks gestational age. Four nonoverlapping groups of women defined as: 1) Normal: glucose challenge test (GCT) <130 mg/dL, 2) elevated GCT + normal oral glucose tolerance test (OGTT): abnormal 1 hour GCT + normal 3 hour OGTT, 3) GDM/International Association of Diabetes in Pregnancy Study Group (IADPSG): abnormal 3 hour OGTT by the IADPSG criteria, and 4) GDM/Carpenter-Coustan (CC): diagnosis per CC criteria. We used logistic regression to examine the association between GDM group classification and main outcome of macrosomia and secondary birth outcomes. Results Prevalences were GDM/CC 4.6%, GDM/IADPSG 3.0, and 7.6% overall. GDM/IADPSG group was associated with increased macrosomia (adj OR [odd ratio] 1.87; 95% CI [confidence interval]: 1.08–3.25; p = 0.02), while GDM/CC group was associated with increased preterm birth (adj OR 1.75; 95% CI: 1.05–2.80; p = 0.03). Conclusion Little difference in birth outcomes was found between the two criteria, GDM/CC and GDM/IADPSG. Randomized controlled trials are needed to clarify the risks and benefits of these screening paradigms before their incorporation into clinical practice.

Maternal and Perinatal Outcomes in Women with Insulin Resistance.

Objective This study aims to estimate the risks of adverse maternal and perinatal outcomes in women with insulin resistance below the threshold of gestational diabetes mellitus (GDM). Methods This was a retrospective cohort study of 5,983 women with singleton pregnancies undergoing universal GDM screening between 24 and 28 weeks gestation. Subjects were divided into those with a normal 1-hour glucose challenge test (GCT), those with an elevated GCT with all normal values on a 3-hour glucose tolerance test (GTT), and those with an elevated GCT with one abnormal value on GTT. Outcomes included macrosomia, pregnancy-induced hypertension (PIH), cesarean section and operative delivery, shoulder dystocia, indicated-preterm birth, and other neonatal outcomes. Logistic regression was performed to compare outcomes among groups. Results The risk of macrosomia was increased for those with an elevated GCT and all normal values on GTT (adjusted odds ratio [aOR], 1.71; 95% confidence interval [CI]: 1.12, 1.97), and for those with an elevated GCT and one abnormal value (aOR, 2.69; 95% CI: 1.49, 4.83). Risks of PIH, cesarean section, and indicated-preterm birth were also increased in those with an elevated 1-hour GCT and no GDM. Conclusion There are increased risks of macrosomia, PIH, indicated-preterm birth, and cesarean section among those with insulin resistance even in the absence of GDM.

Diagnostic ability of elevated 1-h glucose challenge test.

ObjectiveTo determine if a threshold of a 1-hour glucose challenge test (GCT) eliminates the need for a 3-hour glucose tolerance test (GTT).Study DesignA retrospective cohort of patients undergoing GTT after GCT was ≥140 mg/dL. GDM was diagnosed using National Diabetes Data Group (NDDG) and Carpenter Coustan(CC) criteria. Sensitivity, specificity, and predictive values were calculated for 1-hour GCT values of 160 to 220 mg/dL.ResultOf 6218 patients, 988(15.9%) had an elevated GCT and 753(12.1%) underwent a GTT. 165(2.7%) were diagnosed with GDM using NDDG criteria, and 250(4.0%) by CC criteria. The positive predictive value of a 1-hour GCT≥200 mg/dL for GDM was 68.6% by NDDG and 80.0% for GDM by CC criteria.ConclusionAlthough the predictive value of an elevated 1-hour ≥200 mg/dL for GDM was high, 1 in 3 to 1 in 5 women would be overdiagnosed with GDM if the 3-hour GTT were omitted.

The relationship between markedly elevated glucose challenge test results and the rate of gestational diabetes mellitus and gestational impaired glucose tolerance.

BACKGROUND AND OBJECTIVESEven though the 50 g oral glucose challenge test (GCT) is the most commonly used screening modality for gestational diabetes mellitus (GDM), no consensus for the diagnostic approach is available to patients with a markedly elevated GCT result. We aimed to evaluate the diagnostic utility of markedly elevated GCT results and the impact of age using the oral glucose tolerance test (OGTT) as gold standard.DESIGN AND SETTINGRetrospective study conducted in a women’s hospital in Ankara, among patients who underwent GCT from January 2005 to December 2008.PATIENTS AND METHODSIn this retrospective study, we included 626 pregnant women who underwent a 3-hour 100 g OGTT after a GCT result ≥180 mg/dL among 29 842 women. We calculated positive predictive values (PPV) of each GCT category to diagnose GDM and both GDM and gestational impaired glucose tolerance (GIGT).RESULTSA GCT result of ≥240 mg/dL provided 100% PPV for the diagnosis of GDM and a result of >230 mg/dL provided 100% PPV for the diagnosis of GDM + gestational impaired glucose tolerance (GIGT), according to both, National Diabetes Data Group (NDDG) and Carpenter and Coustan (CC) criteria. A result of ≥200 mg/dL provided 100% PPV for diagnosing GDM+GIGT in patients older than 35 years, according to the CC criteria.CONCLUSIONSThe GCT result of 200 mg/dL is an ideal cutoff value for the diagnosis of GDM + GIGT in patients ≥35years, and OGTT can be omitted in these patients. In younger patients, the cutoff value should be chosen as 230 mg/dL.

The Glucose Challenge Test for Screening of Gestational Diabetes

The frequency of gestational diabetes mellitus (GDM) is 0.6% -15% of pregnant woman. The modern trend towards the delay starting family is the main factor responsible for increase prevalence of GDM. This condition is associated with the adverse effect on mother and fetus, so it is important to find out the GDM by screening of all the pregnant women. To observe the feasibility of using the 50g GCT for all pregnant women attending Dhulikhel Hospital, Obstetric OPD. To determine the incidence of gestational diabetes in the population and to observe the maternal and fetal outcome among those having an elevated GCT level and gestational diabetes. A prospective and analytical study of 1598 pregnant women booked and delivered between June 2009and August 2010. Glucose challenge test (GCT) performed by using 50gm glucose and diagnosis of gestational diabetes performed by using the Carpenter Coustan Criteria. Pregnancy outcomes were assessed by the gestation and mode of delivery. Similarly, neonatal outcomes assessed in terms of birth weights, APGAR scores, congenital abnormalities, hyperbilirubinaemia, hypoglycaemia or respiratory distress syndrome. The detected incidence of gestational diabetes was 0.75%. With the threshold plasma glucose level at140 mg/ dl, 198 women needed to undergo the 100g oral glucose tolerance test and 12 women had gestational diabetes. The diagnostic yield was 6.06%. Perinatal outcome was similar to the rest of the women with normal glucose challenge test. The 50g GCT is feasible and also helps to find out GDM. It is easy, user friendly, cheap and convenient for screening purpose.

50-Gram glucose challenge test: is it indicative of outcomes in women without gestational diabetes mellitus?

Objective. To examine whether the 50-gram glucose challenge test (GCT) is associated with perinatal outcomes in women without gestational diabetes mellitus (GDM).Methods. This is a retrospective cohort study of 13,789 women who received the GCT and did not have a diagnosis of GDM at the University of California, San Francisco UCSF. GCT values were categorized and examined as predictors of perinatal morbidity using chi-square test and multivariable logistic regression analyses adjusting for maternal characteristics.Results. In women with an elevated GCT but without GDM, the odds of preeclampsia, cesarean delivery, and elevated birth weight were increased. The odds of large-for-gestational age status were increased with aOR 2.0 (95% CI 1.38–2.90) in the 160–179 mg/dl group. The odds of shoulder dystocia was increased with aOR 3.35 (CI 1.03–10.88) in the ≥180mg/dl group.Conclusion. In women without GDM, elevated 50-gram GCT values were associated with higher odds of perinatal morbidity. These findings further support evidence that impaired glucose tolerance is a continuum with possible associated adverse outcomes even at mild ranges; additional research is required to investigate appropriate interventions for women with abnormal screens for GDM.

The Association Between Maternal Obesity, Glucose Intolerance and Hypertensive Disorders of Pregnancy in Nondiabetic Pregnant Women

Objective. The aim of this study is to evaluate whether pregnancy-induced hypertension (PIH) among nondiabetic patients is associated with glucose intolerance. Materials and Methods. A retrospective case-control study was designed including a study group who had pregnancy-induced hypertension or preeclampsia. Patients with normal pregnancy were used as a control group matched to cases by parity. Diabetic patients, nonsingleton pregnancies, and women without prenatal care were excluded. Data concerning fasting glucose levels, glucose challenge test (GCT), and oral glucose tolerance test (OGTT) were collected from patients' files. Results. There were 131 patients in each study group. The study group had significantly higher mean maternal age, mean GCT levels, and mean pregestational body mass index (BMI) (28.0 ± 5.8 vs. 26.5 ± 5.3, p = 0.02; 5.8 ± 1.4 vs. 5.1 ± 1.1 p = 0.0018; 26 ± 5.1 vs. 23 ± 4.0 p < 0.001, respectively) than the control group. Mean gestational age and birthweight were also significantly lower in the study group (38.5 ± 2.1 vs. 39.4 ± 1.7 p < 0.001; 2929 g ± 614.7 vs. 3225 ± 461.1 p < 0.001, respectively). Stratified analysis according to parity demonstrated that pregestational BMI, weight gain during pregnancy, and cesarean section (CS) were significantly higher in women with pregnancy-induced hypertension than in controls in all parity groups. Maternal age and mean GCT levels of women with pregnancy-induced hypertension were higher in all parity groups but statistically significant only among multiparous patients. Multiple logistic regression demonstrated that BMI, weight gain, and maternal age were independently associated with pregnancy-induced hypertension, while GCT level was not. Conclusions. Elevated pregestational BMI is an independent risk factor for development of pregnancy-induced hypertension (PIH). Its association with elevated GCT levels implies that even without overt diabetes, glucose intolerance may play a role in the pathogenesis of preeclampsia in obese patients.

Is there a difference in the glycemic profile of non-diabetic women with positive/negative glucose challenge test screening (GCT) results?

It has been suggested that the elevated glucose challenge test (GCT) by itself reflects glucose intolerance during pregnancy. We sought to evaluate the glycemic profile characteristics in relation to GCT results in non-diabetic pregnant women.

Glucose screening in Mexican-American women.

We sought to describe the predictive value for gestational diabetes mellitus (GDM) using different glucose challenge test thresholds in Mexican-American women. A prospective population-based study of 6,857 gravid women, who were tested with a 50-g glucose challenge test at 24-28 weeks of gestation, was performed. A screening value of 130 mg/dL or greater was followed by a 3-hour, 100-g oral glucose tolerance test. Gestational diabetes mellitus was diagnosed by 2 or more abnormal values using the Carpenter and Coustan criteria. For purpose of analysis, GDM diagnosis was categorized with glucose challenge test values in 10-mg/dL increments. A comparison between Carpenter-Coustan and the National Diabetic Data Group criteria for GDM diagnosis was performed for each glucose challenge test threshold category. Sensitivity and specificity for GDM diagnosis were further calculated for different glucose challenge test thresholds (130, 135, and 140 mg/dL). Overall, GDM was diagnosed in 469 of 6,857 (6.8%) women, and one abnormal oral glucose tolerance test value was tested in 351 of 6,857 women (5.1%). Normal glucose challenge test results (threshold less than 130 mg/dL) were obtained in 4,316 of 6,857 women. An elevated glucose challenge test value increases the risk of GDM, but even in high glucose challenge test thresholds (more than 180 mg/dL), the predictive value for GDM was only 50%. The sensitivity and specificity for GDM diagnosis using 3 different glucose challenge test thresholds were as follows: threshold 130 mg/dL or more: 97% and 63%; threshold 135 mg/dL or more: 91% and 73%; and threshold 140 mg/dL or more: 85% and 78%, respectively. Data suggests that an elevated glucose challenge test level cannot be used as a single diagnostic tool for GDM even in high test thresholds. A threshold of 130 mg/dL may be recommended as a screening threshold for GDM in Mexican-American women. II-3

The significance of an elevated fasting value on the glucose tolerance test and a markedly elevated glucose challenge test in assessing pregnancy outcome

The significance of an elevated fasting value on the glucose tolerance test and a markedly elevated glucose challenge test in assessing pregnancy outcome