Screening Test For Gestational Diabetes Research Articles

Early pregnancy HbA1c as the first screening test for gestational diabetes: results from three prospective cohorts

More than 90% of gestational diabetes cases are estimated to occur in low-income and middle-income countries (LMICs). Most current guidelines recommend an oral glucose tolerance test (OGTT) at 24-28 weeks of gestation. The OGTT is burdensome, especially in LMICs, resulting in a high proportion of women not being screened. We aimed to develop a simple and effective screening strategy for gestational diabetes. STRiDE, a prospective cohort study, was set up in seven centres in south India and seven centres in western Kenya, and included pregnant women aged 18-50 years of age and at less than 16 weeks of gestation (<20 weeks in Kenya), confirmed by dating ultrasound. We assessed the efficacy of early pregnancy HbA1c (venous and capillary point-of-care), either alone or as part of a composite risk score with age, BMI, and family history of diabetes, in predicting gestational diabetes at 24-28 weeks of gestation, in two LMICs (India and Kenya) and in a UK multi-ethnic population from the PRiDE study. A key secondary outcome was to assess whether an early pregnancy composite risk score can reduce the need for OGTTs. Gestational diabetes was diagnosed using current WHO criteria. Between Feb 15, 2016, Dec 13, 2019, we enrolled 3070 participants in India and 4104 in Kenya. 4320 participants were included from the PRiDE cohort. Gestational diabetes prevalence by OGTT at 24-28 weeks was 19·2% in India, 3·0% in Kenya, and 14·5% in the UK. Early pregnancy HbA1c was independently associated with incidence of gestational diabetes at 24-28 weeks of gestation. Adjusted risk ratios were 1·60 (95% CI 1·19-2·16) in India, 3·49 (2·8-4·34) in Kenya, and 4·72 (3·82-5·82) in the UK. Composite risk score models that combined venous or point-of-care HbA1c with age, BMI, and family history of diabetes best predicted testing positive for gestational diabetes. A population-specific, two-threshold screening strategy of rule-in and rule-out gestational diabetes using early pregnancy composite risk score could reduce the requirement of OGTTs by 50-64%. For the HbA1c-alone model, the thresholds were 5·4% (rule in) and 4·9% (rule out) in India, 6·0% (rule in) and 5·2% (rule out) in Kenya, and 5·6% (rule in) and 5·2% (rule out) in the UK. Early pregnancy HbA1c offers a simple screening test for gestational diabetes, allowing those at highest risk to receive early intervention and greatly reduce the need for OGTTs. This can also be carried out using point-of-care HbA1c in LMICs. UK Medical Research Council and the Indian Department of Biotechnology.

Does health literacy affect the decision to have gestational diabetes screening test?

Objectives: The main objective of this study is to assess the relationship between the level of Health Literacy and the patient's decision to refuse the Gestational diabetes mellitus screening test. Methods: This cross-sectional study was conducted at a high-volume public hospital from March 2020 to September 2020 with women between 24-28 weeks of gestation. Demographic characteristics and gestational diabetes mellitus screening status were recorded for each woman. The European Health Literacy Survey Questionnaire was used to assess health literacy. Results: A total of 364 women were included in the study. Two hundred and three (55.7%) women accepted the gestational diabetes mellitus screening test, and 44.2% did not. Health care, disease prevention, health promotion subscales, and the general scale scores were higher in the gestational diabetes mellitus screening group (p = 0.001, p = 0.024, p = 0.01, and p = 0.003, respectively). It was determined that a 1-point increase in the health care score decreased the probability of rejecting the gestational diabetes mellitus screening by 1.03 times (p = 0.003). Conclusions: Lower health literacy levels were associated with higher rates of gestational diabetes mellitus screening test rejection.

Impact of the COVID-19 pandemic on gestational diabetes screening test performance in WNC

To assess the impact of the COVID-19 pandemic across 3 parallel, 12-month epochs, pre-pandemic through post vaccine availability, on standard of care gestational diabetes screening.

PSUN176 Fructosamine as a screening test for gestational diabetes

Abstract Background All organizations use variable glucose criteria for diagnosis of gestational diabetes (GDM). However all involve OGTT. American college of Obstetrics and Gynecology (ACOG) and American Diabetes Association (ADA) recommend 2 step testing; 1) 1 hour glucose level on 50 gm glucose ingestion at any time during the day (1 hour OGTT) and 2) 3 hour OGTT with 100 gm glucose ingestion after overnight fast in pregnant women with glucose &amp;gt; 140 mg/dl during 1 hour. OGTTs require preparation with least daily intake of carbohydrate 150 gm for 3 days before testing. Many women are hesitant getting tested because of nausea, vomiting on glucose ingestion. Thus, none of the tests is convenient. Objective We examined utility of serum Fructosamine level as a screening test for diagnosis of GDM. Methods Random serum glucose and Fructosamine (mcM/l) levels as well as HbA1c (%) were determined at 24-30 weeks in 206 pregnant women, ages 24-40 years along with 1 hour OGTT and then again with 3 hour OGTT in 46 pregnant women with abnormal 1 hour OGTT and 21 age matched non-pregnant women. Continuous glucose monitoring (CGM) for 2 weeks was performed in 5 pregnant women with abnormal 3 hour OGTT and 7 non-pregnant women. Results Fructosamine levels (192± 4) were significantly lower (p&amp;lt;0.01) in nondiabetic pregnant women when compared with age matched non-pregnant women (224 ± 5). Cutoff serum Fructosamine concentration between groups was 205. Glucose and HbA1c were not significantly different amongst groups. Serum Fructosamine levels in 26 pregnant with abnormal 1 hour but normal 3 hour OGTT were &amp;lt;205, similar to nondiabetic pregnant women. Serum Fructosamine concentrations in women with abnormal 3 hour OGTT and normal CGM e.g, 70-140 mg /dl matched levels in nondiabetic pregnant women. Conclusion CGM may be the most accurate test for diagnosis of GDM. Random serum Fructosamine level may be as accurate as CGM and more accurate than both OGTTs. Importantly, it is a simple and convenient test without requiring fast, glucose ingestion or preparation. Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.

Gestational age, birth weight, and perinatal complications in mothers with diabetes and impaired glucose tolerance: Japan Environment and Children's Study cohort.

We aimed to determine the risk of perinatal complications during delivery in mothers with non-normal glucose tolerance in a large Japanese birth cohort. We analysed data of 24,295 neonate-mother pairs in the Japan Environment and Children's Study cohort between 2011 and 2014. We included 67 mothers with type 1 diabetes, 102 with type 2 diabetes (determined by questionnaire), 2,045 with gestational diabetes (determined by diagnosis), and 2,949 with plasma glucose levels ≥140 mg/dL (shown by a screening test for gestational diabetes). Gestational age, birth weight, placental weight, and proportions of preterm birth, and labour and neonatal complications at delivery in mothers with diabetes were compared with those in mothers with normal glucose tolerance. Mean gestational age was shorter in mothers with any type of diabetes than in mothers without diabetes. Birth weight tended to be heavier in mothers with type 1 diabetes, and placental weight was significantly heavier in mothers with type 1 and gestational diabetes and elevated plasma glucose levels (all p<0.05). The relative risks of any labour complication and any neonatal complication were 1.49 and 2.28 in type 2 diabetes, 1.59 and 1.95 in gestational diabetes, and 1.22 and 1.30 in a positive screening test result (all p<0.05). The relative risks of preterm birth, gestational hypertension, and neonatal jaundice were significantly higher in mothers with types 1 (2.77; 4.07; 2.04) and 2 diabetes (2.65; 5.84; 1.99) and a positive screening test result (1.29; 1.63; 1.12) than in those without diabetes (all p<0.05). In conclusion, placental weight is heavier in mothers with non-normal glucose tolerance. Preterm birth, gestational hypertension, and jaundice are more frequent in mothers with types 1 and 2 diabetes. A positive result in a screening test for gestational diabetes suggests not only a non-normal glucose tolerance, but also a medium (middle-level) risk of perinatal complications.

Fructosamine as a Screening Test for Gestational Diabetes

Fructosamine as a Screening Test for Gestational Diabetes

Long-Term Metabolic Consequences in Patients with a History of Gestational Diabetes.

Gestational diabetes mellitus is a common metabolic complication of pregnancy. Universal guidelines on gestational diabetes have been impeded by the long-term controversies on its definition and screening strategies. The prevalence of gestational diabetes is rising all over the world, is significantly influenced by ethnicity and its rise is mainly attributed to increasing maternal obesity and age. Gestational diabetes mellitus has important long-term implications, including gestational diabetes recurrence, increased risk for developing type 2 diabetes, metabolic syndrome and cardiovascular disease for the mother. Gestational diabetes mellitus may be viewed as a chronic metabolic disorder that is identified in women during gestation and may provide a unique opportunity for the early identification and primary prevention of type 2 diabetes mellitus and cardiovascular disease in these women. In this mini-review, the evolution of screening tests for gestational diabetes and guidelines are briefly described and metabolic and cardiovascular long-term consequences of women with a history of gestational diabetes are summarized. A summary of our own St. Mary's Hospital-UK Research series on long-term metabolic consequences of 368 women with a history of gestational diabetes of 3 different ethnic groups and 482 control women is also included. We found that approximately 2 years following delivery, 37% of women with a history of gestational diabetes had abnormal glucose concentrations, but, most importantly, even those who were normoglycaemic, postpartum displayed metabolic abnormalities on detailed testing. Future research needs to focus on the prevention of gestational diabetes long-term complications, but also in identification of pre-pregnancy predictors and risk reduction before conception.

Are maternal metabolic syndrome and lipid profile associated with preterm delivery and preterm premature rupture of membranes?

We aimed to evaluate the association of metabolic syndrome (MetS), its components and lipid profile in mid-pregnancy with preterm delivery and preterm premature rupture of membranes (PPROM). This prospective cohort study was conducted on 203 pregnant women between 24 and 28weeks of gestation, undergoing gestational diabetes screening test with 50g glucose challenge test (GCT). Fasting serum total cholesterol, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglyceride (TG) levels were measured during the week after GCT assessment. Information on the participants' pre-pregnancy weight, demographic/reproductive characteristics, and height and blood pressure (BP) measurements were documented at baseline entry into the study. Metabolic syndrome was defined as the co-existence of 3 or more of the following criteria: Body mass index (BMI) before pregnancy ≥ 30kg/m2, BP ≥ 130/85mmHg, GCT ≥ 140mg/dl, TG ≥ 150mg/dl, and HDL-C ≤ 50mg/dl. All participants were followed through routine prenatal care, up to delivery. Any deliveries or rupture of membranes of less than 37weeks of pregnancy were considered preterm delivery and PPROM, respectively. Statistical analysis was performed by SPSS V.20, and p value of less than 0.05 was considered significant. MetS was detected in 10 (4.9%) of participants. Logistic regression analysis showed HDL-C levels, and hypertension were associated with spontaneous preterm delivery [(OR 0.952, 95% CI 0.910-0.995), (OR 1.629, 95% CI 1.554-1.709) respectively], but no statistically significant results were found for PPROM. Low HDL-C levels and hypertension in mid-pregnancy are associated with the occurrence of spontaneous preterm deliveries, indicating that MetS and its components should be monitored more closely in pregnancy.

Predictive Power of Unconjugated Estriol in Diagnosis of Gestational Diabetes: A Cohort Study

Background: Gestational diabetes is the most common antenatal medical complication that is associated with adverse short- and long-term maternal, fetal, and neonatal outcomes. Reducing maternal and fetal complications requires the early diagnosis of gestational diabetes. Unconjugated Estriol (UE) has led to insulin resistance under in vitro conditions. Objectives: This study aimed to determine the predictive power of unconjugated estriol in the diagnosis of gestational diabetes in Tehran, Iran. Methods: The present historical cohort study was conducted on 523 pregnant women presenting to two university-affiliated hospitals in Tehran, Iran, 2017 - 2018. The level of unconjugated estriol was determined at the 14th - 17th week of pregnancy, and gestational diabetes was diagnosed at the 24th - 28th week of pregnancy using the oral glucose tolerance test with 75 grams of glucose. Data were collected through interviews and sampling was carried out using a convenience sampling method. Results: Out of 523 pregnant women examined, 63 (12%) were placed in the gestational diabetes group and 460 (88%) in the non-gestational diabetes group. The best cutoff point for unconjugated estriol was determined using the ROC curve as 0.965 MOM. We obtained 66.66% sensitivity, 54.78% specificity, 16.8% positive predictive value, and 92.30 negative predictive value for the UE test. Conclusions: Given the acceptable sensitivity (66.66%) and specificity (54.78%) obtained for the UE test and the area under the ROC curve of 0.60, it appears that the UE test can be considered a new, accessible, and reliable screening test for gestational diabetes.

Clinical utility of ultrasonography-measured visceral adipose tissue depth as a tool in early pregnancy screening for gestational diabetes: a proof-of-concept study.

To examine, in a proof-of-concept study, the ability of visceral adipose tissue depth and subcutaneous fat depth measured in early pregnancy to predict subsequent gestational diabetes, and to assess the performance of these measures as screening tests for gestational diabetes compared with use of the current UK criteria. A total of 100 women in early pregnancy were recruited from a maternity hospital in Belfast, UK. Visceral adipose tissue depth and subcutaneous fat depth were measured, and each participant underwent a 75-g oral glucose tolerance test at 28 weeks' gestation for the diagnosis of gestational diabetes using WHO 2013 criteria. Eighty women completed the study, of whom 15 (19%) developed gestational diabetes. Increasing visceral adipose tissue depth, but not subcutaneous fat depth, was associated with greater gestational diabetes risk after adjusting for confounding factors (odds ratio for a 1-sd rise 2.09, 95% CI 1.06-4.12; P=0.03). Visceral adipose tissue depth ≥4.27 cm had greater sensitivity compared with current National Institute of Health and Care Excellence criteria (87% vs 40%, respectively; P=0.02) and similar specificity (62% vs 74%, respectively; P=0.15) for identifying gestational diabetes. Ultrasonography-measured visceral adipose tissue in early pregnancy is a potential clinical tool for improving sensitivity of selective screening for gestational diabetes, which, compared with universal oral glucose tolerance testing, is likely to reduce by half the numbers requiring this test. Further larger studies are now required for confirmation, including investigation into impact on clinical outcomes.

Does Serum Hemoglobin A1C during Early Pregnancy Predict Performance on the 1-Hour Glucose Challenge Test? [28B

INTRODUCTION: Our objective was to determine the negative and positive predictive values of hemoglobin A1c (HgbA1c) levels, conceptualized as a screening test, in predicting abnormal 1-hour glucose challenge test (GCT) results in pregnancy. METHODS: This was a retrospective cohort study. We calculated the negative predictive value of HgbA1c levels in predicting normal 1-hour GCT (less than or equal to 140 mg/dl) and the positive predictive value in predicting an abnormal 1-hour GCT of greater than 140 mg/dl. RESULTS: We examined 635 pregnancies where the HgbA1c was measured in the same patient on the same day as or before the 1-hour GCT was performed. The median time interval between performance of the HgbA1c test and the 1-hour GCT was 95 days (IQR 56-122 days). Among women with HgbA1c levels less than or equal to 4.9, 5.0, and 5.1, the probability of their 1-hour GCT being 140 mg/dl or less was 91.3%, 91.0% and 90.1%, respectively. Among our study population, 14.5%, 22.8%, and 35.0% had HgbA1c levels less than or equal to 4.9, 5.0 and 5.1, respectively. Among women with HgbA1c levels greater than 6.1, the probability of their 1-hour GCT being greater than 140 mg/dl was 100%. However, only 0.3% of our population had HgbA1c greater than 6.1. CONCLUSION: Our study adds to the body of evidence that HgbA1c cannot replace the 1-hour GCT as a screening test for gestational diabetes, but low values can reliably predict a normal 1-hour GCT. Therefore, some women could be spared from doing the 1-hour GCT.

Fasting and post-prandial plasma glucose screening for gestational diabetes mellitus.

Gestational diabetes mellitus (GDM) is defined as impaired glucose tolerance with onset during the second or third trimester of pregnancy. The purpose of this study was to investigate the prevalence of pregnant women who were not screened for gestational diabetes mellitus and compare the maternal and fetal outcomes of women who had undergone GDM screening. Women who refused to attend the gestational diabetes screening test (n = 162) at a maternity hospital in Ankara, Turkey, between October 2014 and January 2015 were included in this prospective cohort study. The control group (matched for age and body mass index) was recruited from women who agreed to have the gestational diabetes screening test (n = 194). Just 12% of pregnant women did not attend gestational diabetes screening test; these women were at higher risk for idiopathic polyhydramnios (P = 0.026). Prevalence of GDM was 8.8% (n = 17) in the control group and 30.9% (n = 50) in those who refused GDM screening. The maternal and fetal outcomes of GDM patients were similar in both groups. Women who did not attend GDM screening test had increased risk for mild idiopathic polyhydramnios in late gestation. Fasting and postprandial plasma glucose screening can replace gestational diabetes mellitus screening in women who refuse to have the glucose load test.

494: Early hemoglobin A1c as a screening test for gestational diabetes among overweight and obese women

Overweight and obese pregnant woman are known to be at increased risk of developing gestational diabetes. However, little is known about early screening in this population. The objective of this study was to determine early (< 20 gestational age) hemoglobin A1c values between overweight and obese pregnant women who develop gestational diabetes (GDM) compared those who do not develop GDM. A case-control study comparing overweight and obese women with GDM to overweight and obese women without GDM (non-GDM) in a 3:1 ratio between 2011 and 2014 at Oregon Health and Sciences University to determine if early hemoglobin A1C (HbA1C; obtained < 20 weeks gestational age) differs between the two cohorts. Chi squared, Pearson correlation, and Wilcoxon rank-sum test were used to compare GDM and non-GDM pregnancies. Receiver Operating Characteristic (ROC) curve was analyzed to plot the true positive rate against the false positive rate for the different possible cut-points of early HbA1C to predict the diagnosis of GDM among overweight and obese women. A total of 443 subjects were analyzed (n=139 cases and n=304 controls). Women with GDM were more likely to be non-white, older in age, multiparous and have a higher pre-pregnancy BMI (see Table). Women with GDM had a significant difference in early HbA1C compared to non-GDM pregnancies (5.6 and 5.3%, P<0.01). Early HbA1C is more significantly correlated with GDM diagnosis than pre-pregnancy BMI (0.34 vs 0.13; p<0.01). The curve point at which the area under the ROC curve was maximized was an early HbA1C of 5.6% with an AUC = 0.725 (see Figure). Overweight and obese women who develop GDM have significantly different HbA1C than non- GDM pregnancies. The mean HbA1C is lower than the American Diabetes Association definition for pre-diabetes. When using A1c as a screening tool, these data suggest lower cut-points should be considered among overweight and obese pregnant women to perform early diagnostic diabetes testing in pregnancy. However, further studies are needed to determine a reliable, predictive HbA1C.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Ethnic differences in antepartum glucose values that predict postpartum dysglycemia and neonatal macrosomia

Background and ObjectiveGestational diabetes (GDM) occurs more often in women from certain ethnic groups and is also associated with fetal macrosomia. In this study, we investigated the ability of a gestational diabetes screening test (GDS), the 2 h 75 g-Oral Glucose Tolerance Test (OGTT), and glycated hemoglobin (HbA1c) in predicting postpartum dysglycemia and fetal macrosomia in women of Caucasian, Filipino, Chinese and South-Asian descent. Methods848 women diagnosed with carbohydrate intolerance in pregnancy who completed a 2 h 75 g- OGTT within 6 months postpartum, were included in the study. Receiver Operating Characteristic curve analysis was used to test the ability of antepartum GDS, HbA1c and OGTT in predicting postpartum hyperglycemia, type 2 diabetes (T2D) and neonatal macrosomia (birth weight >4000 g). Results20.2% had postpartum hyperglycemia while 3.8% had T2D. Those with postpartum dysglycemia were more likely to be non-Caucasian (South-Asian > Filipino > Chinese), have higher antepartum glucose values, require insulin during pregnancy and have cesarean births. Of HbA1c and the antepartum glucose values, a fasting glucose of ≥5.25 mmol/L was predictive of fetal macrosomia in Caucasians. 1 h glucose of ≥11.05 mmol/L was predictive of postpartum hyperglycemia, while 2 h glucose of ≥9.75 mmol/L was predictive of T2D; ethnicity influenced the predictive ability of these tests. ConclusionsEthnicity influences the ability of antepartum glucose and HbA1c to predict the risk of macrosomia and postpartum dysglycemia. This information will help detect those most at risk of T2D.

Are women positive for the One Step but negative for the Two Step screening tests for gestational diabetes at higher risk for adverse outcomes?

The aim of this study was to evaluate if women meeting criteria for gestational diabetes mellitus (GDM) by the One Step test as per International Association of the Diabetes and Pregnancy Study Groups (IADPSG) criteria but not by other less strict criteria have adverse pregnancy outcomes compared with GDM-negative controls. The primary outcome was the incidence of macrosomia, defined as birthweight >4000g. Electronic databases were searched from their inception until May 2017. All studies identifying pregnant women negative at the Two Step test, but positive at the One Step test for IADPSG criteria were included. We excluded studies that randomized women to the One Step vs. the Two Step tests; studies that compared different criteria within the same screening method; randomized studies comparing treatments for GDM; and studies comparing incidence of GDM in women doing the One Step test vs. the Two Step test. Eight retrospective cohort studies, including 29983 women, were included. Five study groups and four control groups were identified. The heterogeneity between the studies was high. Gestational hypertension, preeclampsia and large for gestational age, as well as in some analyses cesarean delivery, macrosomia and preterm birth, were significantly more frequent, and small for gestational age in some analyses significantly less frequent, in women GDM-positive by the One Step, but not the Two Step. Women meeting criteria for GDM by IADPSG criteria but not by other less strict criteria have an increased risk of adverse pregnancy outcomes such as gestational hypertension, preeclampsia and large for gestational age, compared with GDM-negative controls. Based on these findings, and evidence from other studies that treatment decreases these adverse outcomes, we suggest screening for GDM using the One Step IADPSG criteria.

Second-trimester urinary neutrophil gelatinase-associated lipocalin levels in gestational diabetes: preliminary results

Objective: The objective of this study is to investigate the urinary neutrophil gelatinase-associated lipocalin (uNGAL) levels in the second trimester of pregnant patients at the time of gestational diabetes mellitus (GDM) screening. Materials and methods: Urinary samples from 88 pregnant women who underwent gestational diabetes screening test were collected in late second trimester (24–28 weeks) prospectively. After an overnight fasting, 75 g GTT was performed. The blood samples were drawn for measurement of glucose, insulin, and HbA1c. The urinary and blood parameters were compared for pregnant women with or without gestational diabetes. Results: uNGAL levels were significantly elevated in pregnant women with gesting compared with the control groups (p < .014). There was a positive correlation between uNGAL and HbA1c levels (p = .001). Conclusions: In the second trimester, at the time of GDM screening, high levels of uNGAL indicate tubular injury in GDM cases which seems to be a result of hyperglycemia. uNGAL may correlate with an inflammatory renal involvement in GDM.

Principles of first trimester screening in the age of non-invasive prenatal diagnosis: screening for other major defects and pregnancy complications.

First trimester risk assessment plays a major role in the contemporary pregnancy care. It has evolved significantly since its introduction in the 1990s when it essentially consisted of just the nuchal translucency measurement. Today, it involves the measurement of several biophysical and biochemical markers and can assess the risk for a wide array of major chromosomal and non-chromosomal defects as well as other pregnancy-related complications. A search of the Medline and Embase databases was done looking for articles about first trimester screening. We performed a detailed review of the literature to evaluate the screening tests currently available and their respective test performance. The detailed ultrasound examination results in the detection of about half of major structural defects, determination of a very accurate gestational age, and identification of multiple pregnancies as well as their chorionicity. In addition, risk assessment for preeclampsia and early IUGR can be established at this stage. In case of an increased risk, the daily use of low-dose aspirin can be offered at a point in pregnancy when it still can have a positive impact. Additional screening tests for gestational diabetes and macrosomia are available. Contemporary first trimester screening is essential to establish an individual risk profile and can be used to tailor the pregnancy care.

Diabetes Gestacional e o Impacto do Actual Rastreio

In 2011, a new screening test for gestational diabetes was introduced which allowed an earlier and larger diagnosis with the goal of reducing maternal and perinatal complications. The aim of our study was to evaluate the prevalence of gestational diabetes, compare maternal and perinatal outcomes with the previous and present screening tests and analyze postpartum screening results. Retrospective study of women with singletons and gestational diabetes diagnosed during 2009 (n = 223) and 2012 (n = 237), at Maternidade Dr. Alfredo da Costa, Portugal. Analysis of clinical charts and assessment of demographic data, medical and obstetric history, weight gain during pregnancy, gestational age at diagnosis, treatment regimens, neonatal outcomes and postpartum screening results, followed by comparison of these variables between the years of 2009 and 2012. In 2012, there was an increased gestational diabetes prevalence, lower weight gain during pregnancy (p < 0.001), more frequent use of pharmacological therapy (p < 0.001) and more diagnosed cases during first and second trimester (p < 0.001). As for neonatal outcomes, in this group, the medium weight at birth was significantly lower (p = 0.001) with a decrease of newborns great for gestational age (p = 0.002). Postpartum screening rate was similar among both groups but in 2012 there was an increase of normal results and a decrease of impaired fasting glucose. Tighter criteria of the current screening test resulted in reduction of the majority of gestational diabetes complications but raised new questions. The introduction of the current screening test resulted in an increased prevalence, earlier diagnosis and reduction of macrosomia.

Comparison of the performance of screening test for gestational diabetes in singleton versus twin pregnancies.

ObjectiveWe compared the performance of the 50-g glucose challenge test (GCT) in singleton versus twin pregnancies and investigated the need for adjusting GCT cutoff values for gestational diabetes mellitus (GDM) in twin pregnancies among Korean women.MethodsA retrospective chart review was performed in women who underwent GCT at 24 to 28 weeks' gestation and delivered in our department between January 2000 and April 2008. GCT performance was compared between singleton and twin pregnancies for an ideal cutoff value of the GCT for GDM screening.ResultsGCT results were available in 3,578 pregnancies (3,435 singleton and 143 twin pregnancies). The mean GCT value was higher in the twin group than in the singleton group. Women in the twin group had a higher mean GCT value (P=0.043) and a higher incidence of GCT ≥130, ≥135, and ≥140 mg/dL (P=0.014, 0.005, and 0.015, respectively). The false positive rate for GCT ≥140 mg/dL was significantly higher in the twin than in the singleton group (P=0.042). The optimal GCT screening cutoff value appears to be ≥145 mg/dL in twin pregnancies.ConclusionOur study demonstrates that the GCT is associated with a higher false positive rate in twin rather than singleton pregnancies. This study suggests we should consider adjusting the GCT cutoff value for GDM in Korean twin pregnancies.

Late Preterm Infants' Outcome Born from Mothers with Positive Screening but Negative Diagnostic Test for Gestational Diabetes

Copyrightc 2015 by The Korean Society of Perinatology This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/license/by-nc/3.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided that the original work is properly cited. The Korean Journal of Perinatology · pISSN 1229-2605 eISSN 2289-0432 · e-kjp.org 대한주산의학회지 2015;26(3):200-207에 게재된 논문의 저자의 소속을 아래와 같이 수정합니다.