Alternative methods of diagnosing gestational diabetes mellitus☆,☆☆
Section snippets
Material and methods
We identified from computer files the cohort of all pregnant women who had a 3-hour GTT performed at Brigham and Women’s Hospital between January 1995 and December 1996. This study group was “preselected”; all had undergone a screening glucose loading test in which the measured plasma glucose concentration was ≥140 mg/dL. During this period the hospital practiced universal screening, as recommended by the American Diabetic Association at that time.
A positive GTT result was defined as ≥2 values
Results
We reviewed the data for all 512 women who underwent GTTs during the study period. The population characteristics are shown in Table I, demonstrating that our study group consisted predominantly of women who were nulliparous, white, and ≥30 years old.
Empty Cell % Age at time of GTT <25 y 11 25-29 y 20 30-34 y 35 ≥35 y 34 Race Asian 11 Black 8 Hispanic 19 White 54 Other 4 Unknown 4 Parity Nulliparous 43 Primiparous 22 Multiparous 31 Unknown 4
Comment
The screening and diagnostic algorithm for gestational diabetes first set forth by O’Sullivan and Mahan4 is resource intensive, time-consuming, and inconvenient for a patient. In our preselected population of 512 women who underwent GTTs, we found that omission of the 3-hour value for the GTT would result in failure to diagnose 13% of the cases of gestational diabetes mellitus. In addition, there was no glucose loading test value above which the GTT result was consistently positive. In
Acknowledgements
We thank Michael Greene, MD, for helpful discussions on past and present practice guidelines. We also thank Micheline Chu, MD, for her assistance with data collection.
References (8)
- et al.
Management and outcome of class A diabetes mellitus
Am J Obstet Gynecol
(1977) Clinical practice recommendations 1999
Diabetes Care
(1999)Follow-up studies in women with gestational diabetes mellitus: the experience at Los Angeles County/University of Southern California Medical Center
Diabetes and pregnancy
(1994)
Cited by (46)
Endocrine Diseases of Pregnancy
2019, Yen & Jaffe's Reproductive Endocrinology: Physiology, Pathophysiology, and Clinical Management: Eighth EditionMarkedly different rates of incident insulin treatment based on universal gestational diabetes mellitus screening in a diverse HMO population
2013, American Journal of Obstetrics and GynecologyCitation Excerpt :There has been much research and debate since on the proper GCT lower cutoff to define as normal (with no further testing). However, only a few studies since have evaluated the issue of whether a high GCT could be diagnostic for GDM without further testing, with most using OGTT performance, not clinical outcomes, as the reference.18,19,25-27 Landy et al18 evaluated 514 women with GCT >140 mg/dL who had OGTT (312 with normal OGTT and 202 with GDM) and identified an optimal diagnostic cutpoint of GCT >186 mg/dL, chosen based on high specificity (95.9%) and low false-positive rate (4.1%) for GDM diagnosis, that was also associated with a significantly greater proportion of large-for-gestational-age infants compared to women with GCT 140-185 mg/dL.
Endocrine Diseases of Pregnancy
2013, Yen and Jaffe's Reproductive Endocrinology: Seventh EditionMethods for the screening and diagnosis of gestational diabetes mellitus between 24 and 28 weeks of pregnancy
2010, Diabetes and MetabolismMethods of screening of gestational diabetes between 24 and 28 weeks'gestation
2010, Journal de Gynecologie Obstetrique et Biologie de la ReproductionEndocrine diseases of pregnancy
2009, Yen & Jaffe's Reproductive Endocrinology: Expert Consult - Online and Print
- ☆
Reprint requests: Lorraine Atilano, MD, 547 School St, Belmont, MA 02478.
- ☆☆
0002-9378/99 $8.00 + 06/6/102803