Objective To develop a clinical prediction rule that can help the clinician to identify women at high and low risk for gestational diabetes mellitus (GDM) early in pregnancy in order to improve the efficiency of GDM screening.Design We used data from a prospective cohort study to develop the clinical prediction rule.Setting The original cohort study was conducted in a university hospital in the Netherlands.Population Nine hundred and ninety-five consecutive pregnant women underwent screening for GDM.Methods Using multiple logistic regression analysis, we constructed a model to estimate the probability of development of GDM from the medical history and patient characteristics. Receiver operating characteristics analysis and calibration were used to assess the accuracy of the model.Main outcome measure The development of a clinical prediction rule for GDM. We also evaluated the potential of the prediction rule to improve the efficiency of GDM screening.Results The probability of the development of GDM could be predicted from the ethnicity, family history, history of GDM and body mass index. The model had an area under the receiver operating characteristic curve of 0.77 (95% CI 0.69-0.85) and calibration was good (Hosmer and Lemeshow test statistic, P = 0.25). If an oral glucose tolerance test was performed in all women with a predicted probability of 2% or more, 43% of all women would be tested and 75% of the women with GDM would be identified.Conclusions The use of a clinical prediction model is an accurate method to identify women at increased risk for GDM, and could be used to select women for additional testing for GDM.

OBJECTIVE -To compare the accuracy measures of the random glucose test and the 50-g glucose challenge test as screening tests for gestational diabetes mellitus (GDM).RESEARCH DESIGN AND METHODS -In this prospective cohort study, pregnant women without preexisting diabetes in two perinatal centers in the Netherlands underwent a random glucose test and a 50-g glucose challenge test between 24 and 28 weeks of gestation. If one of the screening tests exceeded predefined threshold values, the 75-g oral glucose tolerance test (OGTT) was performed within 1 week. Furthermore, the OGTT was performed in a random sample of women in whom both screening tests were normal. GDM was considered present when the OGTT (reference test) exceeded predefined threshold values. Receiver operating characteristic (ROC) analysis was used to evaluate the performance of the two screening tests. The results were corrected for verification bias.RESULTS -We included 1,301 women. The OGTT was performed in 322 women. After correction for verification bias, the random glucose test showed an area under the ROC curve of 0.69 (95% CI 0.61-0.78), whereas the glucose challenge test had an area under the curve of 0.88 (0.83-0.93). There was a significant difference in area under the curve of the two tests of 0.19 (0.11-0.27) in favor of the 50-g glucose challenge test.CONCLUSIONS -In screening for GDM, the 50-g glucose challenge test is more useful than the random glucose test. Diabetes Care 30:2779-2784, 2007G estational diabetes mellitus (GDM) is estimated to occur in 2-9% of all pregnancies (1-5). It is defined as carbohydrate intolerance with onset or first recognition during pregnancy and is associated with increased rates of adverse pregnancy outcomes, such as macrosomia; shoulder dystocia; birth-related trauma, such as fractures and nerve palsies; neonatal hypoglycemia; and jaundice. In addition, women with GDM are at substantially higher risk to develop diabetes in later life (1,6 -8). Results from a randomized controlled trial show that treatment of GDM by means of dietary advice, blood glucose monitoring, and insulin therapy, if required, reduces the rate of serious perinatal complications without increasing the rate of caesarean delivery (1). Based on these results, identification through screening and subsequent treatment of women with GDM appears beneficial. However, consensus on the optimal policy for screening is lacking. The American Diabetes Association recommends screening based on risk factors for GDM (age Ͼ25 years, obese, close relative with diabetes, history of GDM or a previous macrosomic infant, or specific ethnicity) followed by the 50-g 1-h oral glucose challenge test as a screening test (9 -11). Other methods of screening that are regularly used are (repeated) random glucose testing and fasting glucose measurement. It is indefinite which test is the most accurate in testing women for GDM.The diversity in screening methods may result in unidentified cases of GDM and preventable neonatal and maternal morbidity. Establishment of ...

Mutations of the tumor necrosis factor receptor 1 (TNFRSF1A) gene underly susceptibility to a subset of autosomal dominant recurrent fevers (ADRFs). We report on a two-generation six-member Dutch family in which a novel R92P mutation and reduced plasma TNFRSF1A levels were found in all the children, including two who are unaffected. However, only the daughter proband and father exhibited a typical TNF-receptor associated periodic syndrome (TRAPS) phenotype. PCR-RFLP analysis revealed that the mutation was not present in 120 control chromosomes from unaffected Dutch individuals. As this R92P mutation is present in two unaffected carriers it appears to be less penetrant than previously reported TNFRSF1A mutations involving cysteine residues in the extracellular domains.

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