Comparison between 100-g glucose tolerance test and two other screening tests for gestational diabetes: combined fasting glucose with risk factors and 50-g glucose tolerance test

BackgroundThe best strategy to identify women with gestational diabetes mellitus (GDM) is unclear.Objectives To perform a systematic review to calculate summary estimates of the sensitivity and specificity of the 50-g glucose challenge test for GDM.Search strategy Systematic search of MEDLINE, EMBASE and Web of Science.Selection criteria Articles that compared the 50-g glucose challenge test with the oral glucose tolerance test (OGTT, with a 75-or 100-g reference standard) before 32 weeks of gestation.Data collection and analysis Summary estimates of sensitivity and specificity, with 95% confidence intervals and summary receiver operating characteristic curves, were calculated using bivariate random-effects models. Two reviewers independently selected articles that compared the 50 g glucose challenge test to the oral glucose tolerance test (OGTT, 75 or 100 gram, reference standard) before 32 weeks of gestation.Main results Twenty-six studies were included (13 564 women). Studies that included women with risk factors showed a pooled sensitivity of the 50-g glucose challenge test of 0.74 (95% CI 0.62-0.87), a pooled specificity of 0.77 (95% CI 0.66-0.89) (threshold value of 7.8 mmol/l), a derived positive likelihood ratio (LR) of 3.2 (95% CI 2.0-5.2) and a negative LR of 0.34 (95% CI 0.22-0.53). In studies with consecutive recruitment, the pooled sensitivity was 0.74 (95% CI 0.62-0.87) for a specificity of 0.85 (95% CI 0.80-0.91), with a derived positive LR of 4.9 (95% CI 3.5-7.0) and negative LR of 0.31 (95% CI 0.20-0.47). Increasing the threshold for disease (OGTT result) increased the sensitivity of the challenge test, and decreased the specificity.Author's conclusions The 50-g glucose challenge test is acceptable to screen for GDM, but cannot replace the OGTT. Further possibilities of combining the 50-g glucose challenge test with other screening strategies should be explored.

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“…Our search resulted in 745 hits. We included 26 studies, comprising 13 564 women, of whom 1027 (7.5%) had GDM 17–42 …”

Section: Resultsmentioning

confidence: 99%

Glucose challenge test for detecting gestational diabetes mellitus: a systematic review

Leeuwen

Louwerse

Opmeer

et al. 2012

BJOG

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“…NPV depend on the test's sensitivity and specificity as well as the prevalence of the disease and may improve the predictive value of Sens/Sp balance 33,34 . The risk factors…”

Section: Resultsmentioning

confidence: 99%

“…The positive likelihood ratio (PLR) shows the best test to use for ruling in a disease while the negative likelihood ratio indicates the test to be used to rule it out. However, this strategy should only be used if the consequences from a false-positive test are the same as the consequences from a false-negative test 32,34 . In the case of GDM-MGH, not identifying the women at risk prevents them from being diagnosed and treated, and this might cause serious short-and long-term harm to the mother and her offspring [38][39][40][41] .…”

Section: Resultsmentioning

confidence: 99%

“…The performance of risk predictors was evaluated in terms of sensitivity (Sens), specificity (Sp), positive and negative predictive values (PPV and NPV, respectively), accuracy, and positive and negative likelihood ratios (PLR and NLR, respectively) with their odds ratio (OR) and 95% CI. Performance analysis also included the assessment of falsepositive results, defined by the formula 1-Sp 16,17,33,34 .…”

Section: Discussionmentioning

confidence: 99%

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Risk Factors for the Prediction of Hyperglycemia during Pregnancy – A Cohort Study from a Brazilian Public Primary Care Center

Vernini¹,

Cassetari²,

Arantes³

et al. 2020

Preprint

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BACKGROUND – In Brazil, the prevalence of maternal hyperglycemia is among the highest, costs are elevated and there is no evidence to recommend universal screening. OBJECTIVE – To evaluate the performance of risk factors (RF) for predicting hyperglycemia in pregnancy – Mild Gestational Hyperglycemia (MGH) or gestational Diabetes Mellitus (GDM) in public primary-care centers in Brazil. METHODS – A cohort study, including 514 women with a single pregnancy and no hyperglycemia. Study participants were evaluated at GA (gestational age) < or ≥ 20 weeks, and underwent a 75g-OGTT along with glycemic profile (GP) testing between 24 and 28 weeks. Clinical, anthropometric and laboratory data – fasting glucose (FG), glycated hemoglobin (HbA1c), basal insulin and lipid profile were obtained. The most common RF associations (OR and 95% CI and p <0.05) and different cut-off points were tested for the prediction of MGH-GDM. Predictive performance was assessed by Sensitivity/Specificity, negative predictive value NPV (negative predictive value) and false positive rates (FP; 1-Esp). RESULTS – At GA <20 weeks, age ≥25 years, WC (Waist circumference) ≥ 88 cm, BMI pre ≥25 kg/m 2 (pre gestational body mass index) and BMI gest ≥25 kg/m 2 (gestational body mass index ); at GA (gestational age) ≥20 weeks, age ≥25 years, BMI pre ≥25 kg/m 2 and TG (triglicerides) ≥150 mg/dL showed better performace for predicting MGH-GDM. Irrespective of gestational age, FG (Fasting glucose) ≥ 85 mg/dL, HbA1c ≥5.7% and HOMA-IR ≥2.71 were good predictors to rule out the risk of these complications. CONCLUSION – The results of this study should contribute to define the best diagnostic approach to MGH-GDM in our center and in others with similar characteristics.

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“…Women with abnormal GTT plus abnormal GP, as well as those with pregestational diabetes were hospitalized for one day (24 hours) on a fortnight basis until 28 weeks of gestation, and on a weekly basis from week 28 until delivery, and were treated with diet plus insulin therapy for blood glucose control. 2,18 Thus, there were studied two groups: diabetic inpatients and diabetic outpatients.…”

Section: Methodsmentioning

confidence: 99%

Care cost for pregnant and parturient women with diabetes and mild hyperglycemia

Cavassini

Lima

Calderon³

et al. 2012

Rev. Saúde Pública

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OBJECTIVE:To compare inpatient and outpatient care costs for pregnant/ parturient women with diabetes and mild hyperglycemia. METHODS:A prospective observational quantitative study was conducted in the Perinatal Diabetes Center in the city of Botucatu, Southeastern Brazil, between 2007 and2008. Direct and indirect costs and disease-specifi c costs (medications and tests) were estimated. Thirty diet-treated pregnant women with diabetes were followed up on an outpatient basis, and 20 who required insulin therapy were hospitalized. RESULTS:The cost of diabetes disease (prenatal and delivery care) was US$ 3,311.84 for inpatients and US$ 1,366.04 for outpatients. CONCLUSIONS:Direct and indirect costs as well as total prenatal care cost were higher for diabetic inpatients while delivery care costs and deliverypostpartum hospitalization were similar. Prenatal and delivery-postpartum care costs were higher for these patients compared to those paid by Brazilian National Health System. Pregnancies complicated by diabetes are associated with an increased risk of maternal and neonatal complications. The most serious maternal complication is the risk of developing type 2 diabetes within 10-12 years after birth. 21 Perinatal complications include macrosomia and increased risk of birth trauma and intrapartum hypoxia/ asphyxia, high C-section rates, delayed pulmonary maturation and consequent risk of respiratory distress syndrome, and metabolic disorders at birth including hypoglycemia, hypocalcemia and hypomagnesemia. 19All these conditions worsen neonatal prognosis and increase perinatal mortality. In addition, Rudge et al 17 demonstrated that pregnant women with mild hyperglycemia (normal 100-g glucose tolerance test [GTT] and abnormal blood glucose profi le) have perinatal outcomes comparable to those of diabetic women and should be treated following the same protocol.Perinatal outcomes with either diabetes or mild hyperglycemia are directly associated to maternal metabolic control. Maternal hyperglycemia should be carefully controlled with either diet alone or diet plus insulin therapy so that effective blood glucose normalization can be achieved and adverse perinatal outcomes prevented. Newborns of pregnant women with inadequate blood glucose control (mean blood glucose >130 mg/dL in the third trimester) are reported to show macrosomia in 52.4%, fetal death in 14.3%, and malformations in 8.2%. Over the past decades, improved maternal and perinatal outcomes of diabetic RESUMO OBJETIVO: Comparar custos de hospitalização e de atenção ambulatorial em gestantes/parturientes diabéticas e com hiperglicemia leve. MÉTODOS:Estudo observacional, prospectivo, quantitativo descritivo realizado em centro de diabete perinatal em Botucatu, SP, entre 2007 e 2008. Foram estimados os custos por absorção diretos e indiretos disponíveis na instituição e os custos específi cos para a doença (medicamentos e exames). As 30 gestantes diabéticas tratadas com dieta foram acompanhadas em ambulatório e 20 tratadas com dieta mais insulina ...

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Comparison between 100-g glucose tolerance test and two other screening tests for gestational diabetes: combined fasting glucose with risk factors and 50-g glucose tolerance test

Cited by 13 publications

References 10 publications

Glucose challenge test for detecting gestational diabetes mellitus: a systematic review

Glucose challenge test for detecting gestational diabetes mellitus: a systematic review

Risk Factors for the Prediction of Hyperglycemia during Pregnancy – A Cohort Study from a Brazilian Public Primary Care Center

Care cost for pregnant and parturient women with diabetes and mild hyperglycemia

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