Controversies in Screening and Diagnostic Criteria for Gestational Diabetes in Early and Late Pregnancy

Huhn, Evelyn A.; Rossi, Simona W.; Hoesli, Irène; Göbl, Christian

doi:10.3389/fendo.2018.00696

Cited by 60 publications

(47 citation statements)

References 74 publications

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“…PAPP‐A2 might also be able to predict GD development in late pregnancy, although any such association would need to be further investigated in prospective studies. The increased risk of adverse outcomes associated with GD coupled with the frequently late diagnosis of the conditions has given rise to numerous studies focused on identifying early‐pregnancy biomarkers for GD . PAPP‐A2 levels in early pregnancy may also merit investigation as a potential pre‐screening biomarker to identify low‐risk women who can be spared from performing the OGTT.…”

Section: Discussionmentioning

confidence: 99%

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Pregnancy‐associated plasma protein‐A2 levels are increased in early‐pregnancy gestational diabetes: a novel biomarker for early risk estimation

et al. 2019

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Aim To determine whether pregnancy‐associated plasma protein‐A2 levels are increased in early pregnancies complicated by gestational diabetes and whether gestation age influences levels. The possible use of pregnancy‐associated plasma protein‐A2 as a pre‐screening biomarker to reduce the need for performing oral glucose tolerance tests in pregnant women was also investigated. Methods Pregnant women were diagnosed with gestational diabetes in early pregnancy after a 2‐hour 75 g oral glucose tolerance test in the catchment area of Skåne University Hospital, Lund, Sweden during 2011–2015 (n = 99). Age‐ and BMI‐matched pregnant women without diabetes were recruited at similar gestational ages from maternal healthcare centres in the same geographical area during 2014–2015 to act as controls (n = 100). Circulating pregnancy‐associated plasma protein‐A2 was analysed in participant serum using commercially available enzyme‐linked immunosorbent assay kits. Results Circulating pregnancy‐associated plasma protein‐A2 was increased in women diagnosed with gestational diabetes [13.5 (9.58–18.8) ng/ml] compared with controls [8.11 (5.74–11.3) ng/ml; P < 0.001]. Pregnancy‐associated plasma protein‐A2 was associated with gestational diabetes independent of age, BMI, C‐peptide and adiponectin (P < 0.001). Pregnancy‐associated plasma protein‐A2 as a pre‐screening biomarker to identify women at a decreased risk of gestational diabetes resulted in a negative predictive value of 99.7%, with a sensitivity of 96% and a specificity of 30% at a cut‐off level of 6 ng/ml. Conclusions This is the first study to show increased pregnancy‐associated plasma protein‐A2 levels in gestational diabetes. Pregnancy‐associated plasma protein‐A2 also shows promise as a pre‐screening biomarker with the potential to reduce the need for performing oral glucose tolerance tests in early pregnancy. Future prospective cohort studies in a larger group of both high‐ and low‐risk women are, however, needed to further confirm this observation.

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Section: Discussionmentioning

confidence: 99%

“…Conversely, some women without traditional risk factors might also suffer adverse perinatal outcomes due to undetected hyperglycaemia if no early OGTT is performed . Finding early‐pregnancy biomarkers to identify women at increased risk of GD could motivate earlier and more efficient interventions .…”

Section: Introductionmentioning

confidence: 99%

Pregnancy‐associated plasma protein‐A2 levels are increased in early‐pregnancy gestational diabetes: a novel biomarker for early risk estimation

et al. 2019

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“…Moreover, an increase in the maternal blood glucose and fetal growth pathway occurs before 24 weeks of gestation, which has not been diagnosed in GDM. Early diagnosis of pregnant women with GDM and timely treatment can reduce the short- and long-term complications associated with it [ 12 ]. Researchers are currently investigating various markers to diagnose GDM, including interleukin-6 (IL-6) [ 13 ].…”

Section: Introductionmentioning

confidence: 99%

Role of interleukin-6 (IL-6) in predicting gestational diabetes mellitus

2020

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Gestational diabetes mellitus (GDM) is the most common pregnancy-associated metabolic disorder that is steadily increasing worldwide. Early diagnosis of pregnant women susceptible to GDM is the first step for deploying effective preventive treatment to reduce maternal, fetal, and neonatal complications. The diagnostic process of GDM is still controversial and interleukin-6 (IL-6) is one of the most recent markers used for the diagnosis of GDM. In this study, we aimed to systematically review the role of IL-6 in the diagnosis of GDM. In this systematic review, Google Scholar, Scopus, PubMed, ISI Web of Science, ProQuest, and MEDLINE databases were searched using the following keywords: GDM, screening, and IL-6, with the time interval 2009–2020. The quality of articles was assessed using the Strengthening the Reporting of Observational Studies in Epidemiology checklist. Twenty-four articles with desired quality that met the inclusion criteria were selected and reviewed further. Sixteen studies showed a statistically significant association, while 8 studies did not report any relationship between IL-6 levels and GDM. Based on the results of these studies, assessing the serum IL-6 levels can be investigated a newly established diagnostic biomarker for GDM. Therefore, through early diagnosis of susceptible women, effective measures can be implemented to reduce its complications.

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“…First prenatal visit is considered the best time to screen for gestational diabetes by the majority of health organizations [1,8]. The aims of early screening are identifying women with overt diabetes and are mainly to diagnose women at low or high risk for gestational diabetes [9]. To obtain such diagnosis, fasting plasma glucose (FPG), random plasma glucose (RPG), and glucose glycosylated hemoglobin A1C (HbA1c) are the most commonly used approaches.…”

Section: Introductionmentioning

confidence: 99%

Temporary changes in clinical guidelines of gestational diabetes screening and management during COVID-19 outbreak: A narrative review

Nouhjah

Jahanfar

Shahbazian

2020

Diabetes & Metabolic Syndrome: Clinical Research & Revi

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Background and aims: New clinical approaches are needed to minimize complications of gestational diabetes during the COVID-19 outbreak with timely screening and proper management. The present study aims to highlight changes in the clinical guideline for gestational diabetes during the pandemic. Methods: In a narrative review, multiple databases were searched. Furthermore, online searches were conducted to identify guidelines or support documents provided by NGOs, local health authorities, and societies and organizations in the field of diabetes and obstetrics. Results: We included five national guidelines that were published in English from Canada, the United Kingdom, Australia, New Zealand, and Australia health agencies. FBG, A1C, RPG were recommended as alternative tests instead of a 2-h oral glucose tolerance test (OGGT) for GDM screening at 24e28 weeks of gestation. Recommendations also included a deferral of postpartum screening till the end of the pandemic, or postponement of testing to 6e12 months after delivery, use telemedicine and telecare. Conclusions: Updated temporary changes in clinical guidelines are sensible and accommodates social distancing and minimizes risk of exposure to COVID-19. Despite many unsolved controversies in screening, treatment, and follow-up of gestational diabetes, it seems involvement with novel coronavirus have made a reach to a global agreement simpler.

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Controversies in Screening and Diagnostic Criteria for Gestational Diabetes in Early and Late Pregnancy

Cited by 60 publications

References 74 publications

Pregnancy‐associated plasma protein‐A2 levels are increased in early‐pregnancy gestational diabetes: a novel biomarker for early risk estimation

Pregnancy‐associated plasma protein‐A2 levels are increased in early‐pregnancy gestational diabetes: a novel biomarker for early risk estimation

Role of interleukin-6 (IL-6) in predicting gestational diabetes mellitus

Temporary changes in clinical guidelines of gestational diabetes screening and management during COVID-19 outbreak: A narrative review

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