First Trimester Combined Test (FTCT) as a Predictor of Gestational Diabetes Mellitus

Abstract

Background—The first trimester combined test (FTCT) is an effective screening tool to estimate the risk of fetal aneuploidy. It is obtained by the combination of maternal age, ultrasound fetal nuchal translucency (NT) measurement, and the maternal serum markers free β-human chorionic gonadotropin (β-hCG) and pregnancy-associated plasma protein A (PAPP-A). However, conflicting data have been reported about the association of FTCT, β-hCG, or PAPP-A with the subsequent diagnosis of gestational diabetes mellitus (GDM). Research design and methods—2410 consecutive singleton pregnant women were retrospectively enrolled in Calabria, Southern Italy. All participants underwent examinations for FTCT at 11–13 weeks (plus 6 days) of gestation, and screening for GDM at 16–18 and/or 24–28 weeks of gestation, in accordance with current Italian guidelines and the International Association Diabetes Pregnancy Study Groups (IADPSG) glycemic cut-offs. Data were examined by univariate and logistic regression analyses. Results—1814 (75.3%) pregnant women were normal glucose tolerant, while 596 (24.7%) were diagnosed with GDM. Spearman univariate analysis demonstrated a correlation between FTCT values and subsequent GDM diagnosis (ρ = 0.048, p = 0.018). The logistic regression analysis showed that women with a FTCT <1:10000 had a major GDM risk (p = 0.016), similar to women with a PAPP-A <1 multiple of the expected normal median (MoM, p = 0.014). Conversely, women with β-hCG ≥2.0 MoM had a reduced risk of GDM (p = 0.014). Conclusions—Our findings indicate that GDM susceptibility increases with fetal aneuploidy risk, and that FTCT and its related maternal serum parameters can be used as early predictors of GDM.

Appropriate Timing of Gestational Diabetes Mellitus Diagnosis in Medium- and Low-Risk Women: Effectiveness of the Italian NHS Recommendations in Preventing Fetal Macrosomia

“…LR women underwent a 75 g OGTT under a laboratory fee schedule, as the NHS does not recommend screening for GDM in these cases [ 17 ]. Consistent with the high prevalence of GDM in Southern Italy [ 7 , 27 – 30 ], out of 769 pregnant women, 219 (28.5%) received a diagnosis of GDM. Among them, 98 (44.7%) were classified as HR, 97 (44.3%) as MR, and 24 (11.0%) as LR.…”

Associations between Human Chorionic Gonadotropin, Maternal Free Thyroxine, and Gestational Diabetes Mellitus

“…Previous studies have shown that mothers diagnosed with GDM have a lower hCG concentration in the first trimester (21)(22)(23). It has been suggested that higher hCG concentrations during this period may reduce the risk of GDM (24,25). However, not all studies to date have replicated this (26,27), potentially due to different ethnic composition of patient cohorts, relatively small study sizes, and/or heterogeneous diagnostic criteria for GDM.…”

Correlation between Oral Glucose Tolerance Test Abnormalities and Adverse Pregnancy Outcomes in Gestational Diabetes: A Cross-Sectional Study

“…While data on the Caucasian population showed a low prevalence of abnormal two-hour OGTT values (7–9%) [ 13 , 15 ], several studies demonstrated marked postprandial hyperglycemia in East Asians compared with matched Caucasian subjects [ 14 , 16 , 17 ]. Our cohort demonstrated similar findings in which the majority of our women had abnormal two-hour abnormality with a relatively low proportion of fasting hyperglycemia.…”