Screening criteria for high-risk gestational diabetic patients

O’Sullivan, John B.; Mahan, Clare M.; Charles, David; Dandrow, Robert V.

doi:10.1016/s0002-9378(16)33833-9

Cited by 430 publications

(223 citation statements)

References 6 publications

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“…Carpenter & Coustan (9) found that the screening test sensitivity at this threshold is closer to unity, that is, the proportion of gravid women with GDM missed by the screening test is reduced to nearly zero. O'Sullivan et al (10) reported the prevalence of GDM among pregnant women with screening test (plasma) values below 7.9 mmol/l to be 0.7%. It is reasonable to assume that the prevalence is substantially smaller below 7.5 mmol/l.…”

Section: Methodsmentioning

confidence: 99%

Risk factors for fetal macrosomia: the importance of a positive oral glucose challenge test

Mello¹,

Parretti²,

Mecacci³

et al. 1997

European Journal of Endocrinology

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Objective: The aim of this study was to investigate whether minor abnormalities of glucose metabolism without gestational diabetes are a risk factor for fetal overgrowth. Design: A sample of 1883 unselected white mother-infant pairs were screened for gestational diabetes using a 50 g 1-h oral glucose challenge test (GCT) in two periods of pregnancy: early (16-20 weeks) and late (26-30 weeks). Methods: The effects of risk factors (glucose metabolism, previous history of mothers, obesity, multiparity and age of mothers) were estimated using a multinomial logit model. Results: The level of risk was related to gestational age at the appearance of an abnormal GCT. Patients with an abnormal GCT in the early and late periods of pregnancy (Group 1) had a risk of delivering a large for gestational age (LGA) infant seven times higher than the control group (normal GCT in both periods), and patients with a normal GCT in the early period and an abnormal GCT in the late period (Group 2) showed a risk three times higher than the control group. Among the historical risk factors for LGA infants, such as maternal obesity, multiparity, previous gestational diabetes and previous delivery of an infant weighing 4000 g or more, only the latter was associated with fetal overgrowth with a risk level 4.7 higher than the control group. Group 1 patients had a significantly higher incidence of pregnancy-induced hypertension and preterm birth. There were no differences in the frequency of 5-min Apgar score <7 and metabolic complications among the infants of all groups. We found a significantly higher rate of shoulder dystocia in Group 1 infants than in infants in the other groups. Conclusions: Our results suggest that a positive GCT at 26-30 weeks is the most important risk factor for fetal overgrowth. This result was strongly enforced in patients who had also shown a positive early GCT at 16-20 weeks.

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Section: Methodsmentioning

confidence: 99%

Risk factors for fetal macrosomia: the importance of a positive oral glucose challenge test

Mello¹,

Parretti²,

Mecacci³

et al. 1997

European Journal of Endocrinology

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“…[23][24][25] Screening for GDM The concept of screening for GDM in pregnant women using an oral glucose load was first introduced by O'Sullivan and Mahan in 1973. 26,27 Although the original goal was to identify a subset of pregnant women at increased risk for developing type 2 diabetes later in life, it was observed that gestational diabetes may be associated with perinatal mortality. 28 Currently, the American College of Obstetricians and Gynecologists (ACOG) recommends that all pregnant women should be screened for GDM, either by clinical history or by laboratory testing.…”

Section: Gestational Diabetes Mellitusmentioning

confidence: 99%

Gestational diabetes: diagnosis and management

Cheng

Caughey

2008

J Perinatol

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Purpose: To review the diagnosis and management of gestational diabetes.Epidemiology: In the United States, approximately 2 to 5% of all pregnant women have gestational diabetes. Those women with a family history of type 2 diabetes mellitus, Asian or native American race, Latina ethnicity or obesity are at higher risk for developing gestational diabetes. Conclusion:Women with gestational diabetes who are treated appropriately can achieve good outcomes in the majority of pregnancies. Frequent blood glucose monitoring, nutrition counseling and frequent physician contact allow for individualized care to achieve optimal outcomes. Such treatment includes diet, exercise and insulin. The use of oral hypoglycemic agents is controversial and there is some concern about worse maternal and neonatal outcomes as compared to treatment with insulin. Evolving technologies promise to provide more therapeutic options.

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“…5 O teste oral de tolerância à glicose simplificado com sobrecarga de 50g (TTG50g), independente do estado alimentar da gestante, consiste na dosagem da glicemia plasmática uma hora após sobrecarga oral de 50g de glicose. É o teste de rastreamento mais utilizado no mundo, provavelmente pela alta correlação com o teste de tolerância à glicose com sobrecarga de 100g (TTG100g), 6 pela capacidade de predizer o desenvolvimento do diabete melito futuro 7 e a recorrência de diabete gestacional. 8 O'Sullivan et al, 6 recomendam sua realização em todas as gestantes, entre a 24ª e a 28ª semanas e, consideram 140mg/dL como ponto de corte.…”

Section: Introductionunclassified

“…É o teste de rastreamento mais utilizado no mundo, provavelmente pela alta correlação com o teste de tolerância à glicose com sobrecarga de 100g (TTG100g), 6 pela capacidade de predizer o desenvolvimento do diabete melito futuro 7 e a recorrência de diabete gestacional. 8 O'Sullivan et al, 6 recomendam sua realização em todas as gestantes, entre a 24ª e a 28ª semanas e, consideram 140mg/dL como ponto de corte. Considerando esse limite, os autores encontraram sensibilidade de 78% e especificidade de 87% em relação ao TTG100g.…”

Section: Introductionunclassified

“…A glicemia de jejum isolada, igual ou superior a 90mg/dl foi encontrada em 22,0% dos casos e, o TTG50g igual ou superior a 140mg/dl, em 17,5% das gestantes. Se, além do TTG50g, o fator de risco, já corrigido, fosse incluído no critério proposto por O'Sullivan et al, 6 os métodos de rastreamento seriam equivalentes, indicando a mesma proporção de gestantes para a confirmação diagnóstica. Entretanto, não se sabe se o TTG50g e a glicemia de jejum estavam alterados nas mesmas gestantes e, também, se os resultados seriam semelhantes mesmo nas gestantes sem fator de risco e com glicemia de jejum menor que 90mg/dl.…”

Section: Introductionunclassified

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