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The Diagnosis of Gestational Diabetes Mellitus Using a 75g Oral Glucose Tolerance Test: A Prospective Observational Study
22 Pages Posted: 31 Mar 2020More...
Background: Screening for Gestational Diabetes Mellitus (GDM) is controversial. This prospective study compared different sets of diagnostic cut-off points on plasma glucose measurements following a 75g Oral Glucose Tolerance Test (OGTT).
Methods: Women who had maternal risk factors for GDM were recruited at their convenience at their first prenatal visit and consented to a one-step OGTT at 26-28 weeks gestation. All women fulfilling the World Health Organization (WHO) 2013 diagnostic criteria received standard care for GDM.
Findings: Of the 202 women, 139 (69%) had one risk factor for GDM and 63 (31%) had >1. Using the WHO criteria, 53% (n=108) had GDM compared with 35% (n=71) using Canadian criteria and 18% (=36) using National Institute for Health Care Excellence criteria (NICE) criteria (both p<0·001). Of the 108 women, 50% (n=54) required pharmacological treatment to control hyperglycaemia. If the Canadian criteria were applied, 11/54 (20.4%) women would not have received hypoglycaemics. If the NICE criteria were applied, 36/54 (66.7%) women would not have received hypoglycaemics. Maternal insulin, HOMA-IR and C-peptide measured at the time of the OGTT showed evidence of increased insulin resistance in women who had GDM based on the WHO criteria but who had a normal OGTT based on the Canadian or NICE criteria.
Interpretation: Under stringent research conditions, the prevalence of GDM was higher using the WHO rather than the Canadian or NICE diagnostic criteria. Our findings also suggest that the Canadian and NICE criteria are not identifying women who may benefit from improved glycaemic control.
Funding Statement: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Declaration of Interests: The authors declare that they have no conflict of interest.
Ethics Approval Statement: The study was approved by the Hospital Research Ethics Committee (Study 14-2017).
Keywords: Gestational diabetes mellitus; Oral glucose tolerance test; glucose sample handling; insulin resistance
Suggested Citation: Suggested Citation