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Prediction of gestational diabetes mellitus in the first trimester, comparison of fasting plasma glucose, two-step and one-step methods: a prospective randomized controlled trial

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Abstract

Our aim was to evaluate and compare the diagnostic performance of three methods commonly used for GDM screening: fasting plasma glucose (FPG), two-step 50 g glucose challenge test (GCT), and 75 g glucose tolerance test (GTT) in a randomized study design to predict GDM in the first trimester and determine the best approach in predicting GDM. In a non-blind, parallel-group prospective randomized controlled study; 736 singleton pregnant women underwent FPG testing in the first trimester and randomly assigned to two groups; two-step 50 g GCT and 75 g GTT. GDM diagnosis was made according to Carpenter–Coustan or ADA (American Diabetes Association) criteria in two-step 50 g GCT and 75 g GTT groups, respectively. Subsequent testing was performed by two-step 50 g GCT at 24–28 weeks for screen negatives. After excluding the women who were lost to follow-up or withdrawn as a result of pregnancy loss, 486 pregnant women were recruited in the study. The FPG, two-step GCT, and one-step GTT methods identified GDM in 25/486 (5.1 %), 15/248 (6.0 %), and 27/238 (11.3 %) women, respectively. Area under ROC curves were 0.623, 0.708, and 0.792, respectively. Sensitivities were 47.17, 68.18, and 87.1 %, respectively. Specificities were 77.37, 100, and 100 %, respectively. Positive predictive values were 20.33, 100, and 100 %, respectively. Negative predictive values were 92.29, 97, and 98.1 %, respectively. Until superior screening alternatives become available, the 75 g GTT may be preferred for GDM screening in the first trimester.

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References

  1. American Diabetes A, Standards of medical care in diabetes–2013. Diabetes Care 36(Suppl 1), S11–S66 (2013). doi:10.2337/dc13-S011

    Article  Google Scholar 

  2. C.J. Nolan, Controversies in gestational diabetes. Best Pract. Res. Clin. Obstet. Gynaecol. 25(1), 37–49 (2011). doi:10.1016/j.bpobgyn.2010.10.004

    Article  PubMed  Google Scholar 

  3. D. Farrar, L. Duley, D.A Lawlor, Different strategies for diagnosing gestational diabetes to improve maternal and infant health. Cochrane Database Syst. Rev. 10, CD007122 (2011). doi:10.1002/14651858.CD007122.pub2

  4. Canadian Diabetes Association, Clinical practice guidelines for the prevention and management of diabetes in Canada. Can. J. Diabetes 32(suppl 1), 1–201 (2008)

    Google Scholar 

  5. ADA, Diagnosis and classification of diabetes mellitus. Diabetes Care 34(Suppl 1), S62–S69 (2011). doi:10.2337/dc11-S062

    Google Scholar 

  6. B.E. Metzger, S.G. Gabbe, B. Persson, T.A. Buchanan, P.A. Catalano, P. Damm, A.R. Dyer, A. Leiva, M. Hod, J.L. Kitzmiler, L.P. Lowe, H.D. McIntyre, J.J. Oats, Y. Omori, M.I. Schmidt, International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care 33(3), 676–682 (2010)

    Article  PubMed  Google Scholar 

  7. ACOG, Committee opinion no. 504: screening and diagnosis of gestational diabetes mellitus. Obstet. Gynecol. 118(3), 751–753 (2011). doi:10.1097/AOG.0b013e3182310cc3

    Article  Google Scholar 

  8. J.D. Walker, NICE guidance on diabetes in pregnancy: management of diabetes and its complications from preconception to the postnatal period. NICE clinical guideline 63. London, March 2008. Diabet. Med. 25(9), 1025–1027 (2008). doi:10.1111/j.1464-5491.2008.02532.x

    Article  CAS  PubMed  Google Scholar 

  9. ACOG, Practice bulletin gestational diabetes. Number 30, September 2001. Obstet. Gynecol. 98(3), 525–538 (2001)

    Google Scholar 

  10. K.G. Alberti, P.Z. Zimmet, Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation. Diabet. Med. 15(7), 539–553 (1998). doi:10.1002/(SICI)1096-9136(199807)15:7<539:AID-DIA668>3.0.CO;2-S

    Article  CAS  PubMed  Google Scholar 

  11. J. Tieu, P. Middleton, A.J. McPhee, C.A. Crowther, Screening and subsequent management for gestational diabetes for improving maternal and infant health. Cochrane. Database Syst. Rev. 7, CD007222 (2010). doi:10.1002/14651858.CD007222.pub2

  12. D.R. Coustan, Point: the American Diabetes Association and the International Association of Diabetes and Pregnancy study groups recommendations for diagnosing gestational diabetes should be used worldwide. Clin. Chem. 58(7), 1094–1097 (2012). doi:10.1373/clinchem.2012.186239

    Article  CAS  PubMed  Google Scholar 

  13. M. van Leeuwen, M.D. Louwerse, B.C. Opmeer, J. Limpens, M.J. Serlie, J.B. Reitsma, B.W. Mol, Glucose challenge test for detecting gestational diabetes mellitus: a systematic review. BJOG 119(4), 393–401 (2012). doi:10.1111/j.1471-0528.2011.03254.x

    Article  PubMed  Google Scholar 

  14. W. Plasencia, R. Garcia, S. Pereira, R. Akolekar, K.H. Nicolaides, Criteria for screening and diagnosis of gestational diabetes mellitus in the first trimester of pregnancy. Fetal Diagn. Ther. 30(2), 108–115 (2011). doi:10.1159/000324684

    Article  PubMed  Google Scholar 

  15. D.A. Sacks, W. Chen, G. Wolde-Tsadik, T.A. Buchanan, Fasting plasma glucose test at the first prenatal visit as a screen for gestational diabetes. Obstet. Gynecol. 101(6), 1197–1203 (2003)

    Article  PubMed  Google Scholar 

  16. S. Riskin-Mashiah, A. Damti, G. Younes, R. Auslender, First trimester fasting hyperglycemia as a predictor for the development of gestational diabetes mellitus. Eur. J. Obstet. Gynecol. Reprod. Biol. 152(2), 163–167 (2010). doi:10.1016/j.ejogrb.2010.05.036

    Article  CAS  PubMed  Google Scholar 

  17. K.F. Schulz, D.G. Altman, D. Moher, C. Group, CONSORT 2010 statement: updated guidelines for reporting parallel group randomized trials. Obstet. Gynecol. 115(5), 1063–1070 (2010). doi:10.1097/AOG.0b013e3181d9d421

    Article  PubMed  Google Scholar 

  18. D.G. Altman, J.M. Bland, How to randomise. BMJ 319(7211), 703–704 (1999)

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  19. M.W. Carpenter, D.R. Coustan, Criteria for screening tests for gestational diabetes. Am. J. Obstet. Gynecol. 144(7), 768–773 (1982)

    CAS  PubMed  Google Scholar 

  20. J.P. Vandorsten, W.C. Dodson, M.A. Espeland, W.A. Grobman, J.M. Guise, B.M. Mercer, H.L. Minkoff, B. Poindexter, L.A. Prosser, G.F. Sawaya, J.R. Scott, R.M. Silver, L. Smith, A. Thomas, A.T. Tita, NIH consensus development conference: diagnosing Gestational diabetes mellitus. NIH consens state Sci Statements 29(1), 1–31 (2013)

    PubMed  Google Scholar 

  21. C. Erem, N. Cihanyurdu, O. Deger, C. Karahan, G. Can, M. Telatar, Screening for gestational diabetes mellitus in northeastern Turkey (Trabzon City). Eur. J. Epidemiol. 18(1), 39–43 (2003)

    Article  PubMed  Google Scholar 

  22. D. Karcaaltincaba, O. Kandemir, S. Yalvac, S. Guvendag-Guven, A. Haberal, Prevalence of gestational diabetes mellitus and gestational impaired glucose tolerance in pregnant women evaluated by National Diabetes Data Group and Carpenter and Coustan criteria. Int. J. Gynaecol. Obstet. 106(3), 246–249 (2009). doi:10.1016/j.ijgo.2009.04.004

    Article  PubMed  Google Scholar 

  23. F. Faul, E. Erdfelder, A.G. Lang, A. Buchner, G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav. Res. Methods 39(2), 175–191 (2007)

    Article  PubMed  Google Scholar 

  24. G.G. Nahum, B.J. Huffaker, Correlation between first- and early third-trimester glucose screening test results. Obstet. Gynecol. 76(4), 709–713 (1990)

    CAS  PubMed  Google Scholar 

  25. S.M. Bhattacharya, Glucose screening test results in first and early third trimester of pregnancy: is there any correlation? J. Obstet. Gynaecol. Res. 28(6), 304–307 (2002)

    Article  PubMed  Google Scholar 

  26. S.J. Meltzer, J. Snyder, J.R. Penrod, M. Nudi, L. Morin, Gestational diabetes mellitus screening and diagnosis: a prospective randomised controlled trial comparing costs of one-step and two-step methods. BJOG 117(4), 407–415 (2010). doi:10.1111/j.1471-0528.2009.02475.x

    Article  CAS  PubMed  Google Scholar 

  27. D.A. Scott, E. Loveman, L. McIntyre, N. Waugh, Screening for gestational diabetes: a systematic review and economic evaluation. Health Technol. Assess. 6(11), 1–161 (2002)

    CAS  PubMed  Google Scholar 

  28. M.M. Agarwal, G.S. Dhatt, J. Punnose, G. Koster, Gestational diabetes in a high-risk population: using the fasting plasma glucose to simplify the diagnostic algorithm. Eur. J. Obstet. Gynecol. Reprod. Biol. 120(1), 39–44 (2005). doi:10.1016/j.ejogrb.2004.07.034

    Article  CAS  PubMed  Google Scholar 

  29. T. Bito, T. Nyari, L. Kovacs, A. Pal, Oral glucose tolerance testing at gestational weeks ≤16 could predict or exclude subsequent gestational diabetes mellitus during the current pregnancy in high risk group. Eur. J. Obstet. Gynecol. Reprod. Biol. 121(1), 51–55 (2005). doi:10.1016/j.ejogrb.2004.11.006

    Article  CAS  PubMed  Google Scholar 

  30. D.M. Jensen, L. Molsted-Pedersen, H. Beck-Nielsen, J.G. Westergaard, P. Ovesen, P. Damm, Screening for gestational diabetes mellitus by a model based on risk indicators: a prospective study. Am. J. Obstet. Gynecol. 189(5), 1383–1388 (2003)

    Article  PubMed  Google Scholar 

  31. D.R. Danilenko-Dixon, J.T. Van Winter, R.L. Nelson, P.L. Ogburn Jr, Universal versus selective gestational diabetes screening: application of 1997 American Diabetes Association recommendations. Am. J. Obstet. Gynecol. 181(4), 798–802 (1999)

    Article  CAS  PubMed  Google Scholar 

  32. I. Satman, T. Yilmaz, A. Sengul, S. Salman, F. Salman, S. Uygur, I. Bastar, Y. Tutuncu, M. Sargin, N. Dinccag, K. Karsidag, S. Kalaca, C. Ozcan, H. King, Population-based study of diabetes and risk characteristics in Turkey: results of the Turkish diabetes epidemiology study (TURDEP). Diabetes Care 25(9), 1551–1556 (2002)

    Article  PubMed  Google Scholar 

  33. I. Satman, B. Omer, Y. Tutuncu, S. Kalaca, S. Gedik, N. Dinccag, K. Karsidag, S. Genc, A. Telci, B. Canbaz, F. Turker, T. Yilmaz, B. Cakir, J. Tuomilehto, T.-I.S. Group, Twelve-year trends in the prevalence and risk factors of diabetes and prediabetes in Turkish adults. Eur. J. Epidemiol. 28(2), 169–180 (2013). doi:10.1007/s10654-013-9771-5

    Article  PubMed Central  PubMed  Google Scholar 

  34. T. Siegmund, N.T. Rad, C. Ritterath, G. Siebert, W. Henrich, K.J. Buhling, Longitudinal changes in the continuous glucose profile measured by the CGMS in healthy pregnant women and determination of cut-off values. Eur. J. Obstet. Gynecol. Reprod. Biol. 139(1), 46–52 (2008). doi:10.1016/j.ejogrb.2007.12.006

    Article  PubMed  Google Scholar 

  35. M.M. Agarwal, G.S. Dhatt, Fasting plasma glucose as a screening test for gestational diabetes mellitus. Arch. Gynecol. Obstet. 275(2), 81–87 (2007). doi:10.1007/s00404-006-0245-9

    Article  PubMed  Google Scholar 

  36. W.W. Zhu, H.X. Yang, Y.M. Wei, J. Yan, Z.L. Wang, X.L. Li, H.R. Wu, N. Li, M.H. Zhang, X.H. Liu, H. Zhang, Y.H. Wang, J.M. Niu, Y.J. Gan, L.R. Zhong, Y.F. Wang, A. Kapur, Evaluation of the value of fasting plasma glucose in the first prenatal visit to diagnose gestational diabetes mellitus in china. Diabetes Care 36(3), 586–590 (2013). doi:10.2337/dc12-1157

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  37. A. Lapolla, M.G. Dalfra, E. Ragazzi, A.P. De Cata, D. Fedele, New International Association of the Diabetes and Pregnancy Study Groups (IADPSG) recommendations for diagnosing gestational diabetes compared with former criteria: a retrospective study on pregnancy outcome. Diabet. Med. 28(9), 1074–1077 (2011). doi:10.1111/j.1464-5491.2011.03351.x

    Article  CAS  PubMed  Google Scholar 

  38. S. Riskin-Mashiah, G. Younes, A. Damti, R. Auslender, First-trimester fasting hyperglycemia and adverse pregnancy outcomes. Diabetes Care 32(9), 1639–1643 (2009). doi:10.2337/dc09-0688

    Article  PubMed Central  PubMed  Google Scholar 

  39. T. Higgins, HbA1c for screening and diagnosis of diabetes mellitus. Endocrine 43(2), 266–273 (2013). doi:10.1007/s12020-012-9768-y

    Article  CAS  PubMed  Google Scholar 

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Acknowledgments

This paper is selected as a poster presentation in the SMFM 33rd Annual Meeting; February 11–16, 2013; San Francisco, USA.

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The authors report no conflicts of interest.

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  1. Department of Perinatology, Zekai Tahir Burak Women Health Care Education and Research Hospital, Ankara, Turkey

    M. Ilkin Yeral, A. Seval Ozgu-Erdinc, Dilek Uygur, K. Doga Seckin, M. Fatih Karsli & A. Nuri Danisman

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  1. M. Ilkin Yeral
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Correspondence to A. Seval Ozgu-Erdinc.

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Yeral, M.I., Ozgu-Erdinc, A.S., Uygur, D. et al. Prediction of gestational diabetes mellitus in the first trimester, comparison of fasting plasma glucose, two-step and one-step methods: a prospective randomized controlled trial. Endocrine 46, 512–518 (2014). https://doi.org/10.1007/s12020-013-0111-z

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