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Objectives To determine the optimal glucose challenge test (GCT) cutoff value for the screening of gestational diabetes mellitus (GDM) based on pre-pregnancy BMI. Methods An-IRB approved retrospective cohort analysis of singleton pregnancies at a large tertiary healthcare center from January 2004 to December 2020 was performed. The first GCT value completed between 20 and 32 weeks was used. Using a receiver operator curve (ROC), we sought to determine the optimal GCT cutoff value for each BMI category that would predict the development of GDM. Youden Index was used to determine optimal cut-point of GCT values for each BMI class. Results A total of 23,550 patients with a GCT value were identified. Of those, 1,676 (7.1%) were diagnosed with GDM. 513 (30.6%) with normal BMI, 449 (26.8%) overweight, 347 (20.7%) class I obese, 210 (12.5%) class II obese, and 157 (9.4%) class III obese patients were diagnosed with GDM. Gestational diabetes was predicted at GCT cutoff value of 130 mg/dL with an area under the curve (AUC) of 0.92 (BMI <25), 131 mg/dL with an AUC of 0.92 (overweight BMI), 131 mg/dL with an AUC of 0.89 (class I BMI), 133 mg/dL with an AUC of 0.88 (class II BMI), and 131 mg/dL with an AUC of 0.88 (class III BMI). Conclusions AUC ranged from 0.88 to 0.92 with 93% or greater sensitivity for GCT cutoff value across each of the BMI categories. The findings support a GCT cutoff value of 130 mg/dL for GDM screening regardless of BMI.

Introduction: Induction of labour is a common procedure performed on labour and delivery. There are multiple ways to achieve cervical ripening, however, no studies have evaluated these methods based on a patient's gestational age. The goal of this study is to compare the length of labour at specific gestational ages in women being induced with either vaginal misoprostol or the dinoprostone insert. Methods: A retrospective cohort study of 3774 singleton pregnancies from 2009 to 2019 at a health system with tertiary care and community hospitals was conducted. The primary outcome was time to insertion of medication to time to vaginal delivery. Secondary outcomes included length of first and second stages of labour, length of rupture of membranes, mode of delivery, neonatal Apgar scores at 1 and 5 min and neonatal intensive care unit admission. A generalized linear model was utilised for continuous outcomes and a logistic regression model was used for binary outcomes. Results: Across all gestational ages, women who received vaginal misoprostol had a shorter labour course than women who received dinoprostone (in hours, preterm 18.2 vs. 26.3 p < 0.01, term 15.9 vs. 24.4 p < 0.01, late term 17.6 vs. 22.3 p < 0.01). Patients that received misoprostol had a shorter first stage of labour (in hours, preterm 18.2 vs. 25.7 p < 0.01, term 15.3 vs. 23.6 p < 0.01, late term 16.5 vs. 21.1 p < 0.01) and second stage of labour in the term and late term group (term 20.5 vs. 30.0 min. p < 0.01, late term 30.0 vs. 47.0, p = 0.05). Patients that received dinoprostone at term had higher odds of undergoing caesarean section (odds ratio (95% confidence interval): 1.34 (1.06, 1.70)). Conclusion: Patients that received vaginal misoprostol was associated with shorter labour course across all gestational ages. Patients that received dinoprostone at term had an increased risk of caesarean section.