A two-step screening algorithm including fasting plasma glucose measurement and a risk estimation model is an accurate strategy for detecting gestational diabetes mellitus

Abstract

Aims/hypothesis It is currently not clear how to construct a time-and cost-effective screening strategy for gestational diabetes mellitus (GDM). Thus, we elaborated a simple screening algorithm combining (1) fasting plasma glucose (FPG) measurement; and (2) a multivariable risk estimation model focused on individuals with normal FPG levels to decide if a further OGTT is indicated. Methods A total of 1,336 women were prospectively screened for several risk factors for GDM within a multicentre study conducted in Austria. Of 714 women (53.4%) who developed GDM using recent diagnostic guidelines, 461 were sufficiently screened with FPG. A risk prediction score was finally developed using data from the remaining 253 women with GDM and 622 healthy women. The screening algorithm was validated with a further 258 pregnant women.Results A risk estimation model including history of GDM, glycosuria, family history of diabetes, age, preconception dyslipidaemia and ethnic origin, in addition to FPG, was accurate for detecting GDM in participants with normal FPG. Including an FPG pretest, the receiver operating Diabetologia (2012) 55:3173-3181 DOI 10.1007/s00125-012-2726 characteristic AUC of the screening algorithm was 0.90 (95% CI 0.88, 0.91

Random plasma glucose in early pregnancy is a better predictor of gestational diabetes diagnosis than maternal obesity

“…Other investigators have recommended a risk-factor-based approach. Göbl and colleagues designed a risk calculator based upon a woman’s history of previous GDM, glycosuria, family history of diabetes, age, pre-conception dyslipidaemia and ethnic origin [ 14 ]. The risk calculator in addition to a fasting plasma glucose concentration was able to predict GDM with a ROC AUC of 0.9.…”

“…The NICE guidelines recommend a 75 g OGTT with glucose measurement at baseline and at 2 h post load. Other groups have suggested that tests such as fasting plasma glucose [ 14 ] or random plasma glucose (RPG) [ 15 ] might have validity in screening for GDM, either alone or as a method of rationing OGTTs. A previous systematic review of the use of RPG to screen for GDM concluded that there was inadequate evidence to support the use of RPG, but only six relevant studies (including a total of 3,537 women) were identified [ 16 ].…”

Prediction of gestational diabetes in obese pregnant women from the UK Pregnancies Better Eating and Activity (UPBEAT) pilot trial

“…Four previous studies have identified a number of patient characteristics and biomarkers associated with the prediction of gestational diabetes . These have been undertaken in populations of mixed risk, including non‐white ethnicity , family history of diabetes , previous history of gestational diabetes , high pre‐pregnancy BMI , older maternal age and differing parity . Savvidou et al .…”

“…Four previous studies have identified a number of patient characteristics and biomarkers associated with the prediction of gestational diabetes [11,14,17,18]. These have been undertaken in populations of mixed risk, including non-white ethnicity [11,17,18], family history of diabetes [11,14,17,18], previous history of gestational diabetes [11,17,18], high pre-pregnancy BMI [11,14,18], older maternal age [11,17,18] and differing parity [14]. Savvidou et al [14] measured nine biomarkers in the first trimester and found that high tissue plasminogen activator and low HDL increased the area under the receiver-operating curve from 0.824 with clinical risk factors alone to 0.861 in a group of all comers, regardless of baseline BMI.…”

Gestational diabetes

“…Other studies however have investigated the value of prognostic models including different risk factors, for the early prediction of women at risk for the development of GDM and show that a two-step screening algorithm including a FPG measurement and a risk estimation model can be an accurate strategy for detecting GDM [21,22]. A study in Vietnam showed that when using the old ADA criteria, a simple prognostic model with a risk threshold of 3%, using age and BMI at booking, gave a 93% sensitivity for the identification of women with GDM with a 27% reduction in the number of OGTTs required [23].…”