Oral glucose tolerance test for suspected late onset gestational diabetes

Mohr–Sasson, Aya; Shats, Maya; Goichberg, Zohar; Mazaki‐Tovi, Shali; Morag, Iris; Hendler, Israel

doi:10.1080/14767058.2019.1702945

Cited by 10 publications

(18 citation statements)

References 17 publications

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“…Hence, it is essential to find a test that would accurately identify glucose intolerance and may help prevent its potential consequences. Our study, consistent with the recently published results of Mohr Sasson et al, 11 demonstrates the limited value of an OGTT performed at term in the clinical management of women suspected to have a missed diagnosis of GDM. Not only could it not identify women at increased risk for obstetric complications, an abnormal result increased the risk of a CD.…”

Section: Discussionsupporting

confidence: 91%

“…7 However, which test needs to be used to diagnose GDM in late pregnancy and the value of a late diagnosis on pregnancy outcomes is not clear. Few studies have examined the use of OGTT in the third trimester and its association with pregnancy complications, [8][9][10][11] yet, its effect on clinical-making decisions and pregnancy outcomes when performed at term has not been studied extensively. The aim of this study was to assess the clinical value of using an OGTT at term to identify complications related to the late or missed diagnosis of GDM in women with an earlier normal GCT.…”

Section: Introductionmentioning

confidence: 99%

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The association between an oral glucose tolerance test performed at term pregnancy and obstetric outcomes

et al. 2021

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Aims Assessing the value of oral glucose tolerance test performed at term pregnancy in identifying obstetric complications. Methods Retrospective cohort study of women with a normal 50 g glucose challenge test who also had an oral glucose tolerance test at term (defined as at or after 37 weeks of gestation). Comparison between the pathological and normal oral glucose tolerance test groups was performed. Results The mean glucose in the glucose challenge test of women in the normal oral glucose tolerance test ( n = 256) group was lower than that in the pathological oral glucose tolerance test ( N = 16) group (105 ± 17 mg/dl (5.8 ± 0.9 mmol/l) vs 117 ± 13 mg/dl (6.5 ± 0.7 mmol/l), p = 0.007). Relevant obstetrical complications did not differ significantly between the groups. Of note, in the pathological oral glucose tolerance test group only one woman delivered a macrosomic infant. Conclusions A pathological oral glucose tolerance test performed at term was unable to identify women at risk for impaired glucose metabolism-related obstetric complications and is therefore of limited clinical value and seems to be unjustified.

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

The association between an oral glucose tolerance test performed at term pregnancy and obstetric outcomes

et al. 2021

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“…We speculated that a diagnosis of GDM also allows clinicians to select caesarean delivery to avoid shoulder dystocia because our data showed higher elective caesarean delivery rates but equivalent emergency caesarean delivery rates in the GDM group. Increased caesarean delivery rates for pregnant women diagnosed with GDM during late pregnancy have been reported by a previous study by Sasson et al, who reported that in a retrospective study of pregnant women who underwent the 100-g 3-hour OGTT after 37 weeks of gestation despite normal GCT results during mid-pregnancy, there was a higher caesarean delivery rate in the GDM group; however, other pregnancy delivery outcomes were unchanged (18). Fonseca et al reported a prospective study of the 75-g 2-hour OGTT performed at 32-36 weeks of gestation for pregnant women who had normal glucose tolerance screening results during mid-pregnancy (with results withheld) to observe differences in delivery outcomes (19).…”

Section: Discussionmentioning

confidence: 61%

Impact of gestational diabetes mellitus diagnosed during the third trimester on pregnancy outcomes: A case control study

Shindo

Aoki

Nakanishi

et al. 2020

Preprint

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Background: In 2010, the International Association of Diabetes and Pregnancy Study Group (IADPSG) proposed new criteria indicating that gestational diabetes mellitus (GDM) can be diagnosed if the fasting threshold of ≤92 mg/dL, 1-hour threshold of ≤180 mg/dL, or 2-hour threshold of ≤153 mg/dL are exceeded during the 75-g 2-hour oral glucose tolerance test (OGTT) performed at 24–28 weeks of gestation. The World Health Organization (WHO) recommends using the proposed diagnostic threshold values of the IADPSG to diagnose GDM, but it does not limit the timing of the 75-g OGTT. Since 2010 in Japan, GDM has been diagnosed using the same criteria as that proposed by the WHO. Nevertheless, there is no justification for these thresholds during specific time windows.Methods: This was a single-centre retrospective study based on the medical records and delivery registry database of our centre. We included women who underwent a 50-g glucose challenge test (GCT) with results <140 mg/dL at 24–28 weeks of gestation and subsequently underwent a 75-g OGTT after 29 weeks of gestation with abnormal glucose tolerance suspected based on clinical findings. The reference values for the 75-g OGTT followed the IADPSG criteria. Subjects were classified as the normal glucose tolerance (NGT) group and the GDM group. The type of delivery and neonatal outcomes of the two groups were compared. A multivariable analysis was performed to match the backgrounds of both groups.Results: A total of 189 women comprised the NGT group and 49 women comprised the GDM group. Emergency caesarean delivery rates were similar in the GDM and NGT groups (10.6% and 12.2%, respectively; adjusted odds ratio [OR], 1.25; 95% confidence interval [CI], 0.43-3.64; p=0.74), but the elective caesarean delivery rate was higher in the GDM group than in the NGT group (16.3% and 5.3%, respectively, adjusted OR, 3.60; 95% CI, 1.27-10.19; p=0.01). There were no differences in other maternal and neonatal outcomes between groups.Conclusion: Whether diagnosing GDM during the third trimester can improve pregnancy outcomes is unknown. However, pregnant women diagnosed with GDM during the third trimester are more likely to undergo caesarean delivery.

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“…Furthermore, OGTT testing is conducted between 20 and 30 g.w., adding additional OGTT after that period could help to determine late onset GDM with increased risk of operative delivery. Sasson et al found that pathological OGTT at term due to the suspicion of LGA resulted in a higher rate of Cesarean section [ 25 ].…”

Section: Discussionmentioning

confidence: 99%

Screening of Gestational Diabetes and Its Risk Factors: Pregnancy Outcome of Women with Gestational Diabetes Risk Factors According to Glycose Tolerance Test Results

Hanson

Ringmets

Kirss

et al. 2022

JCM

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Background: Gestational diabetes mellitus (GDM) can cause maternal and neonatal health problems, and its prevalence is increasing worldwide. We assessed the screening of GDM during a 7-year period and compared the outcome of pregnancies at high risk for GDM. Methods: We analyzed non-selected pregnant women (n = 5021) receiving antenatal care in Tartu University Hospital, Estonia in 2012–2018. Pregnant women were classified based on the absence or presence of GDM risk factors as low risk (n = 2302) or high risk for GDM (n= 2719), respectively. The latter were divided into subgroups after the oral glycose tolerance test (OGTT): GDM (n = 423), normal result (n = 1357) and not tested (n = 939). Results: The proportion of women with GDM risk factors increased from 43.5% in 2012 to 57.8% in 2018, and the diagnosis of GDM more than doubled (5.2% vs. 13.7%). Pregnancies predisposed to GDM but with normal OGTT results were accompanied by an excessive gestational weight gain and increased odds to deliver a LGA baby (AOR 2.3 (CI 1.8–3.0)). Conclusions: An increasing number of pregnancies presenting GDM risk factors are diagnosed with GDM. Pregnant women with GDM risk factors are, despite normal OGTT, at risk of increased weight gain and LGA newborns.

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Oral glucose tolerance test for suspected late onset gestational diabetes

Cited by 10 publications

References 17 publications

The association between an oral glucose tolerance test performed at term pregnancy and obstetric outcomes

The association between an oral glucose tolerance test performed at term pregnancy and obstetric outcomes

Impact of gestational diabetes mellitus diagnosed during the third trimester on pregnancy outcomes: A case control study

Screening of Gestational Diabetes and Its Risk Factors: Pregnancy Outcome of Women with Gestational Diabetes Risk Factors According to Glycose Tolerance Test Results

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