The Oral Glucose Tolerance Test—Is It Time for a Change?—A Literature Review with an Emphasis on Pregnancy

Bogdanet, Delia; O’Shea, Paula; Lyons, Claire L.; Shafat, Amir; Dunne, Fidelma

doi:10.3390/jcm9113451

Cited by 64 publications

(57 citation statements)

References 132 publications

(141 reference statements)

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“…Despite the wide range of endorsements and guidelines for the diagnosis of GDM in pregnant women recommended by international societies [ 1 , 13 , 69 , 70 , 71 , 72 , 73 , 74 ], there is a strong controversy over the definition of GDM including advice on selective approaches such as universal or risk-based screening, the optimal time for screening in the first and second trimesters, appropriate screening method or criteria for diagnosis, and proper threshold values. Furthermore, there are ongoing debates concerning the risk of adverse pregnancy outcomes and the cost-effectiveness of different screening or diagnostic strategies.…”

Section: Discussionmentioning

confidence: 99%

The Impact of Diagnostic Criteria for Gestational Diabetes Mellitus on Adverse Maternal Outcomes: A Systematic Review and Meta-Analysis

Tehrani

Naz

Behboudi‐Gandevani

2021

JCM

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This systematic review and meta-analysis aimed to examine the impact of different gestational-diabetes (GDM) diagnostic-criteria on the risk of adverse-maternal-outcomes. The search process encompassed PubMed (Medline), Scopus, and Web of Science databases to retrieve original, population-based studies with the universal GDM screening approach, published in English language and with a focus on adverse-maternal-outcomes up to January 2020. According to GDM diagnostic criteria, the studies were classified into seven groups. A total of 49 population-based studies consisting of 1409018 pregnant women with GDM and 7,667,546 non-GDM counterparts were selected for data analysis and knowledge synthesis. Accordingly, the risk of adverse-maternal-outcomes including primary-cesarean, induction of labor, maternal-hemorrhage, and pregnancy-related-hypertension, overall, regardless of GDM diagnostic-criteria and in all diagnostic-criteria subgroups were significantly higher than non-GDM counterparts. However, in meta-regression, the increased risk was not influenced by the GDM diagnostic-classification and the magnitude of the risks among patients, using the IADPSG criteria-classification as the most strict-criteria, was similar to other criteria. In conclusion, a reduction in the diagnostic-threshold increased the prevalence of GDM, but the risk of adverse-maternal-outcome was not different among those women who were diagnosed through more or less intensive strategies. Our review findings can empower health-care-providers to select the most cost-effective approach for the screening of GDM among pregnant women.

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Section: Discussionmentioning

confidence: 99%

The Impact of Diagnostic Criteria for Gestational Diabetes Mellitus on Adverse Maternal Outcomes: A Systematic Review and Meta-Analysis

Tehrani

Naz

Behboudi‐Gandevani

2021

JCM

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“…Women are currently diagnosed with GDM using an OGTT. This test is unreliable with poor reproducibility and high vulnerability to external and internal factors [ 14 ]. More so, the OGTT does not identify the continuous correlation between hyperglycemia in the mother and pregnancy complications and possibly omits milder forms of glucose abnormalities that may identify pregnancy risks.…”

Section: Discussionmentioning

confidence: 99%

“…Despite that, most studies show great promise. While there is some evidence that stress, sleep deprivation or exercise influence leptin levels [ 126 , 127 , 128 ], similar to the OGTT [ 14 ], the test can be done in a non-fasting state, which is a clear advantage over the OGTT. Similar to adiponectin, prospective studies are required to determine-trimester-specific reference ranges for the non-diabetic pregnant population,-trimester-specific cutoff points for the GDM population, the impact of confounders (including adiposity markers) on leptin levels and association with pregnancy outcomes.…”

Section: Cytokinesmentioning

confidence: 99%

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Emerging Protein Biomarkers for the Diagnosis or Prediction of Gestational Diabetes—A Scoping Review

Bogdanet

Reddin

Murphy

et al. 2021

JCM

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Introduction: Gestational diabetes (GDM), defined as hyperglycemia with onset or initial recognition during pregnancy, has a rising prevalence paralleling the rise in type 2 diabetes (T2DM) and obesity. GDM is associated with short-term and long-term consequences for both mother and child. Therefore, it is crucial we efficiently identify all cases and initiate early treatment, reducing fetal exposure to hyperglycemia and reducing GDM-related adverse pregnancy outcomes. For this reason, GDM screening is recommended as part of routine pregnancy care. The current screening method, the oral glucose tolerance test (OGTT), is a lengthy, cumbersome and inconvenient test with poor reproducibility. Newer biomarkers that do not necessitate a fasting sample are needed for the prompt diagnosis of GDM. The aim of this scoping review is to highlight and describe emerging protein biomarkers that fulfill these requirements for the diagnosis of GDM. Materials and Methods: This scoping review was conducted according to preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines for scoping reviews using Cochrane Central Register of Controlled Trials (CENTRAL), the Cumulative Index to Nursing & Allied Health Literature (CINAHL), PubMed, Embase and Web of Science with a double screening and extraction process. The search included all articles published in the literature to July 2020. Results: Of the 3519 original database citations identified, 385 were eligible for full-text review. Of these, 332 (86.2%) were included in the scoping review providing a total of 589 biomarkers studied in relation to GDM diagnosis. Given the high number of biomarkers identified, three post hoc criteria were introduced to reduce the items set for discussion: we chose only protein biomarkers with at least five citations in the articles identified by our search and published in the years 2017–2020. When applied, these criteria identified a total of 15 biomarkers, which went forward for review and discussion. Conclusions: This review details protein biomarkers that have been studied to find a suitable test for GDM diagnosis with the potential to replace the OGTT used in current GDM screening protocols. Ongoing research efforts will continue to identify more accurate and practical biomarkers to take GDM screening and diagnosis into the 21st century.

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“…This study did not address other factors that can also introduce error into OGTT, including physiological factors, patient preparation and laboratory error [38] . Analytical error was not available for all sites, however all laboratories were National Association of Testing Authorities, Australia (NATA) accredited.…”

Section: Discussionmentioning

confidence: 99%

Underestimation of risk for large babies in rural and remote Australia: Time to change plasma glucose collection protocols

Jamieson

Spry

Kirke

et al. 2021

Journal of Clinical & Translational Endocrinology

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The Oral Glucose Tolerance Test—Is It Time for a Change?—A Literature Review with an Emphasis on Pregnancy

Cited by 64 publications

References 132 publications

The Impact of Diagnostic Criteria for Gestational Diabetes Mellitus on Adverse Maternal Outcomes: A Systematic Review and Meta-Analysis

The Impact of Diagnostic Criteria for Gestational Diabetes Mellitus on Adverse Maternal Outcomes: A Systematic Review and Meta-Analysis

Emerging Protein Biomarkers for the Diagnosis or Prediction of Gestational Diabetes—A Scoping Review

Underestimation of risk for large babies in rural and remote Australia: Time to change plasma glucose collection protocols

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