The predictive value of the 1-h 50-g glucose screen for diagnosing gestational diabetes mellitus in a high-risk population

Lanni, Susan; Barrett, Diane P

doi:10.1080/14767050410001724308

Cited by 15 publications

(9 citation statements)

References 4 publications

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“…However, only a few studies since have evaluated the issue of whether a high GCT could be diagnostic for GDM without further testing, with most using OGTT performance, not clinical outcomes, as the reference. 18,19,25–27 Landy et al 18 evaluated 514 women with GCT > 140 mg/dL who had OGTT (312 with normal OGTT and 202 with GDM) and identified an optimal diagnostic cutpoint of GCT >186 mg/dL, chosen based on high specificity (95.9%) and low false-positive rate (4.1%) for GDM diagnosis, that was also associated with a significantly greater proportion of large-for-gestational-age infants compared to women with GCT 140–185 mg/dL. In contrast, Lanni and Barrett 27 evaluated 16,898 women (1972 women with GCT >140 mg/dL who also had OGTT), and concluded GCT >200 mg/dL should not be diagnostic because it predicted only 47–54% of their cases (by OGTT) correctly using either C&C or NDDG criteria, and could lead to overdiagnosis.…”

Section: Commentmentioning

confidence: 99%

Markedly different rates of incident insulin treatment based on universal gestational diabetes mellitus screening in a diverse HMO population

Hillier

Ogasawara

Pedula

et al. 2013

American Journal of Obstetrics and Gynecology

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OBJECTIVE We sought to evaluate population gestational diabetes mellitus (GDM) screening results and risk for incident insulin treatment. STUDY DESIGN Among 64,687 pregnant women universally screened for GDM from 1995 through 2010 in 2 regions of a large US health plan, we stratified women requiring insulin treatment during their pregnancy by GDM screening results (50-g glucose challenge test [GCT]), followed by a 3-hour, 100-g oral glucose tolerance test if GCT was positive. Women with GCT >200 mg/dL were evaluated separately. RESULTS Overall, 2% of all pregnant women required insulin treatment, ranging from 0.1% (normal GCT) to 49.9% (GCT >200 mg/dL; P for trend <.0001). Women with GCT >200 mg/dL had a much higher rate of insulin treatment than women with GDM (odds ratio, 3.7; 95% confidence interval, 3.1–4.4). Risk factors for higher insulin treatment rates with GDM or GCT >200 mg/dL included obesity, race/ethnicity, and diagnosed ≤16 weeks’ gestation. CONCLUSION Our results indicate women with GCT >200 mg/dL could be reasonably treated as GDM without requiring additional oral glucose tolerance test for diagnosis.

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Section: Commentmentioning

confidence: 99%

Markedly different rates of incident insulin treatment based on universal gestational diabetes mellitus screening in a diverse HMO population

Hillier

Ogasawara

Pedula

et al. 2013

American Journal of Obstetrics and Gynecology

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“…Another study did not achieve a 100% positive predictive value until a GLT result of 220 mg/dL was reached [10]. Several recent studies have reported that the GLT alone has poor predictive values: 45-54% when GLT results are 185 mg/dL or greater [11,12], and 50-80% when GLT results are 200 mg/dL or greater [11][12][13].…”

Section: Introductionmentioning

confidence: 98%

Screening or diagnostic: Markedly elevated glucose loading test and perinatal outcomes

Cheng

Esakoff

Block-Kurbisch

et al. 2006

The Journal of Maternal-Fetal & Neonatal Medicine

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“…The authors concluded that GCT alone leads to overdiagnosis of GDM. 8 Shivvers and colleagues studied 59 women with GCT≥200, all of whom subsequently completed 3-hour GTT. Nineteen percent of these women (n=11) had normal 3-hour GTT.…”

Section: Discussionmentioning

confidence: 99%

“…In one analysis, 19% of patients diagnosed with GDM on 1-hour GCT ≥ 200 mg/dL had normal 3-hour GTT values, 7 while another study estimated the positive predictive value of 1-hour GCT ≥ 200 mg/dL to be only 54%. 8 It is also unclear if this subset of patients has worse pregnancy outcomes.…”

Section: Introductionmentioning

confidence: 99%

Pregnancy Outcomes in Women with 1-Hour Glucose Challenge Test ≥ 200 mg/dL

2015

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Objective Many protocols diagnose gestational diabetes mellitus (GDM) solely on a 1-hour glucose challenge test (GCT) ≥ 200 mg/dL. However, pregnancy outcomes in these women compared with women diagnosed with a 3-hour glucose tolerance test (GTT) has not been adequately evaluated. We hypothesize that a 1-hour GCT ≥200 mg/dL is associated with worse pregnancy outcomes compared to a GCT 135–199 with positive GTT. Study Design Retrospective cohort of singleton pregnancies complicated by GDM. Maternal outcomes included A2DM, preeclampsia, primary cesarean, and failed trial of labor after cesarean. Perinatal outcomes were large/small for gestational age, shoulder dystocia, and birth injury. Groups were compared with t-test and chi-squared test, and logistic regression to adjust for confounders. Results 602 women diagnosed with GDM by 1-hour GCT 135–199 and confirmatory 3-hour GTT (<200 group) and 225 women diagnosed with 1-hour GCT ≥200 alone (≥200) were included. The ≥200 group had a higher incidence of preeclampsia (16.4% versus 10.6%) and shoulder dystocia (3.1% versus 1.0%). Adjusted ORs and 95% CIs were 1.80 (1.10–2.94) and 5.10 (1.25–20.76) respectively. Conclusion Preeclampsia and shoulder dystocia are more frequent in women with GCT ≥ 200 mg/dL than those with a positive GTT following a GCT of 135–199 mg/dL.

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The predictive value of the 1-h 50-g glucose screen for diagnosing gestational diabetes mellitus in a high-risk population

Abstract: GDM cannot be diagnosed with the 1OGT; predictive values are low. A cut-off of 200 mg/dl predicts only 47-54% of GDM cases correctly, and may lead to over-diagnosis. It is inappropriate for GDM to be diagnosed based on the 1OGT.

Cited by 15 publications

References 4 publications

Markedly different rates of incident insulin treatment based on universal gestational diabetes mellitus screening in a diverse HMO population

Markedly different rates of incident insulin treatment based on universal gestational diabetes mellitus screening in a diverse HMO population

Screening or diagnostic: Markedly elevated glucose loading test and perinatal outcomes

Pregnancy Outcomes in Women with 1-Hour Glucose Challenge Test ≥ 200 mg/dL

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