Predictive Characteristics of Elevated 1-Hour Glucose Challenge Test Results for Gestational Diabetes

Alan T.N. Tita; Yinglei Lai; Mark B. Landon; Susan M. Ramin; Brian Casey; Ronald J. Wapner; Michael W. Varner; John M. Thorp Jr.; Anthony Sciscione; Patrick Catalano; Margaret Harper; George R. Saade; Steve N. Caritis; Yoram Sorokin; Alan M. Peaceman; Jorge E. Tolosa; for the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Maternal-Fetal Medicine Units (MFMU) Network

doi:10.1055/s-0037-1604243

American Journal of Perinatology, Inhaltsverzeichnis

Am J Perinatol 2017; 34(14): 1464-1469
DOI: 10.1055/s-0037-1604243

Original Article

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Predictive Characteristics of Elevated 1-Hour Glucose Challenge Test Results for Gestational Diabetes

Autoren

Alan T.N. Tita

¹Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
Yinglei Lai

²The Biostatistics Center, The George Washington University, Washington, District of Columbia
Mark B. Landon

³Ohio State University, Columbus, Ohio
Susan M. Ramin

⁴University of Texas Health Science Center, Houston-Children's Memorial Hermann Hospital, Houston, Texas
Brian Casey

⁵University of Texas Southwestern Medical Center, Dallas, Texas
Ronald J. Wapner

⁶Columbia University, New York, New York
Michael W. Varner

⁷University of Utah, Salt Lake City, Utah
John M. Thorp Jr.

⁸University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
Anthony Sciscione

⁹Drexel University, Philadelphia, Pennsylvania
Patrick Catalano

¹⁰MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio
Margaret Harper

¹¹Wake Forest University Health Sciences, Winston-Salem, North Carolina
George R. Saade

¹²University of Texas Medical Branch, Galveston, Texas
Steve N. Caritis

¹³University of Pittsburgh, Pittsburgh, Pennsylvania
Yoram Sorokin

¹⁴Wayne State University, Detroit, Michigan
Alan M. Peaceman

¹⁵Northwestern University, Chicago, Illinois
Jorge E. Tolosa

¹⁶Oregon Health and Science University, Portland, Oregon

for the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Maternal-Fetal Medicine Units (MFMU) Network

Abstract

Objective The objective was to estimate the optimal screen-positive 1-hour 50 g glucose challenge test (GCT) threshold for gestational diabetes (GDM) and predictive characteristics of increasing screen-positive GCT threshold values (135–199 mg/dL) for GDM.

Study Design It is a secondary analysis of a multicenter mild GDM study. At 24 to 30 weeks' gestation, women with elevated GCT (135–199 mg/dL) completed a diagnostic 3-hour oral glucose tolerance test (OGTT). A novel change-point analysis method was used to compare the GDM rates for the adjacent GCT values, delineating categories of changing risk such that values within categories have equal risk for GDM. Positive (PPV) and negative (NPV) predictive values for GDM were computed for increasing GCT cut-offs.

Results In 7,280 women with both GCT (135–199 mg/dL) and OGTT results, 4 GDM risk-equivalent GCT categories were identified with escalations at 144, 158, and 174 mg/dL (all p-values <0.05). The PPV for GDM increased from 33 to 64% as GCT increased from 135 to 199 mg/dL, while the NPV decreased from 80 to 67%. PPVs were only 20% and 61% for risk-equivalent categories of 135 to 143 mg/dL and 174 to 199 mg/dL, respectively.

Conclusion Elevated GCT cut-off values between 135 and 143 mg/dL may carry equivalent GDM risk. No threshold GCT value <199 mg/dL alone sufficiently predicts GDM.

Keywords

gestational diabetes mellitus - glucose challenge test - prediction - screening

Volltext

Referenzen

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