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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

Alan T.N. Tita
1   Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
,
Yinglei Lai
2   The Biostatistics Center, The George Washington University, Washington, District of Columbia
,
Mark B. Landon
3   Ohio State University, Columbus, Ohio
,
Susan M. Ramin
4   University of Texas Health Science Center, Houston-Children's Memorial Hermann Hospital, Houston, Texas
,
Brian Casey
5   University of Texas Southwestern Medical Center, Dallas, Texas
,
Ronald J. Wapner
6   Columbia University, New York, New York
,
Michael W. Varner
7   University of Utah, Salt Lake City, Utah
,
John M. Thorp Jr.
8   University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
,
Anthony Sciscione
9   Drexel University, Philadelphia, Pennsylvania
,
Patrick Catalano
10   MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio
,
Margaret Harper
11   Wake Forest University Health Sciences, Winston-Salem, North Carolina
,
George R. Saade
12   University of Texas Medical Branch, Galveston, Texas
,
Steve N. Caritis
13   University of Pittsburgh, Pittsburgh, Pennsylvania
,
Yoram Sorokin
14   Wayne State University, Detroit, Michigan
,
Alan M. Peaceman
15   Northwestern University, Chicago, Illinois
,
Jorge E. Tolosa
16   Oregon 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 › Author Affiliations
Further Information

Publication History

20 January 2017

08 June 2017

Publication Date:
19 July 2017 (online)

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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

Note

This study was presented in part as a poster presentation at the 31st Annual Meeting of the Society for Maternal-Fetal Medicine in San Francisco, CA February 9–12, 2011.


 

  • References

  • 1 Jovanovic L, Pettitt DJ. Gestational diabetes mellitus. JAMA 2001; 286 (20) 2516-2518
    CrossrefPubMedGoogle Scholar
  • 2 Metzger BE, Coustan DR. ; The Organizing Committee. Summary and recommendations of the Fourth International Workshop-Conference on Gestational Diabetes Mellitus. Diabetes Care 1998; 21 (Suppl. 02) B161-B167
    PubMedGoogle Scholar
  • 3 Langer O, Yogev Y, Most O, Xenakis EM. Gestational diabetes: the consequences of not treating. Am J Obstet Gynecol 2005; 192 (04) 989-997
    CrossrefPubMedGoogle Scholar
  • 4 Metzger BE, Lowe LP, Dyer AR. , et al; HAPO Study Cooperative Research Group. Hyperglycemia and adverse pregnancy outcomes. N Engl J Med 2008; 358 (19) 1991-2002
    CrossrefPubMedGoogle Scholar
  • 5 Landon MB, Spong CY, Thom E. , et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. A multicenter, randomized trial of treatment for mild gestational diabetes. N Engl J Med 2009; 361 (14) 1339-1348
    CrossrefPubMedGoogle Scholar
  • 6 Brody SC, Harris R, Lohr K. Screening for gestational diabetes: a summary of the evidence for the U.S. Preventive Services Task Force. Obstet Gynecol 2003; 101 (02) 380-392
    PubMedGoogle Scholar
  • 7 Tuffnell DJ, West J, Walkinshaw SA. Treatments for gestational diabetes and impaired glucose tolerance in pregnancy. Cochrane Database Syst Rev 2003; (03) CD003395
    PubMedGoogle Scholar
  • 8 Metzger BE, Gabbe SG, Persson B. , et al; International Association of Diabetes and Pregnancy Study Groups Consensus Panel. International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care 2010; 33 (03) 676-682
    CrossrefPubMedGoogle Scholar
  • 9 American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care 2011; 34 (Suppl. 01) S62-S69
    CrossrefPubMedGoogle Scholar
  • 10 Grobman WA, Gilbert SA, Iams JD. , et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Maternal-Fetal Medicine Units (MFMU) Network. Activity restriction among women with a short cervix. Obstet Gynecol 2013; 121 (06) 1181-1186
    CrossrefPubMedGoogle Scholar
  • 11 Committee on Practice Bulletins–Obstetrics. Practice Bulletin No. 137: Gestational diabetes mellitus. Obstet Gynecol 2013; 122 (2 Pt 1): 406-416
    CrossrefPubMedGoogle Scholar
  • 12 Dodd JM, Crowther CA, Antoniou G, Baghurst P, Robinson JS. Screening for gestational diabetes: the effect of varying blood glucose definitions in the prediction of adverse maternal and infant health outcomes. Aust N Z J Obstet Gynaecol 2007; 47 (04) 307-312
    CrossrefPubMedGoogle Scholar
  • 13 Leary J, Pettitt DJ, Jovanovic L. Gestational diabetes guidelines in a HAPO world. Best Pract Res Clin Endocrinol Metab 2010; 24 (04) 673-685
    CrossrefPubMedGoogle Scholar
  • 14 Bobrowski RA, Bottoms SF, Micallef JA, Dombrowski MP. Is the 50-gram glucose screening test ever diagnostic?. J Matern Fetal Med 1996; 5 (06) 317-320
    PubMedGoogle Scholar
  • 15 Lai Y. On the adaptive partition approach to the detection of multiple change-points. PLoS One 2011; 6 (05) e19754
    CrossrefPubMedGoogle Scholar
  • 16 Carpenter MW, Coustan DR. Criteria for screening tests for gestational diabetes. Am J Obstet Gynecol 1982; 144 (07) 768-773
    CrossrefPubMedGoogle Scholar
  • 17 Naylor CD, Sermer M, Chen E, Farine D. ; Toronto Trihospital Gestational Diabetes Project Investigators. Selective screening for gestational diabetes mellitus. N Engl J Med 1997; 337 (22) 1591-1596
    CrossrefPubMedGoogle Scholar
  • 18 Mello G, Elena P, Ognibene A. , et al. Lack of concordance between the 75-g and 100-g glucose load tests for the diagnosis of gestational diabetes mellitus. Clin Chem 2006; 52 (09) 1679-1684
    CrossrefPubMedGoogle Scholar
  • 19 Langer O, Conway DL, Berkus MD, Xenakis EMJ, Gonzales O. A comparison of glyburide and insulin in women with gestational diabetes mellitus. N Engl J Med 2000; 343 (16) 1134-1138
    CrossrefPubMedGoogle Scholar
  • 20 Meltzer SJ, Snyder J, Penrod JR, Nudi M, Morin L. Gestational diabetes mellitus screening and diagnosis: a prospective randomised controlled trial comparing costs of one-step and two-step methods. BJOG 2010; 117 (04) 407-415
    CrossrefPubMedGoogle Scholar
  • 21 Lavin Jr JP, Lavin B, O'Donnell N. A comparison of costs associated with screening for gestational diabetes with two-tiered and one-tiered testing protocols. Am J Obstet Gynecol 2001; 184 (03) 363-367
    CrossrefPubMedGoogle Scholar
  • 22 Nicholson WK, Fleisher LA, Fox HE, Powe NR. Screening for gestational diabetes mellitus: a decision and cost-effectiveness analysis of four screening strategies. Diabetes Care 2005; 28 (06) 1482-1484
    CrossrefPubMedGoogle Scholar
  • 23 Landon MB, Mele L, Spong CY. , et al; Eunice Kennedy Shriver National Institute of Child Health, and Human Development (NICHD) Maternal–Fetal Medicine Units (MFMU) Network. The relationship between maternal glycemia and perinatal outcome. Obstet Gynecol 2011; 117 (2 Pt 1): 218-224
    CrossrefPubMedGoogle Scholar
  • 24 Figueroa D, Landon MB, Mele L. , et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Maternal-Fetal Medicine Units (MFMU) Network. Relationship between 1-hour glucose challenge test results and perinatal outcomes. Obstet Gynecol 2013; 121 (06) 1241-1247
    CrossrefPubMedGoogle Scholar