Prediction of gestational diabetes mellitus in the first trimester, comparison of fasting plasma glucose, two-step and one-step methods: a prospective randomized controlled trial

Yeral M. İ., OZGU-ERDINC A. S., UYGUR D., SECKIN K. D., KARSLI M. F., DANISMAN A. N.

ENDOCRINE, vol.46, no.3, pp.512-518, 2014 (SCI-Expanded) identifier identifier identifier

  • Publication Type: Article / Article
  • Volume: 46 Issue: 3
  • Publication Date: 2014
  • Doi Number: 10.1007/s12020-013-0111-z
  • Journal Name: ENDOCRINE
  • Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Scopus
  • Page Numbers: pp.512-518
  • Keywords: Gestational diabetes mellitus, First trimester, Screening, Fasting plasma glucose, Glucose tolerance test, Randomized controlled trial, STUDY-GROUPS RECOMMENDATIONS, INTERNATIONAL ASSOCIATION, SCREENING-TEST, PRENATAL VISIT, PREGNANCY, DIAGNOSIS, HYPERGLYCEMIA, CRITERIA, CLASSIFICATION, COMPLICATIONS
  • Akdeniz University Affiliated: No

Abstract

Our aim was to evaluate and compare the diagnostic performance of three methods commonly used for GDM screening: fasting plasma glucose (FPG), two-step 50 g glucose challenge test (GCT), and 75 g glucose tolerance test (GTT) in a randomized study design to predict GDM in the first trimester and determine the best approach in predicting GDM. In a non-blind, parallel-group prospective randomized controlled study; 736 singleton pregnant women underwent FPG testing in the first trimester and randomly assigned to two groups; two-step 50 g GCT and 75 g GTT. GDM diagnosis was made according to Carpenter-Coustan or ADA (American Diabetes Association) criteria in two-step 50 g GCT and 75 g GTT groups, respectively. Subsequent testing was performed by two-step 50 g GCT at 24-28 weeks for screen negatives. After excluding the women who were lost to follow-up or withdrawn as a result of pregnancy loss, 486 pregnant women were recruited in the study. The FPG, two-step GCT, and one-step GTT methods identified GDM in 25/486 (5.1 %), 15/248 (6.0 %), and 27/238 (11.3 %) women, respectively. Area under ROC curves were 0.623, 0.708, and 0.792, respectively. Sensitivities were 47.17, 68.18, and 87.1 %, respectively. Specificities were 77.37, 100, and 100 %, respectively. Positive predictive values were 20.33, 100, and 100 %, respectively. Negative predictive values were 92.29, 97, and 98.1 %, respectively. Until superior screening alternatives become available, the 75 g GTT may be preferred for GDM screening in the first trimester.