Could different cut-off values be used for 50-gram glucose tolerance test in low and high risk groups?

Abstract

Objectives: There are controversies about screening strategy and cut-off levels for gestational diabetes mellitus (GDM). Here, we aimed to identify optimal cut-off values for 50-gram oral glucose tolerance testing (OGTT) in high and low risk pregnant women.

Methods: A total of 500 patients who underwent two step OGTT were divided into two groups as GDM (n=31) and controls (n=469). Moreover, patients were grouped as high (n=114) and low risk (n=386) for GDM. Having≥2 risk factors such as family history of type-2 diabetes, obesity, glucosuria, previous history of GDM, macrosomia and diabetic complications were accepted as high risk. Demographic data, OGTT results, birth characteristics were recorded and compared between groups. A cut-off value for 50-gram OGTT was evaluated in low and high risk groups.

Results: The 50-gram OGTT value above 140 mg/dL discriminated GDM with 100% sensitivity and 92.11% specificity in all patients (AUC=0.969, P<0.001). The prevalence of GDM was 19.3% in high and 2.3% in low risk group. The 50-gram OGTT value above 140 mg/dL discriminated GDM with 100% sensitivity and 94.57% specificity in high risk patients (AUC=0.992, P<0.001). Furthermore, 50-gram OGTT value above 149 mg/dL discriminated GDM with 100% sensitivity and 93.63% specificity in low risk patients (AUC=0.976, P<0.001).

Conclusions: Although screening in low risk population is a debating issue worldwide, our local guidelines still recommend screening all pregnant women. We suggest that performing 100-gram OGTT only in patients who have higher values than 149 mg/dL in 50-gram OGTT can be an alternative screening strategy in low risk group.

Keywords

• Cut-off
• gestational diabetes mellitus
• oral glucose tolerance test
• threshold

References

1. 1. Diagnostic criteria and classification of hyperglycaemia first detected in pregnancy: a World Health Organization Guideline. Diabetes Res Clin Pract. 2014;103(3):341-363. doi: 10.1016/j.diabres.2013.10.012.
2. 2. Ye W, Luo C, Huang J, Li C, Liu Z, Liu F. Gestational diabetes mellitus and adverse pregnancy outcomes: systematic review and meta-analysis. BMJ. 2022;377:e067946. doi: 10.1136/bmj-2021-067946.
3. 3. Evans MJ. Review: Diabetes and pregnancy: a review of pathology. Br J Diabetes Vasc Dis. 2009;9(5):201-206. doi: 10.1177/1474651409344924.
4. 4. American College of Obstetricians and Gynecologists (ACOG) Practice Bulletin No. 30. Clinical management guidelines for obstetrician-gynecologists. Gestational Diabetes. Washington DC: ACOG; September 2001.
5. 5. American Diabetes Association. Position statement: Standards of Medical Care in Diabetes-2006. Diabetes Care 2006;29(Suppl_1):S4-S42. doi: 10.2337/diacare.29.s1.06.s4.
6. 6. US Preventive Services Task Force; Davidson KW, Barry MJ, Mangione CM, et al. Screening for Gestational Diabetes: US Preventive Services Task Force Recommendation Statement. JAMA. 2021;326(6):531-538. doi: 10.1001/jama.2021.11922.
7. 7. American Diabetes Association Professional Practice Committee. 2. Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes-2022. Diabetes Care. 2022;45(Suppl 1):S17-S38. doi: 10.2337/dc22-S002.
8. 8. Crowther CA, Tran T. Lower versus Higher Glycemic Criteria for Diagnosis of Gestational Diabetes. Reply. N Engl J Med. 2022;387(18):1720-1721. doi: 10.1056/NEJMc2212585.

9. 9. Matta-Coelho C, Monteiro AM, Fernandes V, Pereira ML; Portuguese Diabetes and Pregnancy Study Group; Souto SB. Universal vs. risk-factor-based screening for gestational diabetes-an analysis from a 5-Year Portuguese Cohort. Endocrine. 2019;63(3):507-512. doi: 10.1007/s12020-018-1760-8.
10. 10. Yuen L, Wong VW, Wolmarans L, Simmons D. Comparison of Pregnancy Outcomes Using Different Gestational Diabetes Diagnostic Criteria and Treatment Thresholds in Multiethnic Communities between Two Tertiary Centres in Australian and New Zealand: Do They Make a Difference? Int J Environ Res Public Health. 2021;18(9):4588. doi:10.3390/ijerph18094588.
11. 11. Kleinwechter H, Schäfer-Graf U, Bührer C, et al. German Diabetes Association; German Association for Gynaecology and Obstetrics. Gestational diabetes mellitus (GDM) diagnosis, therapy and follow-up care: Practice Guideline of the German Diabetes Association (DDG) and the German Association for Gynaecologyand Obstetrics (DGGG). Exp Clin Endocrinol Diabetes. 2014;122(7):395-405. doi: 10.1055/s-0034-1366412.
12. 12. Carpenter MW, Coustan DR. Criteria for screening tests for gestational diabetes. Am J Obstet Gynecol. 1982;144(7):768-773. doi: 10.1016/0002-9378(82)90349-0.
13. 13. Abera DA, Larbie C, Abugri J, Ofosu M, Mutocheluh M, Dongsogo J. Prevalence and Predictors of Gestational Diabetes Mellitus in Sub-Saharan Africa: A 10-Year Systematic Review. Endocrinol Diabetes Metab. 2024;7(3):e00478. doi:10.1002/edm2.478.
14. 14. Mistry SK, Das Gupta R, Alam S, Kaur K, Shamim AA, Puthussery S. Gestational diabetes mellitus (GDM) and adverse pregnancy outcome in South Asia: A systematic review. Endocrinol Diabetes Metab. 2021;4(4):e00285. doi:10.1002/edm2.285.
15. 15. Köşüş A, Köşüş N, Turhan N. What is the best cut-off point for screening gestational diabetes in Turkish women? Turk J Med Sci. 2012;42(3):523-531. doi:10.3906/sag-1102-1368.
16. 16. Karaçam Z, Çelik D. The prevalence and risk factors of gestational diabetes mellitus in Turkey: a systematic review and meta-analysis. J Matern Fetal Neonatal Med. 2021;34(8):1331-1341. doi:10.1080/14767058.2019.1635109.
17. 17. Hillier TA, Pedula KL, Ogasawara KK, et al. A Pragmatic, Randomized Clinical Trial of Gestational Diabetes Screening. N Engl J Med. 2021;384(10):895-904. doi: 10.1056/NEJMoa2026028.
18. 18. Juntarat W, Rueangchainikhom W, Promas S. 50-grams glucose challenge test for screening of gestational diabetes mellitus in high risk pregnancy. J Med Assoc Thai. 2007;90(4):617-623.
19. 19. Tan PC, Ling LP, Omar SZ. Screening for gestational diabetes at antenatal booking in a Malaysian university hospital: the role of risk factors and threshold value for the 50-g glucose challenge test. Aust N Z J Obstet Gynaecol. 2007;47(3):191-197. doi: 10.1111/j.1479-828X.2007.00717.x.
20. 20. Basnet T, Pradhan N, Koirala P, Bista KD. Evaluation of glucose challenge test using cut off values 130mg/dl and 140 mg/dl for gestational diabetes mellitus screening. Int J Reprod Contracept Obstet Gynecol. 2018;7(3):801-805. doi:10.18203/2320-1770.ijrcog20180858.
21. 21. Jimenez-Moleon JJ, Bueno-Cavanillas A, Luna-DelCastillo JD, Garcia-Martin M, Lardelli-Claret P, Galvez-Vargas R. Prevalence of gestational diabetes mellitus: variations related to screening strategy used. Eur J Endocrinol. 2002;146(6):831-837. doi:10.1530/eje.0.1460831.
22. 22. Soheilykhah S, Mogibian M, Rahimi-Saghand S, Rashidi M, Soheilykhah S, Piroz M. Incidence of gestational diabetes mellitus in pregnant women. Iran J Reprod Med. 2010;8(1):24-28.
23. 23. Najafian A, Fallahi S, Khasteh Fekr F, Rajaei M, Aman Elahi S, Panah E. Prevalence of gestational diabetes mellitus in low risk pregnant women in the city of Bandar Abbas on April 2012 to October 2013. Bull Env Pharmacol Life Sci. 2014;3(5):37-39.
24. 24. Mahasukontachat S, Siwadune T. Cut-off Values of 50 Grams Glucose Challenge Test for Screening of Gestational Diabetes Mellitus in Antenatal Care Clinic Chonburi Hospital. Thai J Obstet Gynaecol.2011;19(1):12-16.
25. 25. Vitoratos N, Salamalekis E, Bettas P, Kalabokis D, Chrisikopoulos A. Which is the threshold glucose value for further investigation in pregnancy? Clin Exp Obstet Gynecol. 1997;24(3):171-173.
26. 26. Punthumapol C, Tekasakul P. 50 grams glucose challenge test for screening of gestational diabetes mellitus in each trimester in potential diabetic pregnancy. J Med Assoc Thai. 2008;91(6):787-793.
27. 27. Eslamian L, Ramezani Z. Evaluation of a breakfast as screening test for the detection of gestational diabetes. Acta Medica Iranica. 2008;46(1):43-46.
28. 28. Miyakoshi K, Tanaka M, Ueno K, Uehara K, Ishimoto H, Yoshimura Y. Cutoff value of 1 h, 50 g glucose challenge test for screening of gestational diabetes mellitus in a Japanese population. Diabetes Res Clin Pract. 2003;60(1):63-7. doi: 10.1016/s0168-8227(02)00274-7.
29. 29. Korucuoglu U, Biri A, Turkyilmaz E, et al. Glycemic levels with glucose loading test during pregnancy and its association with maternal and perinatal outcomes. Diabetes Res Clin Pract. 2008;80(1):69-74. doi: 10.1016/j.diabres.2007.10.028.