The Diagnostic Value of the 50-Gram Glucose Challenge Test at Various Cut-off Levels Combined with Clinical Risk Factors in Predicting the Diagnosis of Gestational Diabetes Mellitus
DOI:
https://doi.org/10.31584/jhsmr.20241063Keywords:
50-gram glucose challenge test, 100-gram oral glucose tolerance test, clinical risk factors, gestational diabetes mellitus diagnosisAbstract
Objective: To evaluate the diagnostic precision of the 50-gram glucose challenge test (50-g GCT) at various levels for the detection of gestational diabetes mellitus (GDM), and to examine its association with clinical risk indicators.
Material and Methods: At Thammasat University Hospital, our retrospective cohort comprised 1,197 pregnant women screened using the 50-g GCT based on risk factors, including a family history of GDM, obesity, and other factors. Out of these, 219 tested positive, with 83 (37.9%) diagnosed with GDM and 136 (62.1%) without GDM. Comprehensive data including baseline characteristics, as well as maternal and neonatal outcomes, were compiled. We assessed the correlations between clinical risk factors and 50-g GCT values to ascertain GDM. The positive predictive value (PPV) and negative predictive value (NPV) for various cut-off levels were determined.
Results: The best cutoff for the 50-g GCT for GDM diagnosis was ≥220 mg/dL with 100% PPV without adding clinical risk. The PPVs reached 75% and 100%, respectively, when combined with maternal age ≥35 years at 50-g GCT thresholds of ≥210 mg/dL and ≥220 mg/dL. A history of diabetes in the family combined with a 50-g GCT provided 100% PPV at 200 mg/dL.
Conclusion: A 50-g GCT cut-off value of ≥220mg/dL is proposed for a definitive GDM diagnosis in certain circumstances, negating the need for this additional test. When a pregnant woman has a family history of diabetes, the 50-g GCT cut-off of 200 mg/dL could be a promising marker for identifying GDM.
References
ElSayed NA, Aleppo G, Aroda VR, Bannuru RR, Brown FM, Bruemmer D, et al. Classification and diagnosis of diabetes: standards of care in diabetes-2023. Diabetes Care 2023;46:19-40.
US preventive services task force, Davidson KW, Barry MJ, Mangione CM, Cabana M, Caughey AB, et al. Screening for gestational diabetes: US preventive services task force recommendation statement. JAMA 2021;326:531-8.
ACOG Practice Bulletin No. 190: gestational diabetes mellitus. Obstet Gynecol 2018;131:49-64.
HAPO study cooperative research group; Metzger BE, Lowe LP, Dyer AR, Trimble ER, Chaovarindr U, et al. Hyperglycemia and adverse pregnancy outcomes. N Engl J Med 2008;358:1991-2002.
Sirirat S, Boriboonhirunsarn D, Ruangvutilert P, Yapan, P. Prevalence of gestational diabetes mellitus among women with lower risk for gestational diabetes in Siriraj Hospital. J Obstet Gynaecol 2022;30:313-20.
Kang M, Zhang H, Zhang J, Huang K, Zhao J, Hu J, et al. A novel nomogram for predicting gestational diabetes mellitus during early pregnancy. Front Endocrinol (Lausanne) 2021;12:779210.
Spaight C, Gross J, Horsch A, Puder JJ. Gestational diabetes mellitus. Endocr Dev 2016;31:163-78.
Boriboonhirunsarn D, Lertbunnaphong T, Khanmali P. Cutoff value of 50-G glucose challenge test for the diagnosis of gestational diabetes mellitus. Thai J Obstet Gynaecol 2013;21:16-22.
Hillier TA, Pedula KL, Ogasawara KK, Vesco KK, Oshiro CES, Lubarsky SL, et al. A pragmatic, randomized clinical trial of gestational diabetes screening. N Engl J Med 2021;384:895-904.
International Association of Diabetes and Pregnancy Study Groups Consensus Panel; Metzger BE, Gabbe SG, Persson B, Buchanan TA, Catalano PA, et al. International association of diabetes and pregnancy study group's recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care 2010;33:676-82.
Carpenter MW, Coustan DR. Criteria for screening tests for gestational diabetes. Am J Obstet Gynecol 1982;144:768-73.
Diabetes canada clinical practice guidelines expert committee, Feig DS, Berger H, Donovan L, Godbout A, Kader T, et al. Diabetes and pregnancy. Can J Diabetes 2018;42:255-82.
Ankumah NA, Tita AT, Biggio JR, Harper LM. Pregnancy outcomes in women with 1-Hour glucose challenge test ≥ 200 mg/dL. Am J Perinatol 2016;33:490-4.
Melamed N, Hiersch L, Hod M, Chen R, Wiznitzer A, Yogev Y. Is abnormal 50-g glucose-challenge testing an independent predictor of adverse pregnancy outcome. J Matern Fetal Neonatal Med 2012;25:2583-7.
Lakhananurak N, Numthavaj P, Wilasrusmee C, Sirichotiyakul S, Vutyavanich T. Prevalence of gestational diabetes mellitus in Thailand: A systematic review and meta-analysis. J Diabetes Investig 2019;10:116-124.
Moon JH, Jang HC. Gestational diabetes mellitus: diagnostic approaches and maternal-offspring complications. Diabetes Metab J 2022;46:3-14.
Langer O, Yogev Y, Most O, Xenakis EM. Gestational diabetes: the consequences of not treating. Am J Obstet Gynecol 2005;192:989-97.
Karcaaltincaba D, Altinbas S, Akyol M, Ensari T, Yalvac S. The relationship between markedly elevated glucose challenge test results and the rate of gestational diabetes mellitus and gestational impaired glucose tolerance. Ann Saudi Med 2010;32:391-6.
Cha HH, Kim JY, Choi SJ, Oh SY, Roh CR, Kim JH. How high is too high in cutoff levels from 50-g glucose challenge test. Obstet Gynecol Sci 2016;59:178-83.
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