Correspondence between first-trimester fasting glycaemia, and oral glucose tolerance test in gestational diabetes diagnosis

Diabetes Metab. 2012 Nov;38(5):458-61. doi: 10.1016/j.diabet.2012.03.006. Epub 2012 May 15.

Abstract

Aim: To evaluate the correspondence between first-trimester fasting glycaemia and the results of the OGTT in diagnosing gestational diabetes (GDM).

Methods: The medical records of all consecutive women who had undergone a diagnostic OGTT, performed according to the IADPSG, during the past year were retrospectively reviewed. All first-trimester fasting glucose values greater or equal to 5.1 mmol/L (92 mg/dL), recommended as a diagnostic value, were also verified for each patient in this cohort. Moreover, a ROC curve and a multiple logistic-regression model were constructed to calculate the predictive capability of this cut-off value in diagnosing GDM.

Results: In our population of 738 eligible pregnant women, an 11.9% prevalence of GDM was revealed by OGTT. However, when the first-trimester fasting glucose value for each patient was retrospectively considered, there were a further 29 patients who should have been diagnosed as GDM cases (glycaemia ≥ 5.1 mmol/L), although their OGTT was normal. Yet, when the value of fasting glucose was considered not diagnostic, but only predictive, an AUC of 0.614 (95% CI: 0.544-0.684) and an aOR of 7.1 (95% CI: 3.8-13.1) was obtained in these patients compared with the reference group (fasting glucose < 5.1 mmol/L).

Conclusion: There was no complete correspondence in diagnosing GDM between the first-trimester fasting glucose value and the results of a 2-h 75-g OGTT performed early in the third trimester. However, albeit not diagnostic, a fasting glucose value greater or equal to 5.1 mmol/L may be considered a highly predictive risk factor for GDM.

MeSH terms

  • Adult
  • Blood Glucose / metabolism*
  • Diabetes, Gestational / blood
  • Diabetes, Gestational / diagnosis*
  • Diabetes, Gestational / epidemiology
  • Fasting* / blood
  • Female
  • Glucose Tolerance Test*
  • Glycated Hemoglobin A / metabolism*
  • Humans
  • Italy / epidemiology
  • Logistic Models
  • Mass Screening
  • Practice Guidelines as Topic
  • Pregnancy
  • Pregnancy Trimester, First*
  • ROC Curve
  • Reference Values
  • Retrospective Studies

Substances

  • Blood Glucose
  • Glycated Hemoglobin A
  • hemoglobin A1c protein, human