Oral glucose tolerance test to diagnose gestational diabetes mellitus: Impact of variations in specimen handling

Clin Biochem. 2023 May:115:33-48. doi: 10.1016/j.clinbiochem.2022.10.002. Epub 2022 Oct 13.


To improve birth outcomes, all pregnant women without known diabetes are recommended for an oral glucose tolerance test (OGTT) to screen for hyperglycaemia in pregnancy (diabetes in pregnancy or gestational diabetes mellitus (GDM)). This narrative review presents contemporary approaches to minimise preanalytical glycolysis in OGTT samples with a focus on GDM diagnosis using criteria derived from the Hyperglycemia and Adverse Pregnancy Outcomes (HAPO) study. The challenges of implementing each approach across a diverse Australian healthcare setting were explored. Many Australian sites currently collect and transport OGTT samples at ambient temperature in sodium fluoride (NaF) tubes which is likely to lead to missed diagnosis of GDM in a significant proportion of cases. Alternative preanalytical solutions should be pragmatic and tailored to individual settings and as close as possible to the preanalytical conditions of the HAPO study for correct interpretation of OGTT results. Rapid centrifugation of barrier tubes to separate plasma could be suitable in urban settings provided time to centrifugation is strictly controlled. Tubes containing NaF and citrate could be useful for remote or resource poor settings with long delays to analysis but the impact on the interpretation of OGTT results should be carefully considered. Testing venous blood glucose at the point-of-care bypasses the need for glycolytic inhibition but requires careful selection of devices with robust analytical performance. Studies to evaluate the potential error of each solution compared to the HAPO protocol are required to assess the magnitude of misdiagnosis and inform clinicians regarding the potential impact on patient safety and healthcare costs.

Keywords: Australia; Gestational diabetes mellitus; Hyperglycaemia in pregnancy; Oral glucose tolerance test; Preanalytical glycolysis.

Publication types

  • Review

MeSH terms

  • Australia
  • Blood Glucose / analysis
  • Diabetes, Gestational* / diagnosis
  • Female
  • Glucose Tolerance Test
  • Humans
  • Hyperglycemia*
  • Pregnancy
  • Specimen Handling


  • Blood Glucose