Diagnosis of gestational diabetes in early pregnancy.
OBJECTIVE
To determine whether glucose intolerance can be identified early in gestation in a high-risk population so that early intervention can be planned to prevent associated morbidity.


METHODS
After appropriate dietary preparation, patients with a high risk for gestational diabetes underwent a 50-g oral glucose screening test during fasting. Patients were tested on enrollment and every 10 wk until delivery. Those with a 1-h plasma glucose value of greater than or equal to 7.5 mM underwent a 100-g oral glucose tolerance test. Gestational diabetes was based on either a markedly abnormal 50-g screening test or abnormal 100-g oral glucose tolerance test.


RESULTS
Ten of 15 (66%) patients who developed gestational diabetes were diagnosed during the first half of the pregnancy. Six were diagnosed in the first trimester. If the definition of an abnormal 1-h plasma glucose value was lowered from 7.5 to 7.2 mM, an additional 2 patients could have been identified in the first trimester with an improvement in sensitivity from 70 to 91% with only a slight drop in specificity (from 91 to 88%). Diagnosis of gestational diabetes was not enhanced by measuring plasma insulin concentrations or insulin-glucose molar ratios.


CONCLUSIONS
The diagnosis of gestational diabetes in a high-risk population can be made in the first half of pregnancy. Early diagnosis should permit evaluation of intervention strategies, which may result in improved perinatal outcome.
Super
D M
DM
Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, OH.
Edelberg
S C
SC
Philipson
E H
EH
Hertz
R H
RH
Kalhan
S C
SC
D000328:Adult; D001786:Blood Glucose / Q000032:analysis*; D005260:Female; D005951:Glucose Tolerance Test / Q000379:methods*; D006801:Humans; D007328:Insulin / Q000097:blood; D011247:Pregnancy; D011261:Pregnancy Trimester, First; D011262:Pregnancy Trimester, Second; D011254:Pregnancy in Diabetics / Q000097:blood / Q000175:diagnosis*; D012372:ROC Curve; D012307:Risk Factors; D013223:Statistics as Topic
D001786:Blood Glucose; D007328:Insulin