Evaluation of a 1-h 75-g oral glucose tolerance test in the diagnosis of gestational diabetes.
In order to evaluate the performance of a 1-h 75-g oral glucose tolerance test (OGTT) for the diagnosis of gestational diabetes mellitus (GDM), a cohort of 4998 women, 20 years or older, without previous diabetes being treated in prenatal care clinics in Brazil answered a questionnaire and performed a 75-g OGTT including fasting, 1-h and 2-h glucose measurements between their 24th and 28th gestational weeks. Pregnancy outcomes were transcribed from medical registries. GDM was defined according to WHO criteria (fasting: >/=126 mg/dL; 2-h value: >/=140 mg/dL) and macrosomia as a birth weight equal to or higher than 4000 g. Areas under the receiver operator characteristic curve (AUC) were compared and diagnostic properties of various cut-off points were evaluated. The AUCs for the prediction of macrosomia were 0.606 (0.572-0.637) for the 1-h and 0.589 (0.557-0.622) for the 2-h plasma glucose test. Similar predictability was demonstrable regarding combined adverse outcomes: 0.582 (0.559-0.604) for the 1-h test and 0.572 (0.549-0.595) for the 2-h test. When the 1-h glucose test was evaluated against a diagnosis of GDM defined by the 2-h glucose test, the AUC was 0.903 (0.886-0.919). The cut-off point that maximized sensitivity (83%) and specificity (83%) was 141 mg/dL, identifying 21% of the women as positive. A cut-off point of 160 mg/dL, with lower sensitivity (62%), had higher specificity (94%), labeling 8.6% as positive. Detection of GDM can be done with a 1-h 75-g OGTT: the value of 160 mg/dL has the same diagnostic performance as the conventional 2-h value (140 mg/dL). The simplification of the test may improve coverage and timing of the diagnosis of GDM.
Campos
M A A
MA
Programa de Pós-Graduação em Epidemiologia, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil. ameliaac@terra.com.br
Reichelt
A A J
AA
Façanha
C
C
Forti
A C
AC
Schmidt
M I
MI
D000328:Adult; D001786:Blood Glucose / Q000032:analysis; D015331:Cohort Studies; D016640:Diabetes, Gestational / Q000175:diagnosis*; D005260:Female; D005951:Glucose Tolerance Test / Q000379:methods*; D006801:Humans; D008403:Mass Screening; D011237:Predictive Value of Tests; D011247:Pregnancy; D012372:ROC Curve; D012680:Sensitivity and Specificity; D055815:Young Adult
D001786:Blood Glucose