title: Human breath gas analysis in the screening of gestational diabetes mellitus.
abstract: BACKGROUND
  We present a pilot study on the feasibility of the application and advantages of online, noninvasive breath gas analysis (BGA) by proton transfer reaction quadrupole mass spectrometry for the screening of gestational diabetes mellitus (GDM) in 52 pregnant women by means of an oral glucose tolerance test (OGTT).
  
  
  METHODS
  We collected and identified samples of end-tidal breath gas from patients during OGTT. Time evolution parameters of challenge-responsive volatile organic compounds (VOCs) in human breath gas were estimated. Multivariate analysis of variance and permutation analysis were used to assess feasibility of BGA as a diagnostic tool for GDM.
  
  
  RESULTS
  Standard OGTT diagnosis identified pregnant women as having GDM (n = 8), impaired glucose tolerance (n = 12), and normal glucose tolerance (n = 32); a part of this latter group was further subdivided into a "marginal" group (n = 9) because of a marginal high 1-h or 2-h OGTT value. We observed that OGTT diagnosis (four metabolic groups) could be mapped into breath gas data. The time evolution of oxidation products of glucose and lipids, acetone metabolites, and thiols in breath gas after a glucose challenge was correlated with GDM diagnosis (P = 0.035). Furthermore, basal (fasting) values of dimethyl sulfide and values of methanol in breath gas were inversely correlated with phenotype characteristics such as homeostasis model assessment of insulin resistance index (R = -0.538; P = 0.0002, P(corrected) = 0.0034) and pregestational body mass index (R = -0.433; P = 0.0013, P(corrected) = 0.022).
  
  
  CONCLUSIONS
  Noninvasive BGA in challenge response studies was successfully applied to GDM diagnosis and offered an insight into metabolic pathways involved. We propose a new approach to the identification of diagnosis thresholds for GDM screening.
authors: Research Unit Medical Radiation Physics and Diagnostics, Helmholtz Center Munich, Neuherberg, Germany.
authors: Susanne
authors: S
authors: Halbritter
authors: Mattia
authors: M
authors: Fedrigo
authors: Vera
authors: V
authors: Höllriegl
authors: Wilfried
authors: W
authors: Szymczak
authors: Joerg M
authors: JM
authors: Maier
authors: Anette-Gabriele
authors: AG
authors: Ziegler
authors: Michael
authors: M
authors: Hummel
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000378:metabolism*; D015992:Body Mass Index; D001944:Breath Tests; D016640:Diabetes, Gestational / Q000175:diagnosis / Q000378:metabolism*; D005215:Fasting / Q000097:blood; D005240:Feasibility Studies; D005260:Female; D005951:Glucose Tolerance Test; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006801:Humans; D007333:Insulin Resistance; D008403:Mass Screening; D013058:Mass Spectrometry / Q000379:methods*; D010641:Phenotype; D010865:Pilot Projects; D011247:Pregnancy; D055549:Volatile Organic Compounds / Q000378:metabolism*
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D055549:Volatile Organic Compounds; C517652:hemoglobin A1c protein, human