title: Prediction of gestational diabetes mellitus in the first trimester, comparison of fasting plasma glucose, two-step and one-step methods: a prospective randomized controlled trial.
abstract: Our aim was to evaluate and compare the diagnostic performance of three methods commonly used for GDM screening: fasting plasma glucose (FPG), two-step 50 g glucose challenge test (GCT), and 75 g glucose tolerance test (GTT) in a randomized study design to predict GDM in the first trimester and determine the best approach in predicting GDM. In a non-blind, parallel-group prospective randomized controlled study; 736 singleton pregnant women underwent FPG testing in the first trimester and randomly assigned to two groups; two-step 50 g GCT and 75 g GTT. GDM diagnosis was made according to Carpenter-Coustan or ADA (American Diabetes Association) criteria in two-step 50 g GCT and 75 g GTT groups, respectively. Subsequent testing was performed by two-step 50 g GCT at 24-28 weeks for screen negatives. After excluding the women who were lost to follow-up or withdrawn as a result of pregnancy loss, 486 pregnant women were recruited in the study. The FPG, two-step GCT, and one-step GTT methods identified GDM in 25/486 (5.1 %), 15/248 (6.0 %), and 27/238 (11.3 %) women, respectively. Area under ROC curves were 0.623, 0.708, and 0.792, respectively. Sensitivities were 47.17, 68.18, and 87.1 %, respectively. Specificities were 77.37, 100, and 100 %, respectively. Positive predictive values were 20.33, 100, and 100 %, respectively. Negative predictive values were 92.29, 97, and 98.1 %, respectively. Until superior screening alternatives become available, the 75 g GTT may be preferred for GDM screening in the first trimester.
authors.affiliation: Department of Perinatology, Zekai Tahir Burak Women Health Care Education and Research Hospital, Ankara, Turkey.
authors.forename: M Ilkin
authors.initials: MI
authors.lastname: Yeral
authors.forename: A Seval
authors.initials: AS
authors.lastname: Ozgu-Erdinc
authors.forename: Dilek
authors.initials: D
authors.lastname: Uygur
authors.forename: K Doga
authors.initials: KD
authors.lastname: Seckin
authors.forename: M Fatih
authors.initials: MF
authors.lastname: Karsli
authors.forename: A Nuri
authors.initials: AN
authors.lastname: Danisman
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000032:analysis*; D016640:Diabetes, Gestational / Q000097:blood / Q000175:diagnosis*; D005215:Fasting / Q000097:blood*; D005260:Female; D005951:Glucose Tolerance Test; D006801:Humans; D008403:Mass Screening / Q000379:methods; D011247:Pregnancy; D011261:Pregnancy Trimester, First; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D055815:Young Adult
chemical_list: D001786:Blood Glucose