Screening Test for Gestational Diabetes
(Ivanhoe Newswire) -- In a new study, researchers have determined a fasting plasma glucose test used at the first prenatal visit is not an effective method of screening for gestational diabetes.
The standard method of screening for gestational diabetes mellitus (GDM) in expectant mothers is the one-hour glucose challenge test. However, there are some concerns that have surfaced regarding this test's clinical efficacy. For example, test results may vary depending on the amount of time since a woman's last meal. Also, the timing of the test has to be very precise with blood for the glucose test being drawn exactly one hour after ingesting the glucose. Also of concern are unpleasant side effects that the concentrated glucose can cause, often decreasing compliance with the test.
In a new study, researchers from California predicted that using the fasting plasma glucose as a screening test for diabetes early in gestation would offer advantages over the currently used postglucose challenge. The study involved more than 4,500 patients recruited from the Kaiser Permanente Bellflower Medical Center who were not known to have diabetes. All of the women were asked at their first prenatal visit to return for routine laboratory work and a venous plasma glucose test the next morning after a fast beginning no later than midnight.
Upon testing, women whose blood sugar levels were 100 mg/dL to 125mg/dL were advised to have a glucose tolerance test immediately. Those women with a fasting plasma glucose concentration greater than or equal to 126mg/dL were asked to return for a second test. If the second test revealed similar numbers, those women were referred to care for diabetes. All women not identified as having diabetes were advised to have a two-hour GTT at their first visit after their 23rd gestational week.
Study results show that 302 women were identified as having gestational diabetes. However, researchers say there was a false-positive rate of 57 percent to achieve a sensitivity of 80 percent. In other words, over half of all the patients who did not have gestational diabetes underwent a GTT to be able to identify 80 percent of those who did. These false-positive rates were significantly greater than those of other screening methods used to detect gestational diabetes.
Researchers therefore conclude that, while detection of gestational diabetes early in pregnancy is a desirable goal, the implications of the current study show the fasting plasma glucose screening test given at the first prenatal visit is not an efficient screening test for gestational diabetes.
This article was reported by Ivanhoe.com, who offers Medical Alerts by e-mail every day of the week. To subscribe, go to: http://www.ivanhoe.com/newsalert/.
SOURCE: Obstetrics and amp; Gynecology, 2003;101:1197-1203
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