Using fasting plasma glucose concentrations to screen for gestational diabetes mellitus: prospective population based study

BMJ 1999;319:812-815 ( 25 September )

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Using fasting plasma glucose concentrations to screen for gestational diabetes mellitus: prospective population based study

Daniele Perucchini, senior registrar in obstetrics, ^a Ursin Fischer, general practitioner, ^a Giatgen A Spinas, professor of medicine, ^b Renate Huch, professor of obstetrics, ^a Albert Huch, professor of obstetrics, ^a Roger Lehmann, senior registrar in diabetology. ^b

^a Departments of Obstetrics and Gynaecology, University Hospital Zurich, CH-8091 Zurich, Switzerland, ^b Department of Internal Medicine, Division of Endocrinology and Diabetes, University Hospital Zurich

Correspondence to: R Lehmann Roger.Lehmann{at}dim.usz.ch

Objective: To evaluate whether measuring fasting plasmaglucose concentration is an easier screening procedure for gestationaldiabetes mellitus than the 1 hour 50 g glucose challengetest.
Design: Prospective population basedstudy.
Setting: Outpatient clinic in a universityhospital.
Participants: 520 pregnant women (328 (63%) white, 99 (19%)Asian, 31 (6%) African, 62 (12%) others) with mean age 28.4 (SD0.2; range 17-45) years. All underwent a glucose challenge testbetween the 24th and 28th gestational week, followed by a diagnostic3 hour 100 g oral glucose tolerance test within one week. Thiswas done irrespective of the result of the challengetest.
Main outcome measure: Receiver operating curves were used to determinethe best cut off values for screening with fasting plasma glucoseconcentrations.
Results: Fasting plasma glucose concentration at athreshold value of 4.8 mmol/l and the glucose challenge test witha threshold value of 7.8 mmol/l yielded sensitivities of 81% and59% respectively and specificities of 76% and 91% respectively.Measuring fasting plasma glucose concentration as a screeningprocedure required a diagnostic test in 30%, compared with 14%when the challenge test wasused.
Conclusions: Measuring fasting plasma glucose concentrationsusing a cut off value of $>=$ 4.8 mmol/l is an easier screening procedurefor gestational diabetes than the 50 g glucose challenge testand allows 70% of women to avoid the challengetest.

Key messages

Identifying women susceptible to gestational diabetes is particularly important not only to prevent perinatal morbidity but also to improve long term outcomes for the mother and her child
Measuring fasting plasma glucose concentration is an easier screening procedure for gestational diabetes than the 1 hour 50 g glucose challenge test
With a threshold value of 4.8 mmol/l it yields a sensitivity of 81% and a specificity of 76%
Measuring fasting plasma glucose concentration allows 70% of women to avoid a glucose challenge test

© BMJ 1999

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