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PAPERS: Daniele Perucchini, Ursin Fischer, Giatgen A Spinas, Renate Huch, Albert Huch, and Roger Lehmann Using fasting plasma glucose concentrations to screen for gestational diabetes mellitus: prospective population based study BMJ 1999; 319: 812-815 [Abstract] [Full text]

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High prevalence of abnormal OGTT early in pregnancy in the sultanate of Oman

Umesh Kumar Dashora   (3 October 1999)

High prevalence of abnormal OGTT early in pregnancy in the sultanate of Oman 3 October 1999
Umesh Kumar Dashora, Regional Diabetologist Ibri Regional Referral Hospital Send response to journal: Re: High prevalence of abnormal OGTT early in pregnancy in the sultanate of Oman	Perucchini et al have stated in their article (1) that fasting blood sugar (FBS) over 4.8 mmol/l is a good single step screening test to identify patients with gestational diabetes mellitus (GDM). In a prospective observational study conducted at Ibra Hospital in the Sultanate of Oman, 563 antenatal cases were screened for GDM by oral glucose tolerance test using 0 and 2hr-post 75 gram glucose protocol. Whole blood capillary glucose was measured using a glucometer. Fasting more than 5 mmol/L and post glucose 6.7 (equivalent to plasma glucose- 7.8mmol/L) was taken as diagnostic of GDM (2). The prevalence of GDM was 21.31 % ( 95 % confidence limits 18.31% to 24.31%). It was interesting to note that out of 120 patients who exhibited GDM, only 6 had high FBS ( mean- 7.6 ,SD- 2.26 mmol/L ). On the other hand 114 patients had GDM by the criterion of 2 hr post 75 gram glucose ( Mean 8.66, SD 1.72).Control group of non diabetic pregnancy (NDP) had FBS of average 3.76 (SD 0.58) and post glucose blood sugar (PGBS) of mean 4.94 (SD 1.03). In view of the above results we feel that, at least in ethnic groups where diabetes prevalence is high (3) PGBS may be more important than FBS in diagnosing or excluding GDM. Time at which screening for GDM should be done is usually advocated as 28 wks of pregnancy. We did GTT screening for our patients at first contact during antenatal visits. When it was normal the test was repeated 4-6 weeks apart at two additional occasions such that the last GTT coincided with 28 wks pregnancy. Most of the GDM cases were diagnosed at the first testing (i.e. 87.5%) and 2nd and 3rd GTT added additional information only in a minority of cases i.e. 10% and 2.5% respectively. The highest yield of GDM was in 3rd month of pregnancy (25.8%) and almost all cases (over 80 %) were diagnosed much before 28 th week of pregnancy . We therefore feel that the screening for GDM in countries with high prevalence of diabetes should take place much before 28 wk of pregnancy, preferably at the first contact with the patients. Most of the GDM cases exhibited normal glucose tolerance when tested at 40 days postpartum. References: 1 Perucchini D , Fischer U, Spinas G A, Huch R, Huch A, Lehmann R. Using fasting plasma glucose concentrations to screen for gestational diabetes mellitus: prospective population based study . . BMJ 1999;319:812-815 ( 25 September ) 2 Diabetes in Pregnancy.Antenatal care manual.Third Edition 1996.Published by the Department of Family and Community Health,Ministry of Health ,Sultanate of Oman 3. Asfour MG, Lambourne A, Soliman A, Al-Behlani S, Al-Asfoor D, Bold A, Mahtab H, King H High prevalence of diabetes mellitus and impaired glucose tolerance in the Sultanate of Oman: results of the 1991 national survey. Diabet Med 1995 (12):1122-5 Dr Umesh Kumar Dashora, MRCP, Regional Diabetologist Dr Vandana Dashora, MS, Medical Officer, Gynaecology and Obstetrics Dr John Idicula, MS, Medical Superintendent, Ibri Regional Referral Hospital, POB 46 PC 516 Sultanate of Oman.Ph 968 491905 Fax:968 491915 Dr MG Asfour, Head, National Diabetes Center,Muscat- WHO collaborating center E-mail: dashora@hotmail.com Acknowledgement: We are thankful to Mr Ali Abdulla Habsi ,the Director General of North Sherqia region for his kind support for the study.