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Xu Q, Sun M, Wang W, Shi Y. All-Dielectric Metasurface-Based Terahertz Molecular Fingerprint Sensor for Trace Cinnamoylglycine Detection. BIOSENSORS 2024; 14:440. [PMID: 39329815 PMCID: PMC11430580 DOI: 10.3390/bios14090440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2024] [Revised: 08/30/2024] [Accepted: 09/11/2024] [Indexed: 09/28/2024]
Abstract
Terahertz (THZ) spectroscopy has emerged as a superior label-free sensing technology in the detection, identification, and quantification of biomolecules in various biological samples. However, the limitations in identification and discrimination sensitivity of current methods impede the wider adoption of this technology. In this article, a meticulously designed metasurface is proposed for molecular fingerprint enhancement, consisting of a periodic array of lithium tantalate triangular prism tetramers arranged in a square quartz lattice. The physical mechanism is explained by the finite-difference time-domain (FDTD) method. The metasurface achieves a high quality factor (Q-factor) of 231 and demonstrates excellent THz sensing capabilities with a figure of merit (FoM) of 609. By varying the incident angle of the THz wave, the molecular fingerprint signal is strengthened, enabling the highly sensitive detection of trace amounts of analyte. Consequently, cinnamoylglycine can be detected with a sensitivity limit as low as 1.23 μg·cm-2. This study offers critical insights into the advanced application of THz waves in biomedicine, particularly for the detection of urinary biomarkers in various diseases, including gestational diabetes mellitus (GDM).
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Affiliation(s)
| | | | | | - Yanpeng Shi
- School of Integrated Circuits, Shandong University, Jinan 250100, China
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AlShaibani T, Gherbal W, Almarabheh A, Rizk D, Alhakmani E, Alshamrani R, AlBahraini F, Taha H, Hassani A, Naguib Y. Insulin Blood Levels in Gestational Diabetes Mellitus in Relation to Ethnicity and Age in the Kingdom of Bahrain: A Cross-Sectional Study. Cureus 2024; 16:e64886. [PMID: 39035597 PMCID: PMC11258594 DOI: 10.7759/cureus.64886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2024] [Indexed: 07/23/2024] Open
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) is one of the most common complications of pregnancy. It may be attributed to certain placental hormones during pregnancy which render insulin less effective. Our study aimed to focus on the levels of insulin in gestational diabetic women in the Kingdom of Bahrain as compared with non-diabetic pregnant women. Furthermore, we studied the correlation between insulin levels by ethnicity and age of the pregnant women. Methods: A cross-sectional study was conducted on 75 pregnant participants: 41 with GDM (test group) and 34 without GDM (control group). Insulin levels were determined in patients with GDM and compared to non-diabetic pregnant women. A comparison between Bahraini and non-Bahraini women was carried out in two different age groups: below and above 30 years of age. P values < 0.05 were considered significant. RESULTS The results showed higher mean values of fasting blood glucose (FBG), random blood glucose (RBG), and insulin levels in the test group when compared to the control group. There was no significant difference in FBG, RBG, and insulin levels among Bahraini women with GDM and non-Bahraini women (Indian, Pakistani. Bengali, and Filipino) with GDM. Age, less than 30 vs more than 30 years, had no significant effect on women with GDM. CONCLUSION Insulin levels were higher in pregnant women with GDM irrespective of their ethnicity or age. The lack of blood glucose control in GDM even in the presence of high insulin secretion may suggest loss of insulin effectiveness due to other factors such as stress and lactogenic placental hormones.
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Affiliation(s)
| | - Wadeea Gherbal
- Department of Obstetrics and Gynecology, Salmaniya Medical Complex, Manama, BHR
| | - Amer Almarabheh
- Department of Family and Community Medicine, Arabian Gulf University, Manama, BHR
| | - Diaa Rizk
- Department of Obstetrics and Gynecology, Arabian Gulf University, Manama, BHR
| | - Elaf Alhakmani
- Department of Obstetrics and Gynecology, Arabian Gulf University, Manama, BHR
| | - Raghad Alshamrani
- Department of Obstetrics and Gynecology, Arabian Gulf University, Manama, BHR
| | - Farah AlBahraini
- Department of Obstetrics and Gynecology, Arabian Gulf University, Manama, BHR
| | - Husain Taha
- Department of Internal Medicine, Salmaniya Medical Complex, Manama, BHR
| | - Amal Hassani
- Department of Obstetrics and Gynecology, Salmaniya Medical Complex, Manama, BHR
| | - Yahya Naguib
- Department of Physiology, Arabian Gulf University, Manama, BHR
- Department of Clinical Physiology, Faculty of Medicine, Menoufia University, Shibin El Kom, EGY
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Ozgu-Erdinc AS, Sert UY, Kansu-Celik H, Moraloglu Tekin O, Engin-Ustun Y. Prediction of gestational diabetes mellitus in the first trimester by fasting plasma glucose which cutoff is better? Arch Physiol Biochem 2022; 128:195-199. [PMID: 31573373 DOI: 10.1080/13813455.2019.1671457] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE We aimed to predict subsequent gestational diabetes mellitus (GDM) by fasting plasma glucose (FPG) in the first trimester. METHODS Healthy pregnant women who were screened for GDM at 24-28 gestational weeks and had FPG levels calculated during their first antenatal visit and less than 14 gestational weeks were included in this study. RESULTS Of the 2605 women who were recruited for the study, 245 (9.4%) were diagnosed with GDM at weeks 24-28. The diagnostic accuracy for FPG predicting GDM was 66.5, 78.4, and 88.2 for the cutoff values of 87.5 mg/dl, 92 mg/dl, and 99.5 mg/dl, respectively. CONCLUSIONS FPG values which are within the normoglycaemic range constitute an independent risk factor for the development of GDM. The threshold for gestational diabetes diagnosis must be revised.
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Affiliation(s)
- A Seval Ozgu-Erdinc
- Dr. Zekai Tahir Burak Women's Health Care, Education and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Umit Yasemin Sert
- Dr. Zekai Tahir Burak Women's Health Care, Education and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Hatice Kansu-Celik
- Dr. Zekai Tahir Burak Women's Health Care, Education and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Ozlem Moraloglu Tekin
- Dr. Zekai Tahir Burak Women's Health Care, Education and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Yaprak Engin-Ustun
- Dr. Zekai Tahir Burak Women's Health Care, Education and Research Hospital, University of Health Sciences, Ankara, Turkey
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Sert UY, Ozgu-Erdinc AS. Gestational Diabetes Mellitus Screening and Diagnosis. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2020; 1307:231-255. [PMID: 32314318 DOI: 10.1007/5584_2020_512] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
An ideal screening test for gestational diabetes should be capable of identifying not only women with the disease but also the women with a high risk of developing gestational diabetes mellitus (GDM). Screening and diagnosis are the main steps leading to the way of management. There is a lack of consensus among healthcare professionals regarding the screening methods worldwide. Different study groups advocate a variety of screening methods with the support of evidence-based comprehensive data. Some of the organizations suggest screening for high risk or all pregnant women, while others prefer to offer definitive testing without screening. Glycemic thresholds are also not standardized to decide GDM among different guidelines. Prevalence rates of GDM vary between populations and with the choice of glucose thresholds for both screening and definitive tests. One-step or two-step methods have been used for GDM diagnosis. However, screening includes selecting patients with historical risk factors, 50 g 1-h glucose challenge test, fasting plasma glucose, random plasma glucose, and hemoglobin A1c with different cutoffs. In this chapter, screening and diagnosis methods of GDM accepted by different study groups will be discussed which will be followed by the evaluation of different glycemic thresholds. Then the advantages and disadvantages of used methods will be explained and the chapter will finish with an evaluation of the current international guidelines.
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Affiliation(s)
- U Yasemin Sert
- Ministry of Health-Ankara City Hospital, Universiteler Mahallesi Bilkent Cad, Ankara, Turkey
| | - A Seval Ozgu-Erdinc
- Ministry of Health-Ankara City Hospital, Universiteler Mahallesi Bilkent Cad, Ankara, Turkey.
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Reyes-Muñoz E, Sandoval-Osuna NL, Reyes-Mayoral C, Ortega-González C, Martínez-Cruz N, Ramírez-Torres MA, Arce-Sánchez L, Lira-Plascencia J, Estrada-Gutiérrez G, Montoya-Estrada A. Sensitivity of fasting glucose for gestational diabetes mellitus screening in Mexican adolescents based on International Association of Diabetes and Pregnancy Study Groups criteria: a diagnostic accuracy study based on retrospective data analysis. BMJ Open 2018; 8:e021617. [PMID: 29654051 PMCID: PMC5905784 DOI: 10.1136/bmjopen-2018-021617] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 02/24/2018] [Accepted: 03/02/2018] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE To evaluate fasting plasma glucose (FPG) as a screening test for gestational diabetes mellitus (GDM) among Mexican adolescents using International Association of Diabetes and Pregnancy Study Groups criteria. DESIGN Retrospective cohort study. SETTING Level-three medical institution in Mexico City. PARTICIPANTS The study population comprised 1061 adolescent women aged 12-19 years with singleton pregnancies, who underwent a 75 g oral glucose tolerance test (OGTT) between 11 and 35 weeks of gestation. PRIMARY AND SECONDARY OUTCOME MEASURES The sensitivity (Sn), specificity (Sp), positive and negative predictive values (PPV and NPV, respectively), and positive and negative likelihood ratios LR (+) and LR (-), respectively) with 95% CIs for selected FPG cut-off values were compared. Secondary measures were perinatal outcomes in women with and without GDM. RESULTS GDM was present in 71 women (6.7%, 95% CI 5.3% to 8.4%). The performances of FPG at thresholds of ≥80 (4.5 mmol/L), 85 (4.7 mmol/L) and 90 mg/dL (5.0 mmol/L) were as follow (95% CI): Sn: 97% (89% to 99%), 94% (86% to 97%) and 91% (82% to 95%); Sp: 50% (47% to 53%), 79% (76% to 81%) and 97% (95% to 97%); PPV: 12% (9% to 15%), 23% (18% to 28%) and 64% (54% to 73%); NPV: 99% (98.5% to 99.9%) for all three cut-offs; LR (+): 1.9 (1.8 to 2.1), 4.3 (3.8 to 5.0) and 26.7 (18.8 to 37.1) and LR (-): 0.06 (0.02 to 0.23), 0.07 (0.03 to 0.19) and 0.09 (0.04 to 0.19), respectively. No significant differences in perinatal outcomes were found between adolescents with and without GDM. CONCLUSIONS An FPG cut-off of ≥90 mg/dL (5.0 mmol/L) is ideal for GDM screening in Mexican adolescent women. An FPG threshold of 90 mg/dL would miss 6 (8.5%) women with GDM, pick up 34 (3.4%) women without GDM and avoid 962 (90.7%) OGTTs.
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Affiliation(s)
- Enrique Reyes-Muñoz
- Department of Gynecological and Perinatal Endocrinology, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City, Mexico
| | - Norma Lidia Sandoval-Osuna
- Division of Obstetrics and Gynecology, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City, Mexico
| | - Christian Reyes-Mayoral
- Division of Obstetrics and Gynecology, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City, Mexico
| | - Carlos Ortega-González
- Department of Endocrinology, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City, Mexico
| | - Nayeli Martínez-Cruz
- Department of Endocrinology, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City, Mexico
| | - María Aurora Ramírez-Torres
- Department of Endocrinology, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City, Mexico
| | - Lidia Arce-Sánchez
- Department of Endocrinology, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City, Mexico
| | - Josefina Lira-Plascencia
- Research Unit in Adolescent Medicine, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City, Mexico
| | - Guadalupe Estrada-Gutiérrez
- Direction of Research, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City, Mexico
| | - Araceli Montoya-Estrada
- Department of Gynecological and Perinatal Endocrinology, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City, Mexico
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Giannubilo SR, Pasculli A, Ballatori C, Biagini A, Ciavattini A. Fetal Sex, Need for Insulin, and Perinatal Outcomes in Gestational Diabetes Mellitus: An Observational Cohort Study. Clin Ther 2018; 40:587-592. [PMID: 29567300 DOI: 10.1016/j.clinthera.2018.02.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2016] [Revised: 02/21/2018] [Accepted: 02/24/2018] [Indexed: 11/27/2022]
Abstract
PURPOSE This was a prospective observational cohort study that aimed to determine whether fetal sex influences the maternal and fetal outcomes of gestational diabetes mellitus (GDM). METHODS In this study, 327 European primiparous women were consecutively recruited after diagnosis of GDM. AUC on the oral glucose tolerance test (OGTT), need for insulin therapy, maternal and obstetrical outcomes, and fetal fat mass (by measuring the thickness of the anterior abdominal subcutaneous tissue) were recorded and compared between the two subgroups of female and male fetuses. FINDINGS Despite the absence of differences in multiple comparisons of the OGTT, the AUC-OGTT was significantly higher in women carrying a male fetus (22.6 [3.2] mmol/L vs 19.7 [2.8] mmol/L). The abdominal fat thickness appeared to increase with gestational age, with higher growth in male fetuses than in female fetuses. The overall risk of need for insulin therapy was significantly higher in women carrying a male fetus (odds ratio = 1.837). At delivery, birthweight was higher in males than in females only if adjusted for gestational age, similarly for placental weight, otherwise there were no significant differences between the groups in total length of gestation, rates of cesarean delivery, and Apgar scores. IMPLICATIONS Overall, our data propose an association between fetal sex and GDM outcomes, suggesting the hypothesis that in maternal-fetal interactions, the fetus can affect maternal glucose metabolism.
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Affiliation(s)
| | - Angela Pasculli
- Department of Clinical Sciences, Polytechnic University of Marche, Salesi Hospital, Ancona, Italy
| | - Chiara Ballatori
- Department of Clinical Sciences, Polytechnic University of Marche, Salesi Hospital, Ancona, Italy
| | - Alessandra Biagini
- Department of Clinical Sciences, Polytechnic University of Marche, Salesi Hospital, Ancona, Italy
| | - Andrea Ciavattini
- Department of Clinical Sciences, Polytechnic University of Marche, Salesi Hospital, Ancona, Italy
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Rauf M, Sevil E, Ebru C, Cemil C. Early diagnosis of gestational diabetes mellitus during the first trimester of pregnancy based on the one-step approach of the International Association of Diabetes and Pregnancy Study Groups. Int J Diabetes Dev Ctries 2016. [DOI: 10.1007/s13410-016-0545-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
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Cho HY, Jung I, Kim SJ. The association between maternal hyperglycemia and perinatal outcomes in gestational diabetes mellitus patients: A retrospective cohort study. Medicine (Baltimore) 2016; 95:e4712. [PMID: 27603367 PMCID: PMC5023889 DOI: 10.1097/md.0000000000004712] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Pregnancies complicated by gestational diabetes mellitus (GDM) are associated with increased risks of adverse maternal and fetal outcomes. The risks of adverse pregnancy outcomes differ depending on the glucose values among GDM patients. For accurate and effective prenatal counseling, it is necessary to understand the relationship between different maternal hyperglycemia values and the severity of adverse outcomes. With this objective, this study reexamines the relationship between maternal hyperglycemia versus maternal and perinatal outcomes in GDM patients. For this study, maternal hyperglycemia was diagnosed using the 2-step diagnostic approach.Medical records of 3434 pregnant women, who received the 50-g glucose challenge test (GCT) between March 2001 and April 2013, were reviewed. As a result, 307 patients were diagnosed with GDM, and they were divided into 2 groups according to their fasting glucose levels. A total of 171 patients had normal fasting glucose level (<95 mg/dL), and 136 patients had abnormal fasting glucose level (≥95 mg/dL). The 50-g GCT results were subdivided by 20-unit increments (140-159, n = 123; 160-179, n = 84; 180-199, n = 50; and ≥200, n = 50), and the maternal and perinatal outcomes were compared against the normal 50-g GCT group (n = 307).Maternal fasting blood glucose (FBG) level showed clear association with adverse perinatal outcomes. The odds ratio (OR) of macrosomia was 6.72 (95% CI: 2.59-17.49, P < 0.001) between the 2 groups. The ORs of large for gestational age (LGA) and neonatal hypoglycemia were 3.75 (95% CI: 1.97-7.12, P < 0.001) and 1.65 (95% CI: 0.79-3.43, P = 0.183), respectively. Also, the results of the 50-g GCT for each category showed strong association with increased risks of adverse perinatal outcomes compared to the normal 50-g GCT group. The OR of macrosomia (up to 20.31-fold), LGA (up to 6.15-fold), and neonatal hypoglycemia (up to 84.00-fold) increased with increasing 50-g GCT result.
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Affiliation(s)
- Hee Young Cho
- Department of Obstetrics and Gynecology, Institute of Women's Life Medical Science, Yonsei University College of Medicine, Yonsei University Health System, Seoul
- Department of Obstetrics and Gynecology, CHA Bundang Medical Center, CHA University, Seongnam
- Correspondence: Hee Young Cho, Department of Obstetrics and Gynecology, Institute of Women's Life Medical Science, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea; Department of Obstetrics and Gynecology, CHA Bundang Medical Center, CHA University, Seongnam, Korea (e-mail: )
| | - Inkyung Jung
- Department of Biostatistics and Medical Informatics
| | - So Jung Kim
- Department of Medicine, Yonsei University College of Medicine, Seoul, Korea
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Nabuco A, Pimentel S, Cabizuca CA, Rodacki M, Finamore D, Oliveira MM, Zajdenverg L. Early diabetes screening in women with previous gestational diabetes: a new insight. Diabetol Metab Syndr 2016; 8:61. [PMID: 27570545 PMCID: PMC5002139 DOI: 10.1186/s13098-016-0172-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Accepted: 07/18/2016] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) is a risk factor for the development of diabetes mellitus (DM). However, there is a low return rate for this screening, so it is important to search for earlier methods for evaluation after delivery, to increase the number of pregnant women screened, so you can start the treatment or prevention of these early comorbidities. To determine the accuracy of the 75 g 2-h oral glucose tolerance test (OGTT) performed between 48-72 h after delivery for the diagnosis of DM using the OGTT after 6 weeks as the gold standard criterion, and to identify the optimal cutoff points for this exam for diabetes screening after a pregnancy complicated by GDM. METHODS 82 women with previous GDM underwent an OGTT between 48-72 h postpartum and repeated the test 6 weeks after delivery. RESULTS The prevalence of DM and prediabetes based on the first OGTT was 3.7 and 32.9 %, respectively, and 8.5 and 20.7 %, respectively, at the second OGTT. For those with DM, the area under the curve (AUC) based on the fasting plasma glucose (FPG) was 0.77 (95 % CI 0.61-0.92), and based on 2-h OGTT was 0.82 (95 % CI 0.66-0.97). For patients with prediabetes, the AUC based on the FPG was 0.73 (95 % CI 0.59-0.86) and based on the 2-h OGTT was 0.74 (95 % CI 0.61-0.87). Using a FPG cutoff value of 78 mg/dl (4.3 mmol/L) and a 2-h OGTT cutoff value of 130 mg/dl (7.2 mmol/L) for DM, the specificity was 58.7 and 60 %, the sensitivity was 71.4 and 85.7 %, the positive predictive value was 13.9 and 16.7 and the negative predictive value was 95.7 and 97.9 %, respectively. CONCLUSIONS OGTT performed early in postpartum is a useful tool for identifying women with previous GDM who must perform an OGTT 6 weeks after delivery.
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Affiliation(s)
- Aline Nabuco
- Nutrology and Diabetes Section/Maternidade Escola, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro CEP 21941-913 Brazil
- Serviço de Nutrologia e Diabetes, Hospital Universitário Clementino Fraga Filho, Rua Professor Rodolpho Paulo Rocco 255, sala 9E14, University City, CEP 21941-913 Brazil
| | - Samara Pimentel
- Nutrology and Diabetes Section/Maternidade Escola, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro CEP 21941-913 Brazil
| | - Carolina A. Cabizuca
- Nutrology and Diabetes Section/Maternidade Escola, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro CEP 21941-913 Brazil
| | - Melanie Rodacki
- Nutrology and Diabetes Section/Maternidade Escola, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro CEP 21941-913 Brazil
| | - Denise Finamore
- Maternidade Escola, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Marcus M. Oliveira
- Nutrology and Diabetes Section/Maternidade Escola, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro CEP 21941-913 Brazil
| | - Lenita Zajdenverg
- Nutrology and Diabetes Section/Maternidade Escola, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro CEP 21941-913 Brazil
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Agarwal MM. Gestational diabetes mellitus: Screening with fasting plasma glucose. World J Diabetes 2016; 7:279-89. [PMID: 27525055 PMCID: PMC4958688 DOI: 10.4239/wjd.v7.i14.279] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Revised: 05/30/2016] [Accepted: 06/27/2016] [Indexed: 02/05/2023] Open
Abstract
Fasting plasma glucose (FPG) as a screening test for gestational diabetes mellitus (GDM) has had a checkered history. During the last three decades, a few initial anecdotal reports have given way to the recent well-conducted studies. This review: (1) traces the history; (2) weighs the advantages and disadvantages; (3) addresses the significance in early pregnancy; (4) underscores the benefits after delivery; and (5) emphasizes the cost savings of using the FPG in the screening of GDM. It also highlights the utility of fasting capillary glucose and stresses the value of the FPG in circumventing the cumbersome oral glucose tolerance test. An understanding of all the caveats is crucial to be able to use the FPG for investigating glucose intolerance in pregnancy. Thus, all health professionals can use the patient-friendly FPG to simplify the onerous algorithms available for the screening and diagnosis of GDM - thereby helping each and every pregnant woman.
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Soumya S, Rohilla M, Chopra S, Dutta S, Bhansali A, Parthan G, Dutta P. HbA1c: A Useful Screening Test for Gestational Diabetes Mellitus. Diabetes Technol Ther 2015; 17:899-904. [PMID: 26496534 DOI: 10.1089/dia.2015.0041] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) is associated with adverse maternal and fetal outcomes, and the oral glucose tolerance test (OGTT) is the recommended test for its diagnosis. We evaluated the role of glycated hemoglobin (HbA1c) in screening and diagnosis of GDM and its correlation with adverse pregnancy outcomes. SUBJECTS AND METHODS In this prospective observational study, OGTT and HbA1c were performed in 500 antenatal women between 24 and 28 weeks of gestation; the pregnant women were followed up thereafter. Repeat OGTT and HbA1c were done in women with GDM at 6 weeks postpartum. RESULTS Among the 500 women, 45 were diagnosed with GDM, for an incidence of 9%. The mean HbA1c level in women with GDM was 6.2 ± 0.6%, whereas it was 5.4 ± 0.5% in those with normoglycemia. Women with GDM had a higher incidence of pregnancy-related complications compared with normoglycemic women. An HbA1c cutoff of 5.3% had a sensitivity of 95.6% and a specificity of 51.6% for the diagnosis of GDM and would have avoided OGTT in approximately half of antenatal women, while missing 5% of the women. However, those with an abnormal HbA1c will require a confirmatory OGTT, as 50% of normoglycemic women would be misclassified as having GDM by this approach. On repeat testing postpartum, two of 45 women (4.4%) had overt diabetes mellitus, whereas five (11.1%) had impaired glucose tolerance. CONCLUSIONS Although HbA1c cannot replace OGTT in the diagnosis of GDM, it can be used as a screening test, avoiding OGTT in approximately 50% of women, if a cutoff of 5.3% is used.
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Affiliation(s)
- Srmshtty Soumya
- 1 Department of Obstetrics and Gynecology, Postgraduate Institute of Medical Education and Research , Chandigarh, India
| | - Minakshi Rohilla
- 1 Department of Obstetrics and Gynecology, Postgraduate Institute of Medical Education and Research , Chandigarh, India
| | - Seema Chopra
- 1 Department of Obstetrics and Gynecology, Postgraduate Institute of Medical Education and Research , Chandigarh, India
| | - Sourabh Dutta
- 3 Department of Neonatology, Postgraduate Institute of Medical Education and Research , Chandigarh, India
| | - Anil Bhansali
- 2 Department of Endocrinology, Postgraduate Institute of Medical Education and Research , Chandigarh, India
| | - Girish Parthan
- 2 Department of Endocrinology, Postgraduate Institute of Medical Education and Research , Chandigarh, India
| | - Pinaki Dutta
- 2 Department of Endocrinology, Postgraduate Institute of Medical Education and Research , Chandigarh, India
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Lotufo PA. Non-communicable diseases in Brazil: a flood of data is coming! SAO PAULO MED J 2015; 133:283-5. [PMID: 26517144 PMCID: PMC10876353 DOI: 10.1590/1516-3180.2015.13340806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Paulo Andrade Lotufo
- Department of Internal Medicine, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
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Agarwal MM. Gestational diabetes mellitus: An update on the current international diagnostic criteria. World J Diabetes 2015; 6:782-91. [PMID: 26131321 PMCID: PMC4478575 DOI: 10.4239/wjd.v6.i6.782] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Revised: 04/20/2015] [Accepted: 05/16/2015] [Indexed: 02/05/2023] Open
Abstract
The approach to screening and diagnosis of gestational diabetes mellitus (GDM) around the world is disorderly. The protocols for diagnosis vary not only in-between countries, but also within countries. Furthermore, in any country, this disparity occurs in-between its hospitals and often exists within a single hospital. There are many reasons for these differences. There is the lack of an international consensus among preeminent health organizations (e.g., American College of Gynecologists and World Health Organization). Often there is a disagreement between the country's national diabetes organization, its local health society and its regional obstetric organization with each one recommending a different option for approaching GDM. Sometimes the causes for following an alternate approach are very obvious, e.g., a resource strapped hospital is unable to follow the ivory-tower demanding recommendation of its obstetric organization. But more often than not, the rationale for following or not following a guideline, or following different guideline within the same geographic area is without any perceivable explanation. This review is an attempt to understand the problems afflicting the screening and diagnosis of GDM globally. It traces the major temporal changes in the diagnostic criteria of (1) some respected health organizations; and (2) a few selected countries. With an understanding of the reasons for this disparity, a way forward can be found to reach the ultimate goal: a single global guideline for GDM followed worldwide.
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Liu C, Lu L, Kong Q, Li Y, Wu H, Yang W, Xu S, Yang X, Song X, Yang JY, Yang M, Deng Y. Developing discriminate model and comparative analysis of differentially expressed genes and pathways for bloodstream samples of diabetes mellitus type 2. BMC Bioinformatics 2014; 15 Suppl 17:S5. [PMID: 25559614 PMCID: PMC4304197 DOI: 10.1186/1471-2105-15-s17-s5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Background Diabetes mellitus of type 2 (T2D), also known as noninsulin-dependent diabetes mellitus (NIDDM) or adult-onset diabetes, is a common disease. It is estimated that more than 300 million people worldwide suffer from T2D. In this study, we investigated the T2D, pre-diabetic and healthy human (no diabetes) bloodstream samples using genomic, genealogical, and phonemic information. We identified differentially expressed genes and pathways. The study has provided deeper insights into the development of T2D, and provided useful information for further effective prevention and treatment of the disease. Results A total of 142 bloodstream samples were collected, including 47 healthy humans, 22 pre-diabetic and 73 T2D patients. Whole genome scale gene expression profiles were obtained using the Agilent Oligo chips that contain over 20,000 human genes. We identified 79 significantly differentially expressed genes that have fold change ≥ 2. We mapped those genes and pinpointed locations of those genes on human chromosomes. Amongst them, 3 genes were not mapped well on the human genome, but the rest of 76 differentially expressed genes were well mapped on the human genome. We found that most abundant differentially expressed genes are on chromosome one, which contains 9 of those genes, followed by chromosome two that contains 7 of the 76 differentially expressed genes. We performed gene ontology (GO) functional analysis of those 79 differentially expressed genes and found that genes involve in the regulation of cell proliferation were among most common pathways related to T2D. The expression of the 79 genes was combined with clinical information that includes age, sex, and race to construct an optimal discriminant model. The overall performance of the model reached 95.1% accuracy, with 91.5% accuracy on identifying healthy humans, 100% accuracy on pre-diabetic patients and 95.9% accuract on T2D patients. The higher performance on identifying pre-diabetic patients was resulted from more significant changes of gene expressions among this particular group of humans, which implicated that patients were having profound genetic changes towards disease development. Conclusion Differentially expressed genes were distributed across chromosomes, and are more abundant on chromosomes 1 and 2 than the rest of the human genome. We found that regulation of cell proliferation actually plays an important role in the T2D disease development. The predictive model developed in this study has utilized the 79 significant genes in combination with age, sex, and racial information to distinguish pre-diabetic, T2D, and healthy humans. The study not only has provided deeper understanding of the disease molecular mechanisms but also useful information for pathway analysis and effective drug target identification.
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Trujillo J, Vigo A, Reichelt A, Duncan BB, Schmidt MI. Fasting plasma glucose to avoid a full OGTT in the diagnosis of gestational diabetes. Diabetes Res Clin Pract 2014; 105:322-6. [PMID: 25037441 DOI: 10.1016/j.diabres.2014.06.001] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Revised: 05/31/2014] [Accepted: 06/02/2014] [Indexed: 12/11/2022]
Abstract
AIMS To evaluate the performance of fasting plasma glucose (FPG) in determining the need for a full oral glucose tolerance test (OGTT) to diagnose gestational diabetes (GDM) by the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria. METHODS A multicenter cohort study of 4926 pregnant women 20 years or older consecutively enrolled in prenatal care clinics of the Brazilian National Health Service from 1991 to 1995. All women underwent a single 2 h 75 g OGTT by weeks 24-28 of pregnancy and were followed to detect adverse pregnancy outcomes. RESULTS A FPG cut-off value of 80 mg/dl indicated that only 38.7% of all women needed to undergo a complete OGTT, while detecting 96.9% of all GDM cases. When the 85 mg/dl cut-off was used, the corresponding percentages were 18.7% and 92.5%, respectively. The fraction of women labeled with GDM who had adverse pregnancy outcomes was nearly identical when using FPG strategies and universal full testing. CONCLUSIONS Using a FPG cut-off to diagnose GDM and to determine the need for post-load OGTT measurements is a valid strategy to diagnose GDM by IADPSG criteria. This approach may improve feasibility of applying IADPSG diagnostic criteria by reducing costs and increasing convenience.
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Affiliation(s)
- J Trujillo
- Post Graduate Studies Program in Epidemiology, School of Medicine, Rio Grande do Sul Federal University, Rua Ramiro Barcelos 2600, sala 414, 90035-003, Porto Alegre, RS, Brazil.
| | - A Vigo
- Post Graduate Studies Program in Epidemiology, School of Medicine, Rio Grande do Sul Federal University, Rua Ramiro Barcelos 2600, sala 414, 90035-003, Porto Alegre, RS, Brazil
| | - A Reichelt
- Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - B B Duncan
- Post Graduate Studies Program in Epidemiology, School of Medicine, Rio Grande do Sul Federal University, Rua Ramiro Barcelos 2600, sala 414, 90035-003, Porto Alegre, RS, Brazil
| | - M I Schmidt
- Post Graduate Studies Program in Epidemiology, School of Medicine, Rio Grande do Sul Federal University, Rua Ramiro Barcelos 2600, sala 414, 90035-003, Porto Alegre, RS, Brazil
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Herrera K, Brustman L, Foroutan J, Scarpelli S, Murphy E, Francis A, Rosenn B. The importance of fasting blood glucose in screening for gestational diabetes. J Matern Fetal Neonatal Med 2014; 28:825-8. [PMID: 24939625 DOI: 10.3109/14767058.2014.935322] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To determine how well an isolated abnormal fasting blood glucose (FBG) value on the 1-step, 75-g, 2-hour glucose tolerance test (GTT) indicates significant gestational diabetes (GDM). METHODS Retrospective cohort study, January 2011 to May 2012. Patients diagnosed by the 1-step method were assigned by their abnormal results to the isolated fasting (FBG), isolated 1-hour (1HBG), isolated 2-hour (2HBG), or multiple-value (≥2BG) group. Characteristics and outcomes were compared using ANOVA, Kruskal--Wallis, and Chi-squared tests. RESULTS 324 patients were included. Compared to other groups, the FBG group (N = 23) had the highest incidence of requiring medical therapy (78.26%), mean body mass index (29.40 ± 6.20 kg/m(2)), and percentage of Black plus Hispanic women (60.87%). CONCLUSIONS Seven percent of women were diagnosed with GDM by an isolated abnormal fasting BG and have significant disease. This group should not be missed; therefore, fasting BG should be integrated into all GDM screening.
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Affiliation(s)
- Kimberly Herrera
- Department of Obstetrics & Gynecology, St. Luke's-Roosevelt Hospital Center , New York , USA
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Canella DS, Silva ACFD, Jaime PC. Produção científica sobre nutrição no âmbito da Atenção Primária à Saúde no Brasil: uma revisão de literatura. CIENCIA & SAUDE COLETIVA 2013; 18:297-308. [DOI: 10.1590/s1413-81232013000200002] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUÇÃO: Ações de nutrição na Atenção Primária à Saúde (APS) têm importante papel na promoção da saúde e na prevenção e tratamento de agravos. OBJETIVO: Mapear, sistematizar e avaliar a produção científica da nutrição no âmbito da APS no Brasil. MÉTODOS: Trata-se de uma revisão de literatura. A busca de artigos foi feita no PubMed e Lilacs, utilizando descritores referentes à APS e à nutrição. Foram levantados estudos conduzidos no Brasil, com profissionais ou população atendida pelo SUS na APS e publicados até março de 2011. Ainda, foram consultadas as referências dos artigos selecionados, a fim de identificar outros estudos. RESULTADOS: Do total de artigos localizados, 68 foram elegíveis e 49 foram identificados nas listas de referências, totalizando 117 artigos analisados. Estes foram, em sua maioria, artigos originais, quantitativos, conduzidos no estado de SP, pela USP e publicados de 2002 a 2011. Abordavam o diagnóstico, tendo como objeto a avaliação do estado nutricional e envolviam crianças. CONCLUSÃO: A produção na área é crescente, porém há necessidade de redirecionar a abordagem e o objeto de futuros estudos, focando em modelos de intervenção e em avaliação de programas.
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Detsch JCM, Almeida ACRD, Bortolini LGC, Nascimento DJ, Oliveira Junior FC, Réa RR. Marcadores para o diagnóstico e tratamento de 924 gestações com diabetes melito gestacional. ACTA ACUST UNITED AC 2011; 55:389-98. [DOI: 10.1590/s0004-27302011000600005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2010] [Accepted: 06/21/2011] [Indexed: 11/22/2022]
Abstract
OBJETIVOS: Avaliar o perfil epidemiológico e a evolução de mulheres com diabetes melito gestacional (DMG), determinando fatores de risco para maior vigilância. SUJEITOS E MÉTODOS: Foram estudadas 924 gestações de 916 pacientes, de 6 de novembro de 2001 a 21 de setembro de 2009. RESULTADOS: Foram encontrados fatores de risco para DMG em 95,1% dos casos. A prevalência de diabetes materno, paterno e em outros familiares foi de 24,3%, 9,4% e 24,7%, respectivamente. Os fatores preditivos para uso de insulina foram: glicemia de jejum (GJ) no rastreamento ≥ 85, GJ no Teste Oral de Tolerância à Glicose (TOTG) ≥ 95, glicemia 2h após 75 g de glicose ≥ 200 mg/dL, DMG prévio, obesidade, HbA1c > 6% e história familiar de DM em parente de primeiro grau associada à obesidade ou DMG prévio, esta última a associação mais relevante (p < 0,05). CONCLUSÕES: Os fatores de risco analisados se mostraram altamente sensíveis para a detecção de DMG, e a disposição da história familiar reforça sua relação com o DM2. Recomenda-se maior vigilância a gestantes com fatores preditivos para necessidade de insulina.
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Yachi Y, Tanaka Y, Anasako Y, Nishibata I, Saito K, Sone H. Contribution of first trimester fasting plasma insulin levels to the incidence of glucose intolerance in later pregnancy: Tanaka women's clinic study. Diabetes Res Clin Pract 2011; 92:293-8. [PMID: 21396732 DOI: 10.1016/j.diabres.2011.02.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2010] [Revised: 01/30/2011] [Accepted: 02/08/2011] [Indexed: 11/30/2022]
Abstract
AIMS To clarify risk factors predictive of glucose intolerance in later pregnancy. METHODS We prospectively studied 509 pregnant women who visited the obstetrics clinic in Tokyo prior to week 13 of gestation, between September 2008 and January 2010. Biochemical parameters were measured in fasting plasma samples collected at week 8.0 ± 2.0 of gestation. A 50 g glucose challenge test (GCT) was performed between weeks 26 and 29: plasma glucose levels ≥ 7.8 mmol/l 1h after ingestion indicated a positive GCT. Logistic regression was performed, adjusting for relevant covariates. RESULTS We identified 114 patients with positive GCTs, including 8 with gestational diabetes mellitus (GDM). After correcting for baseline body mass index, only the homeostasis model assessment of insulin resistance value remained a significant predictor of GCT positivity (OR 2.07; 1.21-3.55). We identified threshold values of fasting plasma glucose (FPG) ≥ 3.66 mmol/l and fasting plasma insulin (FPI) ≥ 36.69 pmol/l as indicative of a higher risk of positive GCT (OR 2.38; 1.49-3.80). CONCLUSIONS First trimester FPI levels improve the predictive ability of FPG level on subsequent GCT positivity.
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Affiliation(s)
- Yoko Yachi
- Department of Internal Medicine, University of Tsukuba Institute of Clinical Medicine, 3-2-7 Miyamachi, Mito, Ibaraki, Japan
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Virally M, Laloi-Michelin M. Methods for the screening and diagnosis of gestational diabetes mellitus between 24 and 28 weeks of pregnancy. DIABETES & METABOLISM 2011; 36:549-65. [PMID: 21163420 DOI: 10.1016/j.diabet.2010.11.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The aim of this review is to provide answers to the question “How does one screen for and diagnose gestational diabetes mellitus (GDM) between 24 and 28 weeks gestation?” Two methods are currently widely used: a one-step approach (the 75g-Oral Glucose Tolerance Test, OGTT) and a two-step approach (the 50g Glucose Challenge Test, GCT, followed by 100g-OGTT). A review of the literature showed that both methods had good reproducibility (around 80%), whilst neither required preliminary diet changes. The data of the Hyperglycaemia Adverse Pregnancy Outcomes (HAPO) study on materno-foetal morbidity provided consistent support in favour of the 75g-OGTT. In addition, this one-step method presents several advantages over the two-step method, i.e. it provides a faster diagnosis time, better tolerance and it is easier to remember. We thus recommend a 75g-OGTT including three measures of the glycaemia at times 0, 1 and 2 hours for the diagnosis of GDM between 24-28 weeks of pregnancy. A discussion of alternative methods revealed that measuring Fasting Glycaemia (FG) between 24 and 28 weeks of pregnancy was unsuitable, and that measuring HbA1c, fructosamine, glycosuria, or random and postprandial plasma glucose was not advisable. This is based on the fact that too few studies have evaluated these methods, and that the studies usually involved heterogeneous populations in varying numbers, using differing criteria and sensitivity values. However, HbA1c measurements may prove useful in detecting pre-pregnancy diabetes mellitus.
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Affiliation(s)
- M Virally
- AP-HP, Service de médecine B, hôpital Lariboisière, 2, rue Ambroise Paré, 75010 Paris, France.
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Round JA, Jacklin P, Fraser RB, Hughes RG, Mugglestone MA, Holt RIG. Screening for gestational diabetes mellitus: cost-utility of different screening strategies based on a woman's individual risk of disease. Diabetologia 2011; 54:256-63. [PMID: 20809381 DOI: 10.1007/s00125-010-1881-y] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2010] [Accepted: 07/12/2010] [Indexed: 12/25/2022]
Abstract
AIMS/HYPOTHESIS The cost-effectiveness of eight strategies for screening for gestational diabetes (including no screening) was estimated with respect to the level of individual patient risk. METHODS Cost-utility analysis using a decision analytic model populated with efficacy evidence pooled from recent randomised controlled trials, from the funding perspective of the National Health Service in England and Wales. Seven screening strategies using various combinations of screening and diagnostic tests were tested in addition to no screening. The primary outcome measure was the incremental cost per quality-adjusted life-year (QALY) over a lifetime. RESULTS The strategy that has the greatest likelihood of being cost-effective is dependent on the risk of gestational diabetes mellitus for each individual woman. When gestational diabetes mellitus risk is <1% then the no screening/treatment strategy is cost-effective; where risk is between 1.0% and 4.2% fasting plasma glucose followed by OGTT is most likely to be cost-effective; and where risk is >4.2%, universal OGTT is most likely to be cost-effective. However, acceptability of the test alters the most cost-effective strategy. CONCLUSIONS/INTERPRETATION Screening for gestational diabetes can be cost-effective. The best strategy is dependent on the underlying risk of each individual and the acceptability of the tests used. The current study suggests that if a woman's individual risk of gestational diabetes could be accurately predicted, then healthcare resource allocation could be improved by providing an individualised screening strategy.
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Affiliation(s)
- J A Round
- Academic Unit of Health Economics, Institute of Health Sciences, University of Leeds, Leeds, UK.
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Virally M, Laloi-Michelin M. [Methods of screening of gestational diabetes between 24 and 28 weeks' gestation]. ACTA ACUST UNITED AC 2010; 39:S220-38. [PMID: 21185473 DOI: 10.1016/s0368-2315(10)70049-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The aim of this review is to answer the question "how to detect the gestational diabetes mellitus (GDM) between 24 and 28 weeks of gestation?". Two approaches are well established: one-step approach (75 g-OGTT) and two-steps approach (50 g followed 100g-OGTT). The analysis of the literature shows that each of these methods has a good reproducibility close to 80 %, without requiring preliminary dietetics. The HAPO study provides consistent data about the 75 g-OGTT materno-fetal morbidity related. Furthermore, the one-step approach, relationship two-steps approach, has several advantages: reduction of time of diagnosis and primary care, better tolerance, simpler memorization. We recommend for the screening and the diagnosis of GDM an 75 g-OGTT with three measures: FPG, 1-h and 2-h. The various alternative methods are discussed. The measure of the fasting blood glucose isolated between 24 and 28 weeks of gestation is not a relevant approach. None of the other alternative methods (HbA1c, fructosamine, glycosuria, random and postprandial plasma glucose) cannot be recommended. Indeed, these methods have been addressed in little numerous studies, among heterogeneous populations, using variable criteria, and variable sensitivity values. Only the HbA1c might be useful to detect a pre-pregnancy diabetes mellitus.
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Affiliation(s)
- M Virally
- Service de médecine B, hôpital Lariboisière, 2 rue Ambroise Paré, 75010 Paris, France.
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Waugh N, Pearson D, Royle P. Screening for hyperglycaemia in pregnancy: Consensus and controversy. Best Pract Res Clin Endocrinol Metab 2010; 24:553-71. [PMID: 20832736 DOI: 10.1016/j.beem.2010.06.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Policy decisions on whether to implement screening programmes depend on whether the proposed programmes meet a set of criteria laid down by the World Health Organization. Screening for hyperglycaemia in pregnancy (HGP) does not meet all the criteria. However the case for screening has been strengthened by a number of recent developments, including: rising prevalence of HGP because of increasing maternal age and BMI; the results of the Hyperglycaemia and Adverse Pregnancy Outcomes study, showing that adverse effects of HGP are seen over a wider range of plasma glucose levels than previously thought; two large trials which showed the benefits of treating lesser degrees of HGP; trials showing that metformin and glibenclamide were effective and safe alternatives to immediate insulin in those without good control on lifestyle measures alone. However uncertainties remain around the threshold for treatment, and on the best screening strategy.
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Affiliation(s)
- Norman Waugh
- Department of Public Health Medical School Buildings, Foresterhill, Aberdeen, UK.
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Riskin-Mashiah S, Damti A, Younes G, Auslender R. First trimester fasting hyperglycemia as a predictor for the development of gestational diabetes mellitus. Eur J Obstet Gynecol Reprod Biol 2010; 152:163-7. [PMID: 20579799 DOI: 10.1016/j.ejogrb.2010.05.036] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2009] [Revised: 05/29/2010] [Accepted: 05/31/2010] [Indexed: 01/02/2023]
Abstract
OBJECTIVE Screening for gestational diabetes mellitus (GDM) is usually done at 24-28 weeks of gestation. Our goal was to study the association between first trimester fasting plasma glucose level and GDM risk and to evaluate its efficacy as a screening test for GDM in comparison to a traditional risk factor, pregestational body mass index (BMI). STUDY DESIGN The charts of all patients who delivered in our hospital between June 2001 and June 2006 were reviewed. Only subjects with a singleton pregnancy and a recorded first trimester fasting glucose level and BMI were studied. Women with pregestational diabetes mellitus, fasting glucose level >105mg/dl or delivery at <24 weeks were excluded. Screening properties of both fasting glucose level and BMI were calculated and compared using receiver operator characteristic curves. RESULTS GDM was diagnosed in 135 of the 4876 women included in this study. Fasting glucose cut-off levels of 80-85mg/dl yielded sensitivities of 75-55% and specificities of 52-75% for GDM prediction. BMI cut-off values of 25-28 had sensitivities of 60-40% and specificities of 72-86% for GDM prediction. Receiver operator curves for fasting glucose levels and BMI showed similar performance in predicting GDM (area under curve 0.72±0.023 vs. 0.74±0.021 (P=0.44)). There was approximately a 1.5-fold increase in the risk of developing GDM with each 5mg/dl increase in fasting glucose or 3.5kg/m² increase in BMI. CONCLUSION Higher first trimester fasting glucose levels, within the normoglycemic range, constitute an independent risk factor for the development of GDM among young pregnant women.
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Affiliation(s)
- Shlomit Riskin-Mashiah
- Department of Obstetrics and Gynaecology, The Lady Davis Carmel Medical Centre, and Rappaport Faculty of Medicine, Haifa 34362, Israel.
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Negrato CA, Montenegro RM, Mattar R, Zajdenverg L, Francisco RPV, Pereira BG, Sancovski M, Torloni MR, Dib SA, Viggiano CE, Golbert A, Moisés ECD, Favaro MI, Calderon IMP, Fusaro S, Piliakas VDD, Dias JPL, Gomes MB, Jovanovic L. Dysglycemias in pregnancy: from diagnosis to treatment. Brazilian consensus statement. Diabetol Metab Syndr 2010; 2:27. [PMID: 20416099 PMCID: PMC2867808 DOI: 10.1186/1758-5996-2-27] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2009] [Accepted: 04/24/2010] [Indexed: 12/16/2022] Open
Abstract
There is an urgent need to find consensus on screening, diagnosing and treating all degrees of dysglycemia that may occur during pregnancies in Brazil, considering that many cases of dysglycemia in pregnant women are currently not diagnosed, leading to maternal and fetal complications. For this reason the Brazilian Diabetes Society (SBD) and the Brazilian Federation of Gynecology and Obstetrics Societies (FEBRASGO), got together to introduce this proposal. We present here a joint consensus regarding the standardization of clinical management for pregnant women with any degree of dysglycemia, on the basis of current information, to improve medical assistance and to avoid related complications of dysglycemia in pregnancy to the mother and the fetus. This consensus aims to standardize the diagnosis among general practitioners, endocrinologists and obstetricians allowing the dissemination of information in basic health units, public and private services, that are responsible for screening, diagnosing and treating disglycemic pregnant patients.
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Affiliation(s)
| | - Renan M Montenegro
- School of Medicine of the Federal University of Ceará, Fortaleza-Ce, Brazil
| | - Rosiane Mattar
- Federal School of Medicine of São Paulo State (UNIFESP), São Paulo-SP, Brazil
| | | | | | | | | | | | - Sergio A Dib
- Federal School of Medicine of São Paulo State (UNIFESP), São Paulo-SP, Brazil
| | - Celeste E Viggiano
- Nutrition Department of the Brazilian Diabetes Society, São Paulo-SP, Brazil
| | - Airton Golbert
- Federal University of Health Sciences of Porto Alegre (UFRGS), Porto Alegre-RS, Brazil
| | - Elaine CD Moisés
- School of Medicine of Ribeirão Preto (USP), Ribeirão Preto-SP, Brazil
| | | | - Iracema MP Calderon
- Botucatu Medical School, São Paulo State University (UNESP), Botucatu-SP, Brazil
| | - Sonia Fusaro
- Federal School of Medicine of São Paulo State (UNIFESP), São Paulo-SP, Brazil
| | - Valeria DD Piliakas
- Hospital and Maternity Leonor Mendes de Barros, and UNICASTELO, São Paulo-SP, Brazil
| | | | - Marilia B Gomes
- Endocrine and Diabetes Unit, State University of Rio de Janeiro, Rio de Janeiro-RJ, Brazil
| | - Lois Jovanovic
- Sansum Diabetes Research Institute, Santa Barbara, California, USA
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Nunes MAA, Camey S, Ferri CP, Manzolli P, Manenti CN, Schmidt MI. Violence during pregnancy and newborn outcomes: a cohort study in a disadvantaged population in Brazil. Eur J Public Health 2010; 21:92-7. [PMID: 20181682 DOI: 10.1093/eurpub/ckp241] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Violence against pregnant women is an increasing public health concern. The purpose of this study is to estimate the prevalence of violence during pregnancy, to identify characteristics associated and to assess the impact of violence on newborn outcomes. METHODS Prospective cohort study of 652 pregnant women attending primary care clinics in Southern Brazil, from June 2006 to September 2007. Women with gestational age ranging from 16th and 36th were enrolled and their exposure to violence and mental disorder was assessed. After the birth they were contacted by telephone when information on obstetric and neonatal outcomes was obtained. RESULTS Any violence during current pregnancy was reported by 18.3% [95% confidence interval (CI) 15.3-21.4%] participants, 15.0% (95% CI 12.3-17.8%) psychological violence, 6% (95% CI 4.2-7.8%) physical violence and 3% (0-0.5%) sexual violence. These women were more often of low income, did not work or study and had inadequate prenatal care and pregnancy weight gain. There was a statistically significant crude association between exposure to physical and psychological violence [relative risk (RR) 3.21 (1.51-6.80)]. After adjustment for family income, number of prenatal visits, length of gestation and gestational weight gain, the effect size decreased, but remained statistically significant (RR 2.18; 95% CI 1.16-4.08%). CONCLUSION In disadvantaged settings in Brazil, violence in pregnancy is frequent; it is associated with inadequate maternal weight gain during pregnancy and prenatal care, and increases risk of low birth-weight. Thus, violence in pregnancy imposes a challenge to effective prenatal care delivery with potential benefits to the mother and her baby.
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Affiliation(s)
- Maria Angélica Antunes Nunes
- Graduate Studies Program in Epidemiology, School of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil.
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Jin H, Xing X, Zhao H, Chen Y, Huang X, Ma S, Ye H, Cai J. Detection of erythrocytes influenced by aging and type 2 diabetes using atomic force microscope. Biochem Biophys Res Commun 2009; 391:1698-702. [PMID: 20040363 DOI: 10.1016/j.bbrc.2009.12.133] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2009] [Accepted: 12/23/2009] [Indexed: 11/16/2022]
Abstract
The pathophysiological changes of erythrocytes are detected at the molecular scale, which is important to reveal the onset of diseases. Type 2 diabetes is an age-related metabolic disorder with high prevalence in elderly (or old) people. Up to now, there are no treatments to cure diabetes. Therefore, early detection and the ability to monitor the progression of type 2 diabetes are very important for developing effective therapies. Type 2 diabetes is associated with high blood glucose in the context of insulin resistance and relative insulin deficiency. These abnormalities may disturb the architecture and functions of erythrocytes at molecular scale. In this study, the aging- and diabetes-induced changes in morphological and biomechanical properties of erythrocytes are clearly characterized at nanometer scale using atomic force microscope (AFM). The structural information and mechanical properties of the cell surface membranes of erythrocytes are very important indicators for determining the healthy, diseased or aging status. So, AFM may potentially be developed into a powerful tool in diagnosing diseases.
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Affiliation(s)
- Hua Jin
- Chemistry Department, Jinan University, Guangzhou 510632, China
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Yogev Y, Metzger BE, Hod M. Establishing diagnosis of gestational diabetes mellitus: Impact of the hyperglycemia and adverse pregnancy outcome study. Semin Fetal Neonatal Med 2009; 14:94-100. [PMID: 19211315 DOI: 10.1016/j.siny.2009.01.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The diagnosis of gestational diabetes mellitus (GDM) remains controversial, without universal acceptance of a particular set of diagnostic criteria, and, in fact, a lack of consensus as to whether this is an entity worth diagnosis. Some of the debate derives from differences of opinion about what degree of glucose intolerance should be labeled as GDM. Therefore, it is to be expected that there are different viewpoints on how to detect and screen for GDM. It is believed that early diagnosis will result in a significant improvement in perinatal outcome in these patients. In this review, we discuss the current data concerning screening for GDM and new strategies for GDM diagnosis in light of the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study.
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Affiliation(s)
- Yariv Yogev
- Perinatal Division, Helen Schneider Hospital for Women, Rabin Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Petah-Tiqva 49100, Israel
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Hanna FWF, Peters JR, Harlow J, Jones PW. Gestational diabetes screening and glycaemic management; national survey on behalf of the Association of British Clinical Diabetologists. QJM 2008; 101:777-84. [PMID: 18710902 DOI: 10.1093/qjmed/hcn069] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND There is no UK consensus for screening methodology, diagnosis and management of gestational diabetes mellitus (GDM). AIM To evaluate routine practice for GDM management across the UK. METHODS Questionnaires were sent to all members of the Association of British Clinical Diabetologists. They were asked to describe how patients were screened for GDM, the diagnostic criteria and subsequent management and clinical targets. Centres that did not respond were followed up by personal communication. Variability trends within regions were assessed. RESULTS The response rate averaged 46% nationally (35-67%). Most (85%) units hold a joint clinic, regardless of the size. Most (82%) centres routinely screen for GDM; half universally and half screening high risk pregnancies only. Screening tests, cut-off values, timings and subsequent action vary widely. The first screening test to be used varies, with 40% using glycosuria, followed by random plasma glucose (RPG)(28%), high risk features (11%) then FPG in 6%. Cut-off values for both random and plasma glucose as screening methods also vary. The 75 g oral glucose tolerance test (OGTT) is the most likely confirmatory test to be used if initial screening is positive; however, clinicians rely on different cut-off values and timing. Most (95%) centres routinely assess foetal growth. Postpartum screening is undertaken by 90%, using a 75 g OGTT (93%). Most (90%) centres counsel patients about their high risk for further GDM and type 2 diabetes mellitus. Variability trends in any of the responses could not be detected between different regions in the UK. CONCLUSION Standards for GDM screening and management vary significantly across the UK. Although most centres utilize the 75 g OGTT to confirm the diagnosis, there is no consistency in its interpretation. This survey confirms the urgent need for consensus guideline development.
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Affiliation(s)
- F W F Hanna
- University Hospital of North Staffordshire, Stoke-on-Trent ST2 6QG, UK.
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Shirazian N, Mahboubi M, Emdadi R, Yousefi-Nooraie R, Fazel-Sarjuei Z, Sedighpour N, Fadaki SF, Emami P, Hematyar M, Rahimi N, Mozaffari-Kermani R. Comparison of different diagnostic criteria for gestational diabetes mellitus based on the 75-g oral glucose tolerance test: a cohort study. Endocr Pract 2008; 14:312-7. [PMID: 18463038 DOI: 10.4158/ep.14.3.312] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To compare the different diagnostic criteria for gestational diabetes mellitus (GDM) proposed by the American Diabetes Association (ADA), World Health Organization (WHO), and Australian Diabetes in Pregnancy Society (ADIPS) in a 75-g, 2-hour oral glucose tolerance test (OGTT) and to investigate their effects on neonatal birth weight. METHODS Healthy pregnant women were enrolled in a cohort study to undergo a 75-g OGTT during 24 to 28 weeks of pregnancy and then followed up to delivery. ADA criteria and recommendations were used for the management of patients. RESULTS Among 670 pregnant women, GDM was diagnosed in 41 (6.1%), 81 (12.1%), and 126 (18.8%) on the basis of ADA, WHO, and ADIPS criteria, respectively. The kappa value was 0.38 (P<.0001) for the agreement between ADA and WHO criteria, 0.41 (P<.0001) for agreement between ADA and ADIPS criteria, and 0.64 (P<.0001) for agreement between WHO and ADIPS criteria. WHO-only "positive" women had significantly lower fasting plasma glucose (87.9 versus 102.2 mg/dL; P<.0001) and 1-hour plasma glucose levels (146.4 versus 200.5 mg/dL; P<.0001) but higher 2-hour plasma glucose levels (150.1 versus 109.1 mg/dL; P<.0001) than women diagnosed with GDM by only ADA criteria. The correlation coefficient between 1-hour glucose level and neonatal birth weight was 0.09 (P<.02). The adjusted odds ratio of macrosomia associated with GDM according to ADA criteria was 1.34 (95% confidence interval, 0.15 to 12). CONCLUSION The frequency of occurrence of GDM was 6.1% in a 75-g OGTT based on ADA criteria, and there was fair agreement between ADA and WHO criteria, moderate agreement between ADA and ADIPS criteria, and strong agreement between WHO and ADIPS criteria. A modest correlation was found between the 1-hour serum glucose value and neonatal birth weight.
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Clay JC, Deruelle P, Fischer C, Couvreux-Dif D, Vambergue A, Cazaubiel M, Fontaine P, Subtil D. [Fifteen practical questions concerning gestational diabetes]. ACTA ACUST UNITED AC 2007; 35:724-30. [PMID: 17702623 DOI: 10.1016/j.gyobfe.2007.07.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2007] [Accepted: 07/04/2007] [Indexed: 11/16/2022]
Abstract
With a review of the current literature, a clarification on screening and management of gestational diabetes is hereby set out, within the frame of a Clinical Expert Series. According to the ethnic group, the prevalence varies from 1 to 14%. The treatment is based on dietary advice, insulin. The ACHOIS study demonstrates that the treatment of gestational diabetes significantly decreases perinatal complications (4 to 1%). The place of the oral treatment (glyburide) remains to be defined. In most countries, diagnosis rests on oral glucose test tolerance: Sullivan 50 g glucose test (1 hour) and 100 g test of glucose if positive (3 hours); WHO 75 g test (2 hours). The screening can be systematic or only on risk factors (wide variations between studies). Screening of gestational diabetes is required because its management improves pregnancy outcomes. Despite this, there is no consensus on the strategy of screening and diagnosis.
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Affiliation(s)
- J-C Clay
- Service de gynécologie-obstétrique, hôpital Jeanne-de-Flandre, université Lille-II, CHRU de Lille, 2, avenue Oscar-Lambret, 59037 Lille cedex, France.
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Agarwal MM, Dhatt GS, Punnose J. Gestational diabetes: utility of fasting plasma glucose as a screening test depends on the diagnostic criteria. Diabet Med 2006; 23:1319-26. [PMID: 17116182 DOI: 10.1111/j.1464-5491.2006.01987.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
AIMS To demonstrate the effect of diagnostic criteria, as defined by four international expert panels, on the usefulness of fasting plasma glucose (FPG) as a screening test for gestational diabetes mellitus (GDM). METHODS We tested 4602 pregnant women using a 75-g oral glucose tolerance test (OGTT) for universal GDM screening. The area under the receiver operating characteristic curve (AUC) was used to determine the FPG performance to detect GDM by the criteria of the American Diabetes Association (ADA), the Australasian Diabetes in Pregnancy Society, the European Association for the Study of Diabetes, and the World Health Organization (WHO). RESULTS By applying ADA, Australasian, European and WHO criteria, respectively, the FPG: (i) AUC (95% CI) was 0.882 (0.866-0.897), 0.830 (0.809-0.852), 0.808 (0.791-0.825) and 0.690 (0.670-0.710); (ii) independently could 'rule-in' GDM (with 100% specificity) in 74 (10.9%), 620 (53.5%), 252 (45.3%) and 74 (7.6%) women; (iii) independently could 'rule-out' GDM in an additional 2864 (62.2%), 928 (20.2%), 1510 (32.8%) and 1171 (25.4%) women, at FPG thresholds (with 85% sensitivity); (iv) false-positive rate (FPR) was 29.4, 75.5, 63.8 and 71.2%, at these thresholds. CONCLUSIONS The value of the FPG as a screening test for GDM is highly dependent on the diagnostic criteria. The performance is excellent with the ADA criteria. With the other criteria, the high FPR (poor specificity) would limit its utility as a screening test. Regardless of the criteria used, initial testing by FPG can significantly decrease the number of cumbersome OGTTs needed for the diagnosis of GDM.
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Affiliation(s)
- M M Agarwal
- Department of Pathology, Tawam Hospital, Al-Ain Hospita, Al Ain, United Arab Emirates.
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Fadl H, Ostlund I, Nilsson K, Hanson U. Fasting capillary glucose as a screening test for gestational diabetes mellitus. BJOG 2006; 113:1067-71. [PMID: 16956338 DOI: 10.1111/j.1471-0528.2006.01032.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To evaluate fasting capillary glucose as a screening test for gestational diabetes mellitus (GDM) compared with traditional risk factors and repeated random capillary glucose measurements. DESIGN Cross-sectional, population-based study. SETTING Maternal Health Care Clinics in Orebro County, Sweden. POPULATION An unselected population of women without diabetes. METHODS Fasting capillary glucose levels were measured at gestational weeks 28-32. Random capillary glucose levels were measured four to six times during pregnancy. Traditional risk factors for GDM were registered. GDM was diagnosed using a 75-g oral glucose tolerance test. MAIN OUTCOME MEASURES Sensitivity, specificity, likelihood ratios. RESULTS In 55 of 3616 women participating in the study, GDM was diagnosed before 34 weeks of gestation. For fasting capillary glucose cutoff values between 4.0 and 5.0 mmol/l, sensitivity was in the range between 87 and 47% and specificity between 51 and 96%. Using a combined screening model of traditional risk factors with fasting capillary glucose at various cutoff values increased the sensitivity only slightly compared with using fasting capillary glucose alone. CONCLUSION In this Swedish, unselected, low-risk population, fasting capillary glucose measurements were found to be an acceptable and useful screening test for GDM.
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Affiliation(s)
- H Fadl
- Department of Obstetrics and Gynaecology, Orebro University Hospital, Sweden.
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Agarwal MM, Dhatt GS. Fasting plasma glucose as a screening test for gestational diabetes mellitus. Arch Gynecol Obstet 2006; 275:81-7. [PMID: 16967273 DOI: 10.1007/s00404-006-0245-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2006] [Accepted: 08/17/2006] [Indexed: 01/19/2023]
Abstract
Although debated, most preeminent expert panels recommend routine screening for gestational diabetes mellitus (GDM). Among the many tests that have been used and evaluated for the screening of GDM, the fasting plasma glucose (FPG) remains very appealing. It is easy to administer, well tolerated, inexpensive, reproducible and patient friendly. However attractive, the FPG has given varied results in different populations and its use as a screening test for GDM remains uncertain. This review will objectively assess the available studies to find the real value of FPG as a screening test for GDM.
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Affiliation(s)
- Mukesh M Agarwal
- Department of Pathology, Faculty of Medicine, UAE University, P.O. Box 17666, Al Ain, United Arab Emirates.
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Kauffman RP, Castracane VD, Peghee D, Baker TE, Van Hook JW. Detection of gestational diabetes mellitus by homeostatic indices of insulin sensitivity: a preliminary study. Am J Obstet Gynecol 2006; 194:1576-82; discussion 1582-4. [PMID: 16638603 DOI: 10.1016/j.ajog.2006.01.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2005] [Revised: 12/05/2005] [Accepted: 01/09/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVE We investigated whether homeostatic indices of insulin sensitivity might suitably screen for gestational diabetes mellitus. STUDY DESIGN One hundred twenty-three pregnant women who were between 24 and 28 weeks of gestation completed a 3-hour 100-g oral glucose challenge test and fasting insulin level in a nested case-control study design. Insulin sensitivity indices were calculated and tested for their ability to detect gestational diabetes mellitus. RESULTS Fasting glucose demonstrated the best overall accuracy, but the homeostasis model assessment and quick insulin sensitivity check index were also sensitive screening techniques for gestational diabetes mellitus when either the National Diabetes Data Group or Carpenter-Coustan criteria were used. CONCLUSION Homeostasis model assessment, quick insulin sensitivity check index, and fasting glucose are sensitive screening tests for gestational diabetes mellitus and can avoid oral administration of glucose-containing solutions.
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Affiliation(s)
- Robert P Kauffman
- Department of Obstetrics and Gynecology, Texas Tech University Health Sciences Center School of Medicine, Amarillo, TX 79106, USA.
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Agarwal MM, Dhatt GS, Punnose J, Koster G. Gestational diabetes in a high-risk population: using the fasting plasma glucose to simplify the diagnostic algorithm. Eur J Obstet Gynecol Reprod Biol 2005; 120:39-44. [PMID: 15866084 DOI: 10.1016/j.ejogrb.2004.07.034] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2004] [Revised: 07/24/2004] [Accepted: 07/26/2004] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To evaluate the value of fasting plasma glucose (FPG) in screening a high-risk population for gestational diabetes mellitus (GDM). STUDY DESIGN During an 8-month period, 1685 pregnant women underwent the one-step 75 g oral glucose tolerance test (OGTT) as a part of a universal screening program. The receiver operating characteristic (ROC) curve was used to analyze the performance of the FPG. RESULTS 333 (19.8%) women had GDM (WHO criteria). The area under the ROC curve of FPG to detect GDM was 0.639 (95% CI 0.603-0.674), which reflected the degree of the FPG histogram overlap in women with and without GDM. A FPG threshold of 4.7 mmol/l reached the minimally acceptable sensitivity of 78.1% with a corresponding unacceptable specificity of 32.2%. 508 (31%) women were below this threshold, at a negative predictive value of 85.6%. The FPG at higher thresholds with acceptable specificity had poor sensitivity and positive predictive value to be useful. CONCLUSION Though the high false positive rate at any FPG threshold with adequate sensitivity makes the FPG an inappropriate test for GDM screening, the FPG has the potential to avoid nearly one-third of the cumbersome OGTTs at the expense of missing one-fifth of pregnant women with milder GDM.
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Affiliation(s)
- Mukesh M Agarwal
- Department of Pathology, Faculty of Medicine, UAE University, P.O. Box 17666, Al Ain, United Arab Emirates.
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Ayach W, Calderon IDMP, Rudge MVC, Costa RAA. Associação glicemia de jejum e fatores de risco como teste para rastreamento do diabete gestacional. REVISTA BRASILEIRA DE SAÚDE MATERNO INFANTIL 2005. [DOI: 10.1590/s1519-38292005000300009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJETIVOS: comparar dois testes de rastreamento do diabete gestacional. MÉTODOS: estudo prospectivo no qual foram avaliadas 356 gestantes, sem diagnóstico prévio do diabete melito, submetidas, de modo independente, a dois testes de rastreamento: associação glicemia de jejum e fator de risco (GJ+FR) e teste oral simplificado de tolerância à glicose (TTG50g). A comparação entre os métodos foi realizada pelos índices de sensibilidade (S), especificidade (E) e valores preditivos positivo (VPP) e negativo (VPN), resultados falsos, positivos (FP) e negativos (FN) e pela diferença dos resultados observados e esperados, avaliada pelo teste do Qui-quadrado (p<0,05). RESULTADOS: a associação GJ+FR determinou a confirmação diagnóstica em maior número de gestantes (187; 52,5%) que o TTG50g (49; 13,8%). Esta diferença foi significativa (p<0,05). A associação GJ+FR apresentou sensibilidade de 83,7% e valor preditivo negativo (VPN) de 95,3% em relação ao TTG50g. CONCLUSÕES: os índices elevados de sensibilidade e VPN da associação GJ+FR em relação ao TTG50g, sua simplicidade, praticidade, baixo custo e fácil replicação permitem sua indicação no rastreamento do diabete gestacional.
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Affiliation(s)
- Wilson Ayach
- Universidade Federal de Mato Grosso do Sul, Brasil
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Abstract
The term 'gestational diabetes mellitus' is unsatisfactory as it refers to a heterogeneous group of women, including those with minimal abnormality of carbohydrate metabolism and those with undiagnosed type II diabetes. However, perinatal morbidity is increased even in the group of women who have only impaired glucose tolerance; the mothers are at increased risk of subsequent development of diabetes, and there may also be long-term implications for the offspring. Current research is aiming to define the blood glucose levels at which risks increase so that clinical management can be appropriately directed. When available, the criteria required to justify population screening in pregnancy should be satisfied. The glucose challenge and fasting glucose tests are the leading contenders as appropriate screening tests to determine who should have the diagnostic glucose tolerance test. However, until this is reviewed, the widely used scheme of risk factors as a screening method should continue, as it detects at least 50% of women with gestational diabetes.
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Affiliation(s)
- M Maresh
- St Mary's Hospital for Women and Children, Central Manchester and Manchester Children's University Hospitals NHS Trust, Manchester M13 0JH, UK.
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Rey E, Hudon L, Michon N, Boucher P, Ethier J, Saint-Louis P. Fasting plasma glucose versus glucose challenge test: screening for gestational diabetes and cost effectiveness. Clin Biochem 2005; 37:780-4. [PMID: 15329316 DOI: 10.1016/j.clinbiochem.2004.05.018] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2004] [Revised: 05/18/2004] [Accepted: 05/18/2004] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To compare the performance in screening for gestational carbohydrate intolerance of the 1-h 50-g glucose challenge test (GCT), fasting plasma glucose (FPG) and fasting capillary glucose (FCG). DESIGN AND METHODS FPG and FCG were measured at the same time as the GCT in 188 women. Gestational carbohydrate intolerance was diagnosed according to the Canadian Diabetes Association criteria. We constructed receiver operator characteristic (ROC) curves and compared the sensitivity and specificity of the FPG, FCG and GCT. RESULTS Gestational diabetes was diagnosed in 11.2% women and gestational impaired glucose tolerance in 8.4%. The areas under the ROC curves for the FPG, the GCT and the FCG were not statistically different (P = 0.26). The GCT yielded a better specificity than the FPG and the FCG for a comparable level of sensitivity. CONCLUSIONS The GCT is better than the FPG in our population and is cost effective.
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Affiliation(s)
- Evelyne Rey
- Department of Obstetrics and Gynecology, Sainte-Justine Hospital, Montreal, QC, H3T 1C5, Canada.
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Mengue SS, Schenkel EP, Schmidt MI, Duncan BB. Fatores associados ao uso de medicamentos durante a gestação em seis cidades brasileiras. CAD SAUDE PUBLICA 2004; 20:1602-8. [PMID: 15608862 DOI: 10.1590/s0102-311x2004000600018] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
O objetivo deste estudo foi comparar o uso de medicamentos durante a gravidez, segundo variáveis sócio-demográficas, em gestantes que fizeram o pré-natal em serviços do SUS em seis grandes cidades brasileiras. Utilizando-se um questionário estruturado, foram entrevistadas 5.564 gestantes que se apresentaram para consulta em serviço de pré-natal do SUS, participantes do Estudo Brasileiro de Diabetes Gestacional, entre 1991 e 1995. O uso de qualquer medicamento mostrou uma associação positiva com o aumento da escolaridade, da idade e com o fato de ter companheiro, e uma associação negativa com maior número de filhos. O uso de medicamentos multivitamínicos e medicamentos que atuam sobre o aparelho digestivo mostrou aumento da associação com maior escolaridade e idade e uma associação negativa com o aumento do número de filhos. O uso de medicamentos antianêmicos mostrou uma associação negativa com o aumento da escolaridade e com o aumento da idade. O uso de multivitamínicos e medicamentos que atuam sobre o aparelho digestivo mostrou uma associação com variáveis que caracterizam gestantes de melhor nível sócio-econômico, sugerindo que o uso de medicamentos é uma expressão de cuidado com a gestação.
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Affiliation(s)
- Sotero Serrate Mengue
- Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
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Abstract
Gestational diabetes mellitus (GDM) is a risk factor for the mother and foetus. The risks increase proportionally to the maternal blood sugar concentration along a glycaemic continuum. However, there is ongoing controversy about the objectives of active screening and diabetic and obstetrical management for GDM. Various screening and diagnostic tests are used. None of them offers the combination of qualities to be expected from a test: simplicity of use, reproducibility, specificity and sensitivity, but each of them provides a basis on which recommendations can be established. The need to screen GDM as a risk factor in the whole population of pregnant women has led us to propose the use of simple, universally applied test, such as the "practical" test constituted by the assay of fasting and post-prandial blood glucose levels. In addition to screening, a classification which will take into account the results of subsequent as well as initial blood glucose levels could be preferable to evaluate the management and results.
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Affiliation(s)
- A Blayo
- Service du Pr Cabrol, Maternité Port Royal, Groupe Hospitalier Cochin, 123 Boulevard de Port Royal, 75679 Paris Cedex 14, France
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Kroeff LR, Mengue SS, Schmidt MI, Duncan BB, Favaretto ALF, Nucci LB. Fatores associados ao fumo em gestantes avaliadas em cidades brasileiras. Rev Saude Publica 2004; 38:261-7. [PMID: 15122383 DOI: 10.1590/s0034-89102004000200016] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: Avaliar a correlação dos fatores sociodemográficos e estilo de vida com o hábito de fumar em gestantes atendidas em hospitais. MÉTODOS: O delineamento foi o de um estudo transversal. A amostra foi composta por 5.539 gestantes atendidas em ambulatórios de pré-natal em hospitais públicos credenciados nas cidades de Manaus, Fortaleza, Salvador, Rio de Janeiro, São Paulo e Porto Alegre, entre 1991 e 1995. A seleção foi consecutiva para todas as gestantes com 20 anos ou mais de idade, excetuando-se aquelas com diabetes prévia à gestação. Foram realizadas medidas antropométricas e entrevistas entre a 21ª e a 28ª semanas da gravidez. Por meio de um questionário padronizado, considerou-se como fumante quem informou fumar um ou mais cigarros por dia, como ex-fumante quem informou ter fumado mais de um cigarro por dia e ter cessado, e não fumantes quem informou nunca ter fumado um ou mais cigarros por dia. RESULTADOS: O hábito de fumar na gestação associou-se à baixa escolaridade (RC=2,13; IC 95%: 1,76-2,57) e paridade (RC=1,84; IC 95%: 1,53-2,21). Para o aumento da idade da gestante e uso de bebidas alcóolicas também foram observadas associações positivas com o fumo na gestação. Não foi observada nenhuma associação significativa entre cor da pele e situação ocupacional com fumo na gestação. Um efeito protetor foi observado para mulheres casadas ou com companheiro (RC=0,55; IC 95%: 0,42-0,72). Entre as cidades, tomando Manaus como referência, Porto Alegre apresentou o maior risco para fumo na gestação (RC=5,00; IC 95%: 3,35-7,38), seguida de São Paulo (RC=3,42; IC 95%: 2,25-5,20), Rio de Janeiro (RC=2,53; IC 95%: 1,65-3,88) e Fortaleza (RC=2,56; IC95%: 1,74-3,78). CONCLUSÕES: Os achados são semelhantes àqueles descritos na literatura com relação à escolaridade, paridade e situação conjugal. Entretanto, nenhuma associação com a cor da pele foi observada na análise multivariada. As ex-fumantes mostraram características sociodemográficas mais próximas das não fumantes do que das fumantes.
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Affiliation(s)
- Locimara Ramos Kroeff
- Programa de Pós-Graduação em Epidemiologia, Faculdade de Medicina, Universidade Federal do Rio Grande Do Sul, Porto Alegre, RS, Brasil. locirk@ufrgs@br
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Jensen DM, Mølsted-Pedersen L, Beck-Nielsen H, Westergaard JG, Ovesen P, Damm P. Screening for gestational diabetes mellitus by a model based on risk indicators: a prospective study. Am J Obstet Gynecol 2003; 189:1383-8. [PMID: 14634573 DOI: 10.1067/s0002-9378(03)00601-x] [Citation(s) in RCA: 82] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVE This study was performed to prospectively evaluate a screening model for gestational diabetes mellitus on the basis of clinical risk indicators. STUDY DESIGN In a prospective multicenter study with 5235 consecutive pregnant women, diagnostic testing with a 2-hour 75-g oral glucose tolerance test was routinely performed in women with risk indicators and offered to women without risk indicators as part of the study. RESULTS Forty-four percent of the women underwent testing, 43% declined participation, 6% did not speak Danish, and 7% could not be contacted. By extrapolation of the results from tested women to the whole group in question, a 2.4% prevalence of gestational diabetes mellitus was calculated. Sensitivity and specificity of the model was 80.6 (73.7-87.6) and 64.8 (63.5-66.1), respectively (95% CIs). CONCLUSION Under ideal conditions, sensitivity of the model was comparable with universal screening by fasting glucose or a 1-hour 50-g glucose challenge test. Both screening and diagnostic testing could be avoided in two thirds of all pregnant women.
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Affiliation(s)
- Dorte M Jensen
- Department of Endocrinology, Odense University Hospital, Kløvervaenget 6, DL-5000 Odense, Denmark.
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Maegawa Y, Sugiyama T, Kusaka H, Mitao M, Toyoda N. Screening tests for gestational diabetes in Japan in the 1st and 2nd trimester of pregnancy. Diabetes Res Clin Pract 2003; 62:47-53. [PMID: 14581157 DOI: 10.1016/s0168-8227(03)00146-3] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The objective of this study was to investigate the utility and characteristics of various screening procedures for gestational diabetes mellitus (GDM) in Japan during the first trimester and between 24 and 28 weeks of pregnancy. The subjects were 749 pregnant women who came to our hospitals. A 50-g oral glucose challenge test (GCT), casual plasma glucose measurements, fasting blood glucose measurements, and glycosylated hemoglobin measurements were performed in the first trimester. Subjects with no abnormalities were tested again at 24-28 weeks of gestation. Of the 749 subjects, 22 (2.9%) tested positive for GDM. Of those 22 patients, 14 were diagnosed with GDM in the first trimester (63.6%) and eight in the second trimester (36.4%). This finding suggests the importance of screening for glucose intolerance in the first trimester. Furthermore, it appears that the GCT has the most utility for GDM screening; the other screening methods tested were not as useful because of their low sensitivity, particularly in the second trimester.
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Affiliation(s)
- Yuka Maegawa
- Department of Obstetrics and Gynecology, Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
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Miyakoshi K, Tanaka M, Ueno K, Uehara K, Ishimoto H, Yoshimura Y. Cutoff value of 1 h, 50 g glucose challenge test for screening of gestational diabetes mellitus in a Japanese population. Diabetes Res Clin Pract 2003; 60:63-7. [PMID: 12639767 DOI: 10.1016/s0168-8227(02)00274-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A total of 2651 consecutive native Japanese women who underwent a glucose challenge test (GCT) were retrospectively investigated. GCT was performed between 24 and 27 weeks of gestation; each subject received a 50 g oral glucose load without regard to the fasting or fed state, followed by a determination of 1 h venous plasma glucose level. Women demonstrating GCT exceeding 130 mg/dl received a 75 g, 2 h oral glucose tolerance test to determine whether or not they had gestational diabetes mellitus (GDM). All women with GDM were treated with a strict diabetic protocol including insulin therapy. Forty-nine (1.8%) women were diagnosed to have GDM. The receiver-operator characteristic curve identified a GCT finding above 140 mg/dl as the cutoff value for detecting GDM, which showed a sensitivity and specificity of 96 and 76%, respectively. Our results suggest that the cutoff value of a 50 g GCT is 140 mg/dl to identify pregnancies with GDM in a Japanese population.
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Affiliation(s)
- Kei Miyakoshi
- Department of Obstetrics and Gynecology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan.
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Chastang N, Hartemann-Heurtier A, Sachon C, Vauthier D, Darbois Y, Bissery A, Golmard JL, Grimaldi A. Comparison of two diagnostic tests for gestational diabetes in predicting macrosomia. DIABETES & METABOLISM 2003; 29:139-44. [PMID: 12746634 DOI: 10.1016/s1262-3636(07)70020-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To validate a diagnostic test for gestational diabetes which predicts the risk of macrosomia. METHODS A prospective study was carried out among 354 women at risk for gestational diabetes to compare two glucose tests diagnosing pregnancies at risk of macrosomia. The "practical" test consisted in glucose measurement in the fasting state and two hours after an usual breakfast and the "reference" test was the test proposed in France (O'Sullivan test with or without a 100 g oral glucose tolerance test). Both tests were made between the 24(th) and 28(th) week of gestation. Women at high risk for macrosomia were treated. The first assessment criterion was macrosomia (babies large for gestational age). Because of the presence of women treated for gestational diabetes in our sample, the sensitivity and specificity of the tests in diagnosing pregnancies at risk of macrosomia were calculated using either the incidence of macrosomia observed in our population, or the incidence of macrosomia observed theoretically in the absence of treatment (22% in literature). RESULTS Macrosomia was diagnosed in 49 neonates (14%). The "practical" test was significantly more sensitive than the reference test (respectively 46.9% versus 16.3%, p=0.0001 in the first case, and 54.3% versus 20.1%, p=0.0001 in the second case). The "reference" test was significantly more specific than the "practical" test (respectively 80% versus 68.2%, p=0.0001 in the first case, and 80.6% versus 70%, p=0.0001 in the second case). CONCLUSION Our study shows that the simplified "practical" test is more sensitive than the "reference" test currently used in France in screening women at risk of macrosomia.
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Affiliation(s)
- N Chastang
- Department of Diabetology, CHU Pitié Salpêtrière, Paris, France.
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Reichelt AJ, Oppermann MLR, Schmidt MI. Recomendações da 2ª. Reunião do Grupo de Trabalho em Diabetes e Gravidez. ACTA ACUST UNITED AC 2002. [DOI: 10.1590/s0004-27302002000500012] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
O Grupo de Trabalho em Diabetes e Gravidez, reunido durante o XI Congresso Brasileiro de Diabetes em 1997, elaborou normas para o manejo do diabetes gestacional e pré-gestacional. Em 2001, nova reunião ocorreu visando atualizar os posicionamentos assumidos em 1997, a partir de novas evidências da literatura. As mudanças sugeridas estão incorporadas no documento a seguir. O rastreamento do diabetes gestacional deve ser universal e, para isso, é sugerido o emprego da glicemia de jejum a partir da 20ª semana de gestação. Os pontos de corte para classificação de rastreamento positivo são 85mg/dl ou 90mg/dl; nos casos de rastreamento positivo, o exame recomendado é o teste oral de tolerância com 75g de glicose e os critérios para o diagnóstico do diabetes gestacional são glicemia de jejum > ou = 110mg/dl ou glicemia de 2h > ou = 140mg/dl. São apresentadas também estratégias de manejo metabólico e obstétrico do diabetes gestacional e do diabetes pré-gestacional.
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Abstract
Gestational diabetes is carbohydrate intolerance, with onset or first recognition of hyperglycaemia during pregnancy. Several studies have suggested that gestational hyperglycaemia is associated with adverse maternal and fetal outcomes, promoting the case for screening. Conversely, others argue that screening for gestational diabetes may colour the clinical judgement, influencing further management, e.g. more 'unjustified' caesarean sections. Additionally, the lack of definitive data either on a clear-cut glycaemic threshold for the development of adverse outcomes or on the impact of intervention is emphasized by opponents of screening. This review attempts to evaluate the available data on screening for gestational diabetes. Oral glucose tolerance test is promoted on the basis that the diabetogenic stress of pregnancy is encountered during late gestation and is best recognized in the fed state. There are different tests, including the 1 h/50-g, 2 h/75-g and 3 h/100-g tests, with practical limitations, including the time and cost involved and the unpleasant supra-physiological glucose load that is unrelated to body weight, and issues of reproducibility and sensitivity/specificity profiles. Despite its convenience, the poor sensitivity of random glucose has precluded its routine use for screening. Fasting glucose appears to be promising but further testing is required to ensure satisfactory sensitivity/specificity in different populations. Despite its limitations, the oral glucose tolerance test has become established as the 'most acceptable' diagnostic test for gestational diabetes. More convenient methods, e.g. fasting or random or post-load glucose, have to be validated therefore against the oral glucose tolerance test to gain acceptance for routine screening.
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