Fasting plasma glucose level to guide the need for an OGTT to screen for gestational diabetes mellitus

• Published in: Acta diabetologica Vol. 59; no. 3; pp. 381 - 394
• Main Authors: Beunen, Kaat, Neys, Astrid, Van Crombrugge, Paul, Moyson, Carolien, Verhaeghe, Johan, Vandeginste, Sofie, Verlaenen, Hilde, Vercammen, Chris, Maes, Toon, Dufraimont, Els, Roggen, Nele, De Block, Christophe, Jacquemyn, Yves, Mekahli, Farah, De Clippel, Katrien, Van Den Bruel, Annick, Loccufier, Anne, Laenen, Annouschka, Devlieger, Roland, Mathieu, Chantal, Benhalima, Katrien
• Format: Journal Article
• Language: English
• Published: Milan Springer Milan 01.03.2022; Springer Nature B.V
• Subjects: Beta cells; Blood Glucose - metabolism; Diabetes; Diabetes mellitus; Diabetes, Gestational - diagnosis; Diabetes, Gestational - epidemiology; Fasting; Female; Fetal Macrosomia; Fetuses; Gestational age; Gestational diabetes; Glucose; Glucose tolerance; Glucose Tolerance Test; Humans; Insulin; Insulin resistance; Internal Medicine; Laboratory testing; Medicine; Medicine & Public Health; Metabolic Diseases; Original Article; Pregnancy; Pregnancy and diabetes; Prospective Studies; Gestational diabetes mellitus; Screening; Fasting plasma glucose; Pregnancy outcomes
• ISSN: 0940-5429; 1432-5233
• DOI: 10.1007/s00592-021-01812-9

Aims To determine the fasting plasma glucose (FPG) level at which an oral glucose tolerance test (OGTT) could be avoided to screen for gestational diabetes (GDM) and to evaluate the characteristics of women across this FPG threshold. Methods A multi-centric prospective cohort study with 1843 women receiving universal screening for GDM with a 75 g OGTT. Results In the total population, GDM prevalence was 12.5% (231). A FPG < 78 mg/dL was the cut-off with best trade-off to limit the number of missed GDM cases [44 (19.0%)] with a negative predictive value of 97.3% (95% CI 96.5–98.0) for GDM, while avoiding 52.2% OGTTs. Compared to GDM with FPG ≥ 78 mg/dL [187 (81.0%)], GDM women with FPG < 78 mg/dL had a significantly lower BMI (27.1 ± 4.5 vs. 29.6 ± 5.2 kg/m 2 , p  = 0.003), less insulin resistance [Matsuda: 0.4 (0.4–0.7) vs. 0.3 (0.2–0.5), p  < 0.001] and better β-cell function [ISSI-2: 0.13 (0.08–0.25) vs. 0.09 (0.04–0.15), p  = 0.004]. Compared to NGT women (1612) with FPG ≥ 78 mg/dL [846 (52.5%)], NGT with FPG < 78 mg/dL [766 (47.5%)] had a significantly lower BMI (26.0 ± 3.9 vs. 27.8 ± 4.7 kg/m 2 , p  < 0.001), less insulin resistance [Matsuda: 0.7 (0.5–0.9) vs. 0.5 (0.4–0.7), p  < 0.001], better β-cell function [ISSI-2: 0.17 (0.10–0.30) vs. 0.12 (0.07–0.21), p  < 0.001], and less often large-for-gestational age infants [9.2 (70) vs. 16.2% (136), p  < 0.001]. Conclusions FPG < 78 mg/dL can be used to limit the number of OGTTs when screening for GDM. Women with FPG < 78 mg/dL had a better metabolic profile and in NGT women also less fetal overgrowth.