Obstet Gynecol Sci.  2016 May;59(3):178-183. 10.5468/ogs.2016.59.3.178.

How high is too high in cutoff levels from 50-g glucose challenge test

• Cha HH
• Kim JY
• Choi SJ
• Oh SY
• Roh CR
• Kim JH

• KMID: 2351782
• DOI: http://doi.org/10.5468/ogs.2016.59.3.178

Abstract

OBJECTIVE
To determine the highest 50-g glucose challenge test (GCT) value that indicates no further diagnostic test is needed to confirm a diagnosis of gestational diabetes mellitus (GDM) under the criteria of National Diabetes Data Group (NDDG) or the Carpenter and Coustan (C&C) and fasting glucose thresholds from the International Association of Diabetes and Pregnancy Study Group (IADPSG).
METHODS
We collected the 50-g GCT results from 16,560 pregnancies and identified 2,457 gravidas with positive 50-g GCT (≥130 mg/dL) values who underwent the 100-g glucose tolerance test. We investigated GDM prevalence in pregnancies with positive 50-g GCT according to the respective diagnostic thresholds and determined the 50-g GCT cutoff values with 100% positive predictive value for GDM under each diagnostic threshold.
RESULTS
Twelve point five percent (306/2,457), 20.0% (492/2,457), and 9.6% (235/2,457) met the diagnostic criteria of GDM with the application of NDDG, C&C criteria, and fasting glucose thresholds from IADPSG (≥92 mg/dL), respectively. We also found that the prevalence of GDM increased with increasing 50-g GCT values using each diagnostic criterion. Importantly, we identified that all subjects with a 50-g GCT value ≥223, ≥217, or ≥228 mg/dL can be exclusively diagnosed as having gestational diabetes according to the criteria of NDDG, C&C, and fasting glucose thresholds from IADPSG, respectively.
CONCLUSION
We propose that women with a 50-g GCT screening value ≥228 mg/dL can be reliably omitted from further confirmative tests for GDM, such as 100- or 75-g glucose tolerance test.

Keyword

Diabetes, gestational; Glucose tolerance test; Positive predictive value

MeSH Terms

Diabetes, Gestational
Diagnosis
Diagnostic Tests, Routine
Fasting
Female
Glucose Tolerance Test
Glucose*
Humans
Mass Screening
Pregnancy
Prevalence
Glucose

Figure

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  Fig. 1 Prevalence of gestational diabetes mellitus (GDM) in pregnancies with positive 50-g glucose challenge test results. GDM prevalence increased with increasing 50-g glucose challenge test results (P<0.001). In addition, the GDM prevalence was highest with the application of the Carpenter and Coustan criteria. IADPSG, International Association of Diabetes and Pregnancy Study Group.

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  Fig. 2 Receiver operator characteristic curve for 50-g glucose challenge test according to respective criteria. (A) National Diabetes Data Group criteria, (B) Carpenter and Coustan criteria, and (C) fasting glucose levels from International Association of Diabetes and Pregnancy Study Group.

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