Assessment of the appropriate cut-off point in glucose challenge test based on the risk of gestational diabetes in pregnant women

Document Type : Original Article

Authors

1 Associate Professor, Department of Obstetrics and Gynecology, School of Medicine, Rafsanjan University of Medical Sciences, Rafsanjan, Iran.

2 Professor, Department of Social Medicine and Work Environment Research Center, School of Medicine, Rafsanjan University of Medical Sciences, Rafsanjan, Iran

3 General Practitioner, School of Medicine, Rafsanjan University of Medical Sciences, Rafsanjan, Iran

4 MSc of Epidemiology, School of Medicine, Rafsanjan University of Medical Sciences, Rafsanjan, Iran

Abstract

Introduction: Determination of the appropriate basis in glucose challenge test is considered as the most important problems discussed in screening for Gestational Diabetes Mellitus. Therefore, this study was conducted with aim to assess the appropriate cut-off point in glucose challenge test in pregnant women.
Methods: In this study, data of Iranian pregnant women without diabetes referring to Rafsanjan gynecology clinics for assessment of gestational diabetes were collected. GCT was performed for the women in 24 to 28 weeks of pregnancy. Oral Glucose Tolerance Test was performed for women who their test result was ≥135 mg/dl and ≤200 mg/dl. The OGTT results were interpreted by Carpenter and Coustan criteria. Finally, the appropriate cut-off point of GCT was calculated by SPSS software (version 22) and the ROC curve.
Results: The results of GCT showed that the maximum and minimum values of GCT were 93 and 199 mg/dl respectively, with mean±SD of 161.99±15.83 mg/dl. 235 cases of pregnant women had positive GTT test. According to the ROC curves for all study population, GTT cut-off point was 140 mg/dl with 97% sensitivity, in low-risk group for gestational diabetes was 147 mg/dl with 96% sensitivity and for high risk group was 135 mg/dl with 100% sensitivity and had the most predictive value.
Conclusion: Suitable cut-off point in GCT for gestational diabetes is different in low and high risk pregnant women. Depending on the presence or absence of risk factors in mothers, we can reduce or increase the cut-off point of the GCT.

Keywords


  1. Crowther CA, Hiller JE, Moss JR, McPhee AJ, Jeffries WS, Robinson JS. Effect of treatment of gestational diabetes mellitus on pregnancy outcomes. N Engl J Med  2005; 352(24): 2477-86.
  2. Hoffman L, Nolan C, Wilson JD, Oats JJ, Simmons D. Gestational diabetes mellitus--management guidelines. The Australasian Diabetes in Pregnancy Society. Med J Aust 1998; 169(2): 93-7.
  3. Roglic G, Colagiuri S. Gestational diabetes mellitus: squaring the circle. Diabetes care 2014; 37(6): e143-4.
  4. Patil S, Pandey PD, Patange R. Gestational Diabetes Mellitus Diagnosed with 2hr 75g-Oral Glucose Tolerance Test (DIPSI) and Its Adverse Perinatal Outcome . International J of Recent Trends in Science and Technology 2014; 10(2):323-330.
  5. Cunningham F, Leveno K, Bloom S, Hauth J, Rouse D, Spong C. Williams Obstetrics. 23rd  ed. New York:  McGraw Hill, 2010.
  6. Basirat Z, Asnafi N, Kashifard M. Correlation between Abnormal Glucose Challenge Test and Pregnancy Outcomes. J Reprod Infertil 2010; 11(2): 113-9. [Persian]
  7. Khoshnniat Nikoo M, Abbaszadeh Ahranjani S, Larijani B. A review on the prevalence of gestational diabetes mellitus (GDM) in different regions of Iran. Iran JDiabetes Lipid Disorders. 2009;47-56.
  8. Gibbs R, Karlan B, Haney A, Nygaard I. Danforth's Obstetrics and Gynecology: Lippincott Williams & Wilkins; 2008.
  9. Association AD. Diagnosis and Classification of Diabetes Mellitus. Diabetes care. 2010; 33(Supplement 1): S62-S9.
  10. Kjos SL, Buchanan TA. Gestational diabetes mellitus. N Engl J  Med 1999; 341(23): 1749-56.
  11. Esakoff TF, Cheng YW, Caughey AB. Screening for gestational diabetes: different cut-offs for different ethnicities? Am J obstet Gynecol  2005; 193(3pt2): 1040-4.
  12. 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(1):63-7.
  13. Wei YM, Yang HX, Gao XL.  Investigation into the prevalence and suitable diagnostic criteria of gestational diabetes mellitus in China. Zhonghua Fu Chan ke za zhi 2008; 43(9): 647-50.
  14. Bonomo M, Gandini ML, Mastropasqua A, Begher C, Valentini U, Faden D, et al. Which cutoff level should be used in screening for glucose intolerance in pregnancy? Definition of Screening Methods for Gestational Diabetes Study Group of the Lombardy Section of the Italian Society of Diabetology.     Am J Obstet  Gynecol 1998; 179(1): 179-85.
  15. American College of Obstetricians and Gynecologists, Committee on Practice Bulletins.  ACOG Practice Bulletin. Clinical management guidelines for obstetrician-gynecologists. Number 32, November 2001 (replaces Technical Bulletin Number 181, June 1993, and Committee Opinion Number 241, September 2000). Thyroid disease in pregnancy. Obstet  Gynecol 2001; 98(5 Pt 1): 879-88
  16. American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes care 2014;  37 Suppl 1:S81-90
  17. Getahun D, Nath C, Ananth CV, Chavez MR, Smulian JC. Gestational diabetes in the United States: temporal trends 1989 through 2004 Am J Obstet Gyneco  2008; 198(5): 525. e1-5.
  18. Naylor CD, Sermer M, Chen E, Farine D. Selective screening for gestational diabetes mellitus. Toronto Trihospital Gestational Diabetes Project Investigators. N Engl J Med 1997; 337(22): 1591-6.
  19. 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(5): 1383-8.
  20. Goli M, Firouzeh F. Prevalence of gestational diabetes and efficacy of risk factors in screening of referrals to health centers. Holist Nurs Midwifery 2014; 24(3): 56-63.
  21. Bouzari ZS, Yazdani S, Abedi Samakoush M, Mohammad Nataj M, Emami Mobidi S. Prevalence of Gestational Diabetes and Its Risk Factors in Pregnant Women Referred to Health Centers of Babol, Iran, from September 2010 to March 2012. Iran J Obstet, GynecolInfertil 2013;16(43):6-13.
  22. Scott DA, Loveman E, McIntyre L, Waugh N. Screening for gestational diabetes: a systematic review and economic evaluation. Health Technol Assess 2002; 6(11(: 1-161
  23. Eslami M. Comparing the results of the screening test for diabetes in pregnant women with no risk factors and risk factors in 200 patients at 24-48 weeks of gestation, Bu-Ali Hospital, Tehran. [PHD Thesis]. Shahid Beheshti University 1998; p:51-77.
  24. Homko CJ, Reece EA. To screen or not to screen for gestational diabetes mellitus: the clinical quagmire. Clin Perinatol 2001;28(2):407-17.
  25. Alimohammadi M, Rostami M, Jorfi M. Disorders of glucose challenge test (GCT) in pregnant women referred to Khatam-o-allanbia laboratory of Arak city, Iran. Med Lab J 2012;6(2):1-2.
  26. Kashani Zadeh N, Lalooei A. Evaluation of diabetes screening test with 50 g glucose for detection of gestational diabetes in pregnant women with no risk factors. Kowsar Med J2006;11(2):205-12.
  27. Sacks DB, Bruns DE, Goldstein DE, Maclaren NK, McDonald JM, Parrott M. Guidelines and recommendations for laboratory analysis in the diagnosis and management of diabetes mellitus. Clin chem 2002;48(3):436-72.