Difference between 2 h and 3 h 75 g glucose tolerance test in the diagnosis of gestational diabetes mellitus (GDM): Results from a national survey on prevalence of GDM

Abstract

The possibility of the 2 h oral glucose tolerance test (OGTT) as an alternative to the 3 h OGTT was investigated based on data from a national survey on pregnancy-associated diabetes. Data were retrieved from 4179 pregnant women who had OGTT performed after an abnormal 50 g glucose challenge test (GCT). All of the 4 glucose levels during their OGTT were collected and analyzed. According to American Diabetes Association (ADA) gestational diabetes mellitus (GDM) diagnostic criteria, among the 4179 pregnant women who required OGTT, 3429 (82.1%) were normal and 750 (17.9%) were diagnosed as GDM. If the 3rd h glucose levels were omitted from OGTT, 79 cases of GDM (10.5%) would be overlooked. No trend was shown where women with more risk factors were more likely to be overlooked if the 3rd h test was omitted (χ² for trend= 0.038, P>0.05). No significant differences were found in the rate of cesarean section (CS), preterm births or macrosomia between the 79 cases and those with normal OGTT results and in the gestational weeks when OGTT was performed. It shows that in order to diagnose one woman with GDM, another 52 pregnant women would have an innocent 3rd h glucose test. Omission of the 3rd h glucose test in OGTT might be reasonable due to its convenience, better compliance and a small number of possibly miss-diagnosed cases, and their pregnancy outcomes have no significant difference from those of normal pregnant women.

Keywords

diabetes / gestational / oral glucose tolerance test

References

[1] MetzgerB E, CoustanD R. Summary and recommendations of the fourth international workshop-conference on gestational diabetes mellitus. The Organizing Committee. Diabetes Care, 1998, 21(Suppl 2): B161-B167

[2] GaoX L, YangH X. Current situation of the studies on pregnancy associated with diabetes in China. Zhongguo Quan Ke Yi Xue, 2008, 11(4A): 547-550 (in Chinese)

[3] YangH, WeiY, GaoX, XuX, FanL, HeJ, HuY, LiuX, ChenX, YangZ, ZhangC; China National GDM Survey Working Group. Risk factors for gestational diabetes mellitus in Chinese women: a prospective study of 16,286 pregnant women in China. Diabet Med, 2009, 26(11): 1099-1104

[4] WeiY M, YangH X, GaoX L. Investigation into the prevalence and suitable diagnostic criteria of gestational diabetes mellitus in China. Zhonghua Fu Chan Ke Za Zhi, 2008, 43(9): 647-650 (in Chinese)

[5] RumboldA R, CrowtherC A. Guideline use for gestational diabetes mellitus and current screening, diagnostic and management practices in Australian hospitals. Aust N Z J Obstet Gynaecol, 2001, 41(1): 86-90

[6] CunninghamF G, GantN F, LevenoK J, GilstrapL C III, HauthJ C, WenstromK D. Williams Obstetrics. 23rd ed. New York: McGraw-Hill, 2005, 127-128

[7] XieY, XuX M, LiS D. Feasibility of diagnosing gestational diabetes mellitus by oral glucose tolerance test without the third-hour plasma glucose level. Zhonghua Wei Chan Yi Xue Za Zhi, 2005, 8(2): 89-91 (in Chinese)

[8] JakobiP, SoltI, WeissmanA. A 2 hour versus the 3 hour 100 g glucose tolerance test for diagnosing gestational diabetes mellitus. J Perinat Med, 2004, 32(4): 320-322

[9] AtilanoL C, Lee-ParritzA, LiebermanE, CohenA P, BarbieriR L. Alternative methods of diagnosing gestational diabetes mellitus. Am J Obstet Gynecol, 1999, 181(5 Pt 1): 1158-1161

[10] HodM, JovanovicL, Di RenzoG C. Textbook of Diabetes and Pregnancy. London: Martin Dunitz, 2003, 32-64

[11] YangH X, GaoX L, DongY, ShiC Y. Analysis of oral glucose tolerance test in pregnant women with abnormal glucose metabolism. Chin Med J (Engl), 2005, 118(12): 995-999

[12] QinS W, ChengN H, LiuJ T, ShanY, BianX M, XiangH D. 100 g oral glucose tolerance test in patients with gestational diabetes mellitus. Shengzhi Yi Xue Za Zhi, 2007, 16(1): 1-3 (in Chinese)

[13] American Diabetes Association. Standards of medical care in diabetes-2010. Diabetes Care, 2010, 33(Suppl 1): S11-S61

Acknowledgements

We have no conflict of interest with any companies or organizations.

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2014 Higher Education Press and Springer-Verlag Berlin Heidelberg