Simplifying the screening of gestational diabetes by maternal age plus fasting plasma glucose at first prenatal visit: A prospective cohort study
Journal
PLoS ONE
Journal Volume
15
Journal Issue
44416
Pages
e0237224
Date Issued
2020
Author(s)
Abstract
Aim The addition of maternal age to fasting plasma glucose (FPG) at 24–28 gestational weeks improves the performance of GDM screening as maternal age increases. However, this method delays the diagnosis of GDM. Since FPG at the first prenatal visit (FPV) is a screening option for pre-existing diabetes, we evaluated the performance of age plus FPG at the FPV to reduce the need for the OGTT. Methods Pregnant women were recruited consecutively in 2013–2018 (the training cohort) and 2019 (the validation cohort). We excluded women with twin pregnancies, unavailable FPG at the FPV or OGTT data, pre-pregnancy diabetes, or a history of GDM. All participants underwent FPG and haemoglobin A1c (HbA1c) at the FPV and received 75-g OGTT at 24–28 gestational weeks if FPG at the FPV was <92 mg/dL. GDM was diagnosed by the IADPSG criteria. Two algorithms were developed with the cutoffs determined when the percentage requiring OGTT (OGTT%) was the lowest and the sensitivity was ≧90%. Results The incidence of GDM increased with age. The “FPG at the FPV” algorithm reduced OGTT % to 68.8% with the FPG cutoff at 79 mg/dl. The "age plus FPG at the FPV" algorithm, with the cutoff of 114, further reduced OGTT% to 58.3%, with the sensitivity of 90.7% (9.3% GDM missed) and the specificity of 100%. These findings were replicated in the validation cohort. Conclusions Screening GDM by maternal age plus FPG at the FPV can reduce OGTT%, especially in populations with a significant proportion of pregnant women with advanced ages. ? 2020 Tai et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
SDGs
Other Subjects
hemoglobin A1c; glycosylated hemoglobin; adult; Article; cohort analysis; controlled study; diagnostic test accuracy study; early intervention; fasting; female; gestational age; glucose blood level; Han Chinese; hemoglobin blood level; human; learning algorithm; logistic regression analysis; major clinical study; maternal age; oral glucose tolerance test; ovary polycystic disease; practice guideline; predictive value; pregnancy diabetes mellitus; prenatal screening; prospective study; sensitivity and specificity; simulation; validation process; World Health Organization; blood; diet restriction; glucose blood level; glucose tolerance test; mass screening; maternal age; pregnancy; pregnancy diabetes mellitus; Adult; Blood Glucose; Diabetes, Gestational; Fasting; Female; Glucose Tolerance Test; Glycated Hemoglobin A; Humans; Mass Screening; Maternal Age; Pregnancy; Prospective Studies
Publisher
Public Library of Science
Type
journal article