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. 1999 Sep 25;319(7213):812-5.
doi: 10.1136/bmj.319.7213.812.

Using fasting plasma glucose concentrations to screen for gestational diabetes mellitus: prospective population based study

D Perucchini  1 , U Fischer, G A Spinas, R Huch, A Huch, R Lehmann
Affiliations

Using fasting plasma glucose concentrations to screen for gestational diabetes mellitus: prospective population based study

D Perucchini et al. BMJ. .

Abstract

Objective: To evaluate whether measuring fasting plasma glucose concentration is an easier screening procedure for gestational diabetes mellitus than the 1 hour 50 g glucose challenge test.

Design: Prospective population based study.

Setting: Outpatient clinic in a university hospital.

Participants: 520 pregnant women (328 (63%) white, 99 (19%) Asian, 31 (6%) African, 62 (12%) others) with mean age 28.4 (SD 0.2; range 17-45) years. All underwent a glucose challenge test between the 24th and 28th gestational week, followed by a diagnostic 3 hour 100 g oral glucose tolerance test within one week. This was done irrespective of the result of the challenge test.

Main outcome measure: Receiver operating curves were used to determine the best cut off values for screening with fasting plasma glucose concentrations.

Results: Fasting plasma glucose concentration at a threshold value of 4.8 mmol/l and the glucose challenge test with a threshold value of 7.8 mmol/l yielded sensitivities of 81% and 59% respectively and specificities of 76% and 91% respectively. Measuring fasting plasma glucose concentration as a screening procedure required a diagnostic test in 30%, compared with 14% when the challenge test was used.

Conclusions: Measuring fasting plasma glucose concentrations using a cut off value of >/=4. 8 mmol/l is an easier screening procedure for gestational diabetes than the 50 g glucose challenge test and allows 70% of women to avoid the challenge test.

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Figures

Figure
Figure
Receiver operating characteristics of two different screening procedures for gestational diabetes (fasting plasma glucose concentration and 50 g glucose challenge test independent of prior food intake). The area under the curve is 0.897 for fasting plasma glucose concentration and 0.815 for the glucose challenge test. The true positive rates (sensitivity) versus the false positive rates (1-specificity) are plotted for the cut off values (each data point is 0.2 mmol/l apart)
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