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Improved gestational diabetes screening protocol.
- Source :
-
Advances in laboratory medicine [Adv Lab Med] 2021 Feb 17; Vol. 2 (1), pp. 87-107. Date of Electronic Publication: 2021 Feb 17 (Print Publication: 2021). - Publication Year :
- 2021
-
Abstract
- Objectives: This work aimed to assess the diagnostic validity of two approaches for the screening of gestational diabetes mellitus (GDM) with less discomfort for pregnant women.<br />Methods: A prospective diagnostic validation study was conducted with 2007 pregnant women. According to risk factors for GDM, women were classified into high-risk and low-risk groups. The current diagnostic procedure, based on oral glucose overload, was followed; simultaneously HbA <subscript>1c</subscript> was tested and an algorithm combining both biomarkers was applied.<br />Results: In the low-risk group, the Glucose challenge test (GCT) showed a higher area under the curve (AUC 0.953; 95% CI 0.915-0.992) than the HbA <subscript>1c</subscript> test (0.688; 95% CI 0.541-0.834). The best GCT cut-off, 153.5 mg/dL (8.52 mmol/L), showed higher diagnostic validity than that for HbA <subscript>1c</subscript> , 28 mmol/mol (4.75%), and that the algorithm using both tests. In the high-risk group, the GCT showed better diagnostic performance than the HbA <subscript>1c</subscript> and the algorithm; the optimal GCT cut-offs were higher than those recommended in current protocols. 13th week: GCT AUC 0.882 (95% CI 0.843-0.921), HbA <subscript>1c</subscript> AUC 0.624 (95% CI 0.562-0.686), GCT cut-off 140.5 mg/dL (7.8 mmol/L), HbA <subscript>1c</subscript> cut-off 33 mmol/mol (5.15%). 24th week: GCT AUC 0.944 (95% CI 0.925-0.962), HbA <subscript>1c</subscript> AUC 0.642 (95% CI 0.575-0.709), GCT cut-off, 145.5 mg/dL (8.08 mmol/L), HbA <subscript>1c</subscript> cut-off 29 mmol/mol (4.85%).<br />Conclusions: The GDM diagnostic approach using as the first step the GCT with higher cut-offs showed the best diagnostic validity. Applying these thresholds, 55.6 and 13.7% of 100 g. Oral glucose overloads would have been avoided in low-risk and high-risk pregnant women.<br />Competing Interests: Competing interests: Authors state no conflict of interest.<br /> (© 2021 Miguel Calero Rojas et al., published by De Gruyter, Berlin/Boston.)
Details
- Language :
- English; Spanish; Castilian
- ISSN :
- 2628-491X
- Volume :
- 2
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- Advances in laboratory medicine
- Publication Type :
- Academic Journal
- Accession number :
- 37359196
- Full Text :
- https://doi.org/10.1515/almed-2020-0072