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Underestimation of risk for large babies in rural and remote Australia: Time to change plasma glucose collection protocols
- Source :
- Journal of Clinical & Translational Endocrinology, Journal of Clinical & Translational Endocrinology, Vol 23, Iss, Pp 100247-(2021)
- Publication Year :
- 2021
- Publisher :
- Elsevier, 2021.
-
Abstract
- Highlights • In remote Australia, many women with GDM are missed due to test sample instability. • FC tubes stabilise glucose but markedly increase GDM diagnosis in lower-risk women. • Adjustment of FC results lowered GDM and improved risk-assessment for a large baby.<br />Aims Preanalytical glycolysis in oral glucose tolerance tests (OGTT) leads to substantial underestimation of gestational diabetes mellitus (GDM) and hence risk for large-for-gestational-age (LGA) babies. This paper quantified the impact of glycolysis on identification of LGA risk in a prospective rural and remote Australian cohort. Methods For 495 women, OGTT results from room temperature fluoride-oxalate (FLOX) tubes were algorithmically corrected for estimated glycolysis compared to 1) the Hyperglycaemia and Adverse Pregnancy Outcomes (HAPO) study protocol (FLOX tubes in ice-slurry); and 2) room temperature fluoride-citrate (FC) tubes. GDM was defined by International Association of the Diabetes and Pregnancy Study Groups (IADPSG) criteria. Unadjusted and corrected OGTT were related to LGA outcome. Results Correction for FC tubes increased GDM incidence from 9.7% to 44.6%. After correction for HAPO protocol, GDM incidence was 27.7% and prediction of LGA risk (RR 1.82, [1.11–2.99]) improved compared to unadjusted rates (RR 1.12, [0.51–2.47]). To provide similar results for FC tube correction (29.3% GDM; RR 1.81, [1.11–2.96]) required + 0.2 mmol/L adjustment of IADPSG criteria. Conclusions FC tubes present a practical alternative to the HAPO protocol in remote settings but give + 0.2 mmol/L higher glucose readings. Modification of IADPSG criteria would reduce perceived ‘overdiagnosis’ and improve LGA risk-assessment.
- Subjects :
- medicine.medical_specialty
endocrine system diseases
Endocrinology, Diabetes and Metabolism
030209 endocrinology & metabolism
lcsh:Diseases of the endocrine glands. Clinical endocrinology
03 medical and health sciences
0302 clinical medicine
Endocrinology
Diabetes mellitus
Rural and remote health
Medicine
030212 general & internal medicine
Overdiagnosis
Pregnancy outcomes
Diagnostics
Gestational diabetes
Pregnancy
Plasma glucose
lcsh:RC648-665
Indigenous health
business.industry
Obstetrics
Incidence (epidemiology)
nutritional and metabolic diseases
medicine.disease
female genital diseases and pregnancy complications
Cohort
business
Glycolysis
Research Paper
Subjects
Details
- Language :
- English
- ISSN :
- 22146237
- Volume :
- 23
- Database :
- OpenAIRE
- Journal :
- Journal of Clinical & Translational Endocrinology
- Accession number :
- edsair.doi.dedup.....129383bc9c19f2926709abe948054b72