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Fasting plasma glucose level to guide the need for an OGTT to screen for gestational diabetes mellitus

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A Letter to the Editor to this article was published on 13 March 2023

Abstract

Aims

To determine the fasting plasma glucose (FPG) level at which an oral glucose tolerance test (OGTT) could be avoided to screen for gestational diabetes (GDM) and to evaluate the characteristics of women across this FPG threshold.

Methods

A multi-centric prospective cohort study with 1843 women receiving universal screening for GDM with a 75 g OGTT.

Results

In the total population, GDM prevalence was 12.5% (231). A FPG < 78 mg/dL was the cut-off with best trade-off to limit the number of missed GDM cases [44 (19.0%)] with a negative predictive value of 97.3% (95% CI 96.5–98.0) for GDM, while avoiding 52.2% OGTTs. Compared to GDM with FPG ≥ 78 mg/dL [187 (81.0%)], GDM women with FPG < 78 mg/dL had a significantly lower BMI (27.1 ± 4.5 vs. 29.6 ± 5.2 kg/m2, p = 0.003), less insulin resistance [Matsuda: 0.4 (0.4–0.7) vs. 0.3 (0.2–0.5), p < 0.001] and better β-cell function [ISSI-2: 0.13 (0.08–0.25) vs. 0.09 (0.04–0.15), p = 0.004]. Compared to NGT women (1612) with FPG ≥ 78 mg/dL [846 (52.5%)], NGT with FPG < 78 mg/dL [766 (47.5%)] had a significantly lower BMI (26.0 ± 3.9 vs. 27.8 ± 4.7 kg/m2, p < 0.001), less insulin resistance [Matsuda: 0.7 (0.5–0.9) vs. 0.5 (0.4–0.7), p < 0.001], better β-cell function [ISSI-2: 0.17 (0.10–0.30) vs. 0.12 (0.07–0.21), p < 0.001], and less often large-for-gestational age infants [9.2 (70) vs. 16.2% (136), p < 0.001].

Conclusions

FPG < 78 mg/dL can be used to limit the number of OGTTs when screening for GDM. Women with FPG < 78 mg/dL had a better metabolic profile and in NGT women also less fetal overgrowth.

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Acknowledgments

KB (Katrien Benhalima) and RD are the recipient of a ‘Fundamenteel Klinisch Navorserschap FWO Vlaanderen’.

Funding

This investigator-initiated study was funded by the Belgian National Lottery, the Fund of the Academic studies of UZ Leuven, and the Fund Yvonne and Jacques François-de Meurs of the King Baudouin Foundation. KB (Katrien Benhalima) and RD are the recipient of a ‘Fundamenteel Klinisch Navorserschap FWO Vlaanderen’.

Author information

Authors and Affiliations

  1. Department of Endocrinology, University Hospital Gasthuisberg, KU Leuven, Herestraat 49, 3000, Leuven, Belgium

    Kaat Beunen, Carolien Moyson, Chantal Mathieu & Katrien Benhalima

  2. KU Leuven, Herestraat 49, 3000, Leuven, Belgium

    Astrid Neys

  3. Department of Endocrinology, OLV Ziekenhuis Aalst-Asse-Ninove, Moorselbaan 164, 9300, Aalst, Belgium

    Paul Van Crombrugge

  4. Department of Obstetrics and Gynecology, University Hospital Gasthuisberg, KU Leuven, Herestraat 49, 3000, Leuven, Belgium

    Johan Verhaeghe & Roland Devlieger

  5. Department of Obstetrics and Gynecology, OLV Ziekenhuis Aalst-Asse-Ninove, Moorselbaan 164, 9300, Aalst, Belgium

    Sofie Vandeginste & Hilde Verlaenen

  6. Department of Endocrinology, Imelda Ziekenhuis, Imeldalaan 9, 2820, Bonheiden, Belgium

    Chris Vercammen & Toon Maes

  7. Department of Obstetrics and Gynecology, Imelda Ziekenhuis, Imeldalaan 9, 2820, Bonheiden, Belgium

    Els Dufraimont & Nele Roggen

  8. Department of Endocrinology-Diabetology-Metabolism, Antwerp University Hospital, Drie Eikenstraat 655, 2650, Edegem, Belgium

    Christophe De Block

  9. Department of Obstetrics and Gynecology, Antwerp University Hospital, Drie Eikenstraat 655, 2650, Edegem, Belgium

    Yves Jacquemyn

  10. Department of Endocrinology, Kliniek St-Jan Brussel, Kruidtuinlaan 32, 1000, Brussel, Belgium

    Farah Mekahli

  11. Department of Obstetrics and Gynecology, Kliniek St-Jan Brussel, Kruidtuinlaan 32, 1000, Brussel, Belgium

    Katrien De Clippel

  12. Department of Endocrinology, AZ St Jan Brugge, Ruddershove 10, 8000, Brugge, Belgium

    Annick Van Den Bruel

  13. Department of Obstetrics and Gynecology, AZ St Jan Brugge, Ruddershove 10, 8000, Brugge, Belgium

    Anne Loccufier

  14. Center of Biostatics and Statistical Bioinformatics, KU Leuven, Kapucijnenvoer 35 bloc d, box 7001, 3000, Leuven, Belgium

    Annouschka Laenen

Authors
  1. Kaat Beunen
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  2. Astrid Neys
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  19. Roland Devlieger
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  20. Chantal Mathieu
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Contributions

KB (Katrien Benhalima), PVC, and CM (Chantal Mathieu) conceived the project. CM (Carolien Moyson), KDW, and AE prepared the data and AL did the statistical analysis. KB (Kaat Beunen) did the literature review. KB (Kaat Beunen) and KB (Katrien Benhalima) wrote the first draft of the manuscript. All authors contributed to the study design, including data collection, data interpretation, and manuscript revision.

Corresponding author

Correspondence to Kaat Beunen.

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The authors declare that they have no conflict of interest.

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The study protocol was approved by the Institutional Review Boards of all participating centers. All investigations have been carried out in accordance with the principles of the Declaration of Helsinki as revised in 2008.

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All participants provided informed consent prior to inclusion in the study.

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Beunen, K., Neys, A., Van Crombrugge, P. et al. Fasting plasma glucose level to guide the need for an OGTT to screen for gestational diabetes mellitus. Acta Diabetol 59, 381–394 (2022). https://doi.org/10.1007/s00592-021-01812-9

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