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Simplifying the screening of gestational diabetes by maternal age plus fasting plasma glucose at first prenatal visit: A prospective cohort study

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 diabe...

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Autores principales: Tai, Yi-Yun, Lee, Chien-Nan, Kuo, Chun-Heng, Lin, Ming-Wei, Chen, Kuan-Yu, Lin, Shin-Yu, Li, Hung-Yuan
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7444589/
https://www.ncbi.nlm.nih.gov/pubmed/32817647
http://dx.doi.org/10.1371/journal.pone.0237224
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author Tai, Yi-Yun
Lee, Chien-Nan
Kuo, Chun-Heng
Lin, Ming-Wei
Chen, Kuan-Yu
Lin, Shin-Yu
Li, Hung-Yuan
author_facet Tai, Yi-Yun
Lee, Chien-Nan
Kuo, Chun-Heng
Lin, Ming-Wei
Chen, Kuan-Yu
Lin, Shin-Yu
Li, Hung-Yuan
author_sort Tai, Yi-Yun
collection PubMed
description 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.
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spelling pubmed-74445892020-08-27 Simplifying the screening of gestational diabetes by maternal age plus fasting plasma glucose at first prenatal visit: A prospective cohort study Tai, Yi-Yun Lee, Chien-Nan Kuo, Chun-Heng Lin, Ming-Wei Chen, Kuan-Yu Lin, Shin-Yu Li, Hung-Yuan PLoS One Research Article 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. Public Library of Science 2020-08-20 /pmc/articles/PMC7444589/ /pubmed/32817647 http://dx.doi.org/10.1371/journal.pone.0237224 Text en © 2020 Tai et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Tai, Yi-Yun
Lee, Chien-Nan
Kuo, Chun-Heng
Lin, Ming-Wei
Chen, Kuan-Yu
Lin, Shin-Yu
Li, Hung-Yuan
Simplifying the screening of gestational diabetes by maternal age plus fasting plasma glucose at first prenatal visit: A prospective cohort study
title Simplifying the screening of gestational diabetes by maternal age plus fasting plasma glucose at first prenatal visit: A prospective cohort study
title_full Simplifying the screening of gestational diabetes by maternal age plus fasting plasma glucose at first prenatal visit: A prospective cohort study
title_fullStr Simplifying the screening of gestational diabetes by maternal age plus fasting plasma glucose at first prenatal visit: A prospective cohort study
title_full_unstemmed Simplifying the screening of gestational diabetes by maternal age plus fasting plasma glucose at first prenatal visit: A prospective cohort study
title_short Simplifying the screening of gestational diabetes by maternal age plus fasting plasma glucose at first prenatal visit: A prospective cohort study
title_sort simplifying the screening of gestational diabetes by maternal age plus fasting plasma glucose at first prenatal visit: a prospective cohort study
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7444589/
https://www.ncbi.nlm.nih.gov/pubmed/32817647
http://dx.doi.org/10.1371/journal.pone.0237224
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