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Identifying women with gestational diabetes based on maternal characteristics: an analysis of four Norwegian prospective studies
BACKGROUND: There is still no worldwide agreement on the best diagnostic thresholds to define gestational diabetes (GDM) or the optimal approach for identifying women with GDM. Should all pregnant women perform an oral glucose tolerance test (OGTT) or can easily available maternal characteristics, s...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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BioMed Central
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8427855/ https://www.ncbi.nlm.nih.gov/pubmed/34496778 http://dx.doi.org/10.1186/s12884-021-04086-9 |
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author | Rai, Anam Shakil Sletner, Line Jenum, Anne Karen Øverby, Nina Cecilie Stafne, Signe Nilssen Lekva, Tove Pripp, Are Hugo Sagedal, Linda Reme |
author_facet | Rai, Anam Shakil Sletner, Line Jenum, Anne Karen Øverby, Nina Cecilie Stafne, Signe Nilssen Lekva, Tove Pripp, Are Hugo Sagedal, Linda Reme |
author_sort | Rai, Anam Shakil |
collection | PubMed |
description | BACKGROUND: There is still no worldwide agreement on the best diagnostic thresholds to define gestational diabetes (GDM) or the optimal approach for identifying women with GDM. Should all pregnant women perform an oral glucose tolerance test (OGTT) or can easily available maternal characteristics, such as age, BMI and ethnicity, indicate which women to test? The aim of this study was to assess the prevalence of GDM by three diagnostic criteria and the predictive accuracy of commonly used risk factors. METHODS: We merged data from four Norwegian cohorts (2002–2013), encompassing 2981 women with complete results from a universally offered OGTT. Prevalences were estimated based on the following diagnostic criteria: (1999)WHO (fasting plasma glucose (FPG) ≥7.0 or 2-h glucose ≥7.8 mmol/L), (2013)WHO (FPG ≥5.1 or 2-h glucose ≥8.5 mmol/L), and (2017)Norwegian (FPG ≥5.3 or 2-h glucose ≥9 mmol/L). Multiple logistic regression models examined associations between GDM and maternal factors. We applied the (2013)WHO and (2017)Norwegian criteria to evaluate the performance of different thresholds of age and BMI. RESULTS: The prevalence of GDM was 10.7, 16.9 and 10.3%, applying the (1999)WHO, (2013)WHO, and the (2017)Norwegian criteria, respectively, but was higher for women with non-European background when compared to European women (14.5 vs 10.2%, 37.7 vs 13.8% and 27.0 vs 7.8%). While advancing age and elevated BMI increased the risk of GDM, no risk factors, isolated or in combination, could identify more than 80% of women with GDM by the latter two diagnostic criteria, unless at least 70–80% of women were offered an OGTT. Using the (2017)Norwegian criteria, the combination “age≥25 years or BMI≥25 kg/m(2)” achieved the highest sensitivity (96.5%) with an OGTT required for 93% of European women. The predictive accuracy of risk factors for identifying GDM was even lower for non-European women. CONCLUSIONS: The prevalence of GDM was similar using the (1999)WHO and (2017)Norwegian criteria, but substantially higher with the (2013)WHO criteria, in particular for ethnic non-European women. Using clinical risk factors such as age and BMI is a poor pre-diagnostic screening method, as this approach failed to identify a substantial proportion of women with GDM unless at least 70–80% were tested. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12884-021-04086-9. |
format | Online Article Text |
id | pubmed-8427855 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-84278552021-09-10 Identifying women with gestational diabetes based on maternal characteristics: an analysis of four Norwegian prospective studies Rai, Anam Shakil Sletner, Line Jenum, Anne Karen Øverby, Nina Cecilie Stafne, Signe Nilssen Lekva, Tove Pripp, Are Hugo Sagedal, Linda Reme BMC Pregnancy Childbirth Research BACKGROUND: There is still no worldwide agreement on the best diagnostic thresholds to define gestational diabetes (GDM) or the optimal approach for identifying women with GDM. Should all pregnant women perform an oral glucose tolerance test (OGTT) or can easily available maternal characteristics, such as age, BMI and ethnicity, indicate which women to test? The aim of this study was to assess the prevalence of GDM by three diagnostic criteria and the predictive accuracy of commonly used risk factors. METHODS: We merged data from four Norwegian cohorts (2002–2013), encompassing 2981 women with complete results from a universally offered OGTT. Prevalences were estimated based on the following diagnostic criteria: (1999)WHO (fasting plasma glucose (FPG) ≥7.0 or 2-h glucose ≥7.8 mmol/L), (2013)WHO (FPG ≥5.1 or 2-h glucose ≥8.5 mmol/L), and (2017)Norwegian (FPG ≥5.3 or 2-h glucose ≥9 mmol/L). Multiple logistic regression models examined associations between GDM and maternal factors. We applied the (2013)WHO and (2017)Norwegian criteria to evaluate the performance of different thresholds of age and BMI. RESULTS: The prevalence of GDM was 10.7, 16.9 and 10.3%, applying the (1999)WHO, (2013)WHO, and the (2017)Norwegian criteria, respectively, but was higher for women with non-European background when compared to European women (14.5 vs 10.2%, 37.7 vs 13.8% and 27.0 vs 7.8%). While advancing age and elevated BMI increased the risk of GDM, no risk factors, isolated or in combination, could identify more than 80% of women with GDM by the latter two diagnostic criteria, unless at least 70–80% of women were offered an OGTT. Using the (2017)Norwegian criteria, the combination “age≥25 years or BMI≥25 kg/m(2)” achieved the highest sensitivity (96.5%) with an OGTT required for 93% of European women. The predictive accuracy of risk factors for identifying GDM was even lower for non-European women. CONCLUSIONS: The prevalence of GDM was similar using the (1999)WHO and (2017)Norwegian criteria, but substantially higher with the (2013)WHO criteria, in particular for ethnic non-European women. Using clinical risk factors such as age and BMI is a poor pre-diagnostic screening method, as this approach failed to identify a substantial proportion of women with GDM unless at least 70–80% were tested. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12884-021-04086-9. BioMed Central 2021-09-08 /pmc/articles/PMC8427855/ /pubmed/34496778 http://dx.doi.org/10.1186/s12884-021-04086-9 Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data. |
spellingShingle | Research Rai, Anam Shakil Sletner, Line Jenum, Anne Karen Øverby, Nina Cecilie Stafne, Signe Nilssen Lekva, Tove Pripp, Are Hugo Sagedal, Linda Reme Identifying women with gestational diabetes based on maternal characteristics: an analysis of four Norwegian prospective studies |
title | Identifying women with gestational diabetes based on maternal characteristics: an analysis of four Norwegian prospective studies |
title_full | Identifying women with gestational diabetes based on maternal characteristics: an analysis of four Norwegian prospective studies |
title_fullStr | Identifying women with gestational diabetes based on maternal characteristics: an analysis of four Norwegian prospective studies |
title_full_unstemmed | Identifying women with gestational diabetes based on maternal characteristics: an analysis of four Norwegian prospective studies |
title_short | Identifying women with gestational diabetes based on maternal characteristics: an analysis of four Norwegian prospective studies |
title_sort | identifying women with gestational diabetes based on maternal characteristics: an analysis of four norwegian prospective studies |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8427855/ https://www.ncbi.nlm.nih.gov/pubmed/34496778 http://dx.doi.org/10.1186/s12884-021-04086-9 |
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