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Prenatal screening for gestational diabetes throughout office hours

par Kirkpatrick, Christine ;Schwers, Jean;Désir, Daniel
Référence European Journal of Obstetrics Gynecology and Reproductive Biology, 27, 4, page (299-306)
Publication Publié, 1988

Article révisé par les pairs

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Résumé :

A group of 1666 consecutive pregnant women attending our prenatal clinic was screened for gestational diabetes (GD). Patients with risk factors (155) underwent a classical 50 g OGTT, while 1511 patients without risk factors for GD were submitted at random throughout the day to a simplied OGTT, consisting of a single blood glucose determination 1 h after the glucose ingestion. In these patients, plasma glucose 1 h after the glucose load averaged 104 ± 1 mg/dl and exceeded 135 mg/dl in 315 patients. In the latter group, retested with a standard 50 g OGTT, 48 out of 1511 patients (3.2%) finally met the criteria for GD, while 25 patients had an abnormal OGTT in the group with risk factors. The blood glucose levels after simplified 50 g glucose load were significantly higher in the third (vs. first) trimester of pregnancy (113 ± 1 vs. 96 ± 1 mg/dl, p < 0.001). A significant increase in mean glucose concentrations was also observed for those patients tested after 11 a.m. (107 ± 1 mg/dl vs. 99 ± 1 mg/dl prior to 11 a.m. p < 0.001) and for the women with an ideal body weight (IBW) ≥ 150% at the beginning of pregnancy (124 ± 7 mg/dl vs. 105 ± 1 mg/dl for < 150% IBW, p < 0.001). These variations in glucose tolerance, related to the time of the day, the gestational age and the body weight, are of limited amplitude and should not be considered in the determination of the cut-off point of the screening test. Glucose loading at random throughout the day is a simple and useful tool for the routine detection of unsuspected GD in pregnant patients attending prenatal clinics.