Gestational Diabetes Diagnostic Methods (GD2M) Pilot Randomized Trial Diagnosis of gestational diabetes mellitus in Nigerian pregnant women--comparison between 75G and 100G oral glucose tolerance tests. Differences in postload plasma glucose levels between 100-g and 75-g oral glucose tolerance tests in normal pregnant women: a potential role of early insulin secretion. Screening uptake rates and the clinical and cost effectiveness of screening for gestational diabetes mellitus in primary versus secondary care: study protocol for a randomised controlled trial Toward universal criteria for gestational diabetes: relationships between seventy-five and one hundred gram glucose loads and between capillary and venous glucose concentrations. Effect of treatment of gestational diabetes mellitus on pregnancy outcomes. Prior feeding Alters the Response to the 50-g Glucose Challenge Test in Pregnancy: The Staub-Traugott Effect revisited No influence of high- and low-carbohydrate diet on the oral glucose tolerance test in pregnancy. A randomized controlled trial using glycemic plus fetal ultrasound parameters versus glycemic parameters to determine insulin therapy in gestational diabetes with fasting hyperglycemia. Screening For Gestational Diabetes Mellitus: Comparison Of A Glucose Polymer And A Glucose Monomer Test Beverage Prediction of gestational diabetes mellitus in the first trimester, comparison of fasting plasma glucose, two-step and one-step methods: a prospective randomized controlled trial Comparison of Glucose Polymer and Glucose for Screening and Tolerance Tests in Pregnancy [Perinatal outcomes of patients with gestational diabetes diagnosed by three different methods]. A comparison between a 75-g and 100-g oral glucose tolerance test in pregnant women. Screening for gestational diabetes mellitus by a model based on risk indicators: a prospective study. Jelly beans as an alternative to a fifty-gram glucose beverage for gestational diabetes screening. Investigating the effects of treatment based on single high blood glucose in gestational diabetes screening on maternal and neonatal complications Screening for gestational diabetes mellitus: a decision and cost-effectiveness analysis of four screening strategies. [Post-prandial plasma glucose test as screening tool for gestational diabetes: A prospective randomized trial]. A double-blind, randomised, cross-over study comparing the 50g OGTT and the 75g OGTT for pregnant women in the third trimester. Feasibility, acceptability and uptake rates of gestational diabetes mellitus screening in primary care vs secondary care: findings from a randomised controlled mixed methods trial Universal vs. risk factor‐based screening for gestational diabetes mellitus: detection rates, gestation at diagnosis and outcome Use of a standard preparatory diet for the oral glucose tolerance test. Is it necessary? [Screening for gestational diabetes with capillary blood glucose]. Carbohydrate sources for gestational diabetes mellitus screening. A comparison. Detection of glucose intolerance in pregnancy. Screening for gestational diabetes mellitus in primary versus secondary care: The clinical outcomes of a randomised controlled trial. Glucose Tolerance Test Periodicity: The Effect of Glucose Loading To evaluate the prevalence and clinical outcomes using a one-step method versus a two-step method to screen gestational diabetes mellitus Variations in oral glucose tolerance tests: the 100- versus 75-g controversy. Gestational diabetes mellitus screening and diagnosis: a prospective randomised controlled trial comparing costs of one‐step and two‐step methods Comparison of glucose and a glucose polymer for testing oral carbohydrate tolerance in pregnancy. A multicenter, randomized trial of treatment for mild gestational diabetes.
To test the feasibility of conducting a pragmatic r and omized controlled trial ( RCT ) comparing the International Association of Diabetes in Pregnancy Study Groups ( IADPSG ) versus Carpenter – Coustan diagnostic criteria for gestational diabetes ( GDM ) , and to examine patient and provider views on GDM screening . A single-blinded pragmatic pilot RCT . Participants with a singleton pregnancy between 24 and 28 weeks gestation received a 50 g oral glucose challenge test and if the value was < 200 mg/dL were r and omized to either the 2 h 75 g OGTT using the IADPSG criteria or the 3 h 100 g OGTT using the Carpenter – Coustan criteria . Primary outcome was the feasibility of r and omization and screening . Secondary outcomes included patient and provider views ( or preferences ) on GDM testing .  Sixty-eight women were recruited , 48 ( 71 % ) enrolled and 47 ( 69 % ) were r and omized . Participants in both study arms identified the main challenges to GDM testing to be : drinking the glucola , fasting prior to testing , waiting to have blood drawn , and multiple venipuntures . Women in both study arms would prefer the 2 h 75 g OGTT or whichever test is recommended by their doctor in a future pregnancy . Physicians and nurse midwives endorsed screening and were comfortable with being blinded to the GDM testing strategy and results values . Both pregnant women and providers value GDM screening , and pregnant women can be recruited to a blinded , r and omized GDM screening trial with minimal attrition and missing data STUDY OBJECTIVE To compare the diagnostic performances of 75 g and 100 g oral glucose tolerance tests in detecting  Gestational Diabetes Mellitus in Nigerian pregnant women . MATERIAL S AND METHODS 248 women in 3rd trimester attending antenatal clinic of the Lagos University Teaching Hospital , Lagos , between November 1997 and July 1999 were r and omly subjected to st and ard oral glucose tolerance tests ( OGTT ) . 110 had 100 g OGTT while 138 had 75 g OGTT . The plasma glucose response ( PGR ) was assessed and glucose tolerance status of each patient was determined using WHO ( 1985 ) criteria to interpret 75 g OGTT and National Diabetes Data Group ( NDDG ) ( 1979 ) criteria for 100 g OGTT . The PGR in the two study groups were compared . The prevalence rates of GDM using either of the two criteria were evaluated and compared . Incidences of foetal macrosomia in GDM cases diagnosed by either set of criteria were also compared . RESULTS The mean age of the study subjects was 30.7(+/-4.2 ) years while the BMI was 25.4(+/-4.9 ) kg/m2 . The mean parity was 1.33 . Traditional risk factors for GDM were found in 47.5 % of them . The plasma glucose response ( PGR ) to 100 g OGTT was found to be higher than that of 75 g OGTT at 1 hour , 2hour and 3 hour sampling times but the difference was only significant at 3rd hour ( p values = 0.68 , 0.137 , 0.007 respectively ) . The total area under the glucose response curve ( AUC ) for 75 g OGTT was 345.1 ( + /-49.5 ) AAU while for 100 g OGTT , it was 363.4(+/-61.4 ) AAU . The difference was not statistically significant ( p value > 0.05 ) . The prevalence rate of GDM diagnosed by 75 g OGTT was 11.6 % while that of 100 g OGTT was 4.5 % . The difference was significant ( p value = 0.04 ) . The incidence rate of foetal macrosomia among GDM cases diagnosed by 100 g OGTT was 66.7 % as against 23.1 % among those diagnosed by 75 g OGTT . Statistical difference could not be determined because of the small number . CONCLUSION Plasma glucose response to OGTT among Nigerian pregnant women has little or no respect for the load of the glucose administered . 100 g OGTT- based NDDG criteria was more stringent than 75 g OGTT-based WHO criteria in identifying GDM . However it appears to be more specific for detecting the complications associated with the condition though it will require a larger study to vali date this cl aim OBJECTIVE To demonstrate a role of early insulin secretion on plasma glucose levels after different amounts of oral glucose loads in pregnant women . MATERIAL AND METHOD Forty-one pregnant women with normal glucose tolerance according to the Carpenter and Coustan ' s criteria and 25 non-pregnant women ( control group ) with normal glucose tolerance according to the World Health Organization criteria were enrolled . Each subject was r and omly scheduled to perform both the 100-g and 75-g OGTT within a 1-week interval . Venous blood was drawn at fasting , 30- , 60- , 120- , and 180-minute intervals during both tests for determination of plasma glucose and serum insulin levels . RESULTS The mean ( + /- SE ) ages of the pregnant and control groups were 33.3 + /- 0.9 and 31.8 + /- 1.4 years , respectively . The mean gestational age at the time of performing OGTT of the pregnant group was 28.7 + /- 0.6 weeks . In the non-pregnant group , the plasma glucose concentrations were not different between 75-g and 100-g OGTT whereas the serum insulin levels at the 30 and 180 minutes of the 100-g OGTT were significantly higher than those of the 75-g OGT . In the pregnant group , both plasma glucose and serum insulin concentrations at the 120 and 180 minutes of the 100-g OGTT were significantly higher than those of the 75-g OGT . CONCLUSION The limited ability of early insulin secretion to increase when glucose load increased in the pregnant women could explain the high plasma glucose levels at 2 and 3 hours of 100-g OGTT compared to those of 75-g OGTT Background The risks associated with gestational diabetes mellitus ( GDM ) are well recognized , and there is increasing evidence to support treatment of the condition . However , clear guidance on the ideal approach to screening for GDM is lacking . Professional groups continue to debate whether selective screening ( based on risk factors ) or universal screening is the most appropriate approach . Additionally , there is ongoing debate about what levels of glucose abnormalities during pregnancy respond best to treatment and which maternal and neonatal outcomes benefit most from treatment . Furthermore , the implication s of possible screening options on health care costs are not well established . In response to this uncertainty there have been repeated calls for well- design ed , r and omised trials to determine the efficacy of screening , diagnosis , and management plans for GDM . We describe a r and omised controlled trial to investigate screening uptake rates and the clinical and cost effectiveness of screening in primary versus secondary care setting s. Methods / Design This will be an unblinded , two-group , parallel r and omised controlled trial ( RCT ) . The target population includes 784 women presenting for their first antenatal visit at 12 to 18 weeks gestation at two hospitals in the west of Irel and : Galway University Hospital and Mayo General Hospital . Participants will be offered  universal screening for GDM  at 24 to 28 weeks gestation in either primary care ( n = 392 ) or secondary care ( n = 392 ) locations . The primary outcome variable is the uptake rate of screening . Secondary outcomes include indicators of clinical effectiveness of screening at each screening site ( primary and secondary ) including gestational week at time of screening , time to access antenatal diabetes services for women diagnosed with GDM , and pregnancy and neonatal outcomes for women with GDM . In addition , parallel economic and qualitative evaluations will be conducted . The trial will cover the period from the woman ’s first hospital antenatal visit at 12 to 18 weeks gestation , until the completion of the pregnancy . Trial registration Current Controlled Trials : IS RCT OBJECTIVES Replacement of the two-step , 100 gm , 3-hour National Diabetes Data Group procedure by the one-step , 75 gm , 2-hour World Health Organization oral glucose tolerance test has been hindered by a paucity of data comparing the two tests during pregnancy . The current series compared 100 gm and 75 gm glucose loads and glucose measurements in venous plasma or capillary blood . STUDY DESIGN After a 75 gm oral glucose tolerance test  30 gestational diabetics and 30 metabolically healthy pregnant women were r and omly assigned to a second 75 or 100 gm test within 3+/-1.3 ( mean+/-SD ) days . Glucose levels at both tests was measured in capillary blood and venous plasma , as were insulin and C peptide . RESULTS In controls 1-hour maternal glucose levels ( 112 vs 128 mg/dl ) and 2-hour levels ( 104 vs 113 mg/dl ) differed significantly after a 75 or 100 gm load ( paired t test ) . In gestational diabetes mellitus , however , there was no difference ( 176 vs 178 mg/dl ) but a low insulin/glucose quotient at 1 hour . Only 2-hour levels differed significantly ( 133 vs 149 mg/dl ) . In controls glucose measurement in capillary blood and venous plasma differed significantly at 1 hour ( 126 vs 115 mg/dl ) and 2 hours ( 111 vs 104 mg/dl ) independently of the glucose load . In gestational diabetes mellitus , however , glucose measurement in capillary blood and venous plasma differed neither in 1-hour levels ( 179 vs 174 mg/dl ) nor in 2-hour levels ( 142 vs 139 mg/dl ) . CONCLUSION In metabolically healthy women both different loading and different blood fractions lead to statistically different blood glucose levels at 1 and 2 hours . In gestational diabetes mellitus , however , 1-hour glucose levels do not differ after a 75 or 100 gm load or after glucose measurement in capillary blood or venous plasma . This is due to elevated insulin resistance shown by a low insulin/glucose quotient at 1 hour . For comparison of tests in gestational diabetes mellitus only , 2-hour values must be adjusted by 16 mg/dl after different loading BACKGROUND We conducted a r and omized clinical trial to determine whether treatment of women with gestational diabetes mellitus reduced the risk of perinatal complications . METHODS We r and omly assigned women between 24 and 34 weeks ' gestation who had gestational diabetes to receive dietary advice , blood glucose monitoring , and insulin therapy as needed ( the intervention group ) or routine care . Primary outcomes included serious perinatal complications ( defined as death , shoulder dystocia , bone fracture , and nerve palsy ) , admission to the neonatal nursery , jaundice requiring phototherapy , induction of labor , cesarean birth , and maternal anxiety , depression , and health status . RESULTS The rate of serious perinatal complications was significantly lower among the infants of the 490 women in the intervention group than among the infants of the 510 women in the routine-care group ( 1 percent vs. 4 percent ; relative risk adjusted for maternal age , race or ethnic group , and parity , 0.33 ; 95 percent confidence interval , 0.14 to 0.75 ; P=0.01 ) . However , more infants of women in the intervention group were admitted to the neonatal nursery ( 71 percent vs. 61 percent ; adjusted relative risk , 1.13 ; 95 percent confidence interval , 1.03 to 1.23 ; P=0.01 ) . Women in the intervention group had a higher rate of induction of labor than the women in the routine-care group ( 39 percent vs. 29 percent ; adjusted relative risk , 1.36 ; 95 percent confidence interval , 1.15 to 1.62 ; P<0.001 ) , although the rates of cesarean delivery were similar ( 31 percent and 32 percent , respectively ; adjusted relative risk , 0.97 ; 95 percent confidence interval , 0.81 to 1.16 ; P=0.73 ) . At three months post partum , data on the women 's mood and quality of life , available for 573 women , revealed lower rates of depression and higher scores , consistent with improved health status , in the intervention group . CONCLUSIONS Treatment of gestational diabetes reduces serious perinatal morbidity and may also improve the woman 's health-related quality of life OBJECTIVE To examine the effect of prior meal ingestion on the glucose , insulin , and C-peptide response to a 50-g glucose challenge test in the third trimester of pregnancy . RESEARCH DESIGN AND METHODS Ten pregnant women with gestational diabetes mellitus and 12 nondiabetic pregnant control subjects matched for age and weight underwent a 50-g glucose challenge test on three occasions within a 2-wk period , in r and om order . On one occasion the test was administered in the fasting state ( fasting glucose challenge test ) , on a second occasion the test was administered 1 h after ingestion of a st and ard mixed meal ( 1-h postpr and ial study ) , and on a third occasion the test was administered 2 h after ingestion of a st and ard mixed meal ( 2-h postpr and ial study ) . RESULTS In the control subjects , the plasma glucose level 1 h after ingestion of 50 g of glucose was higher in the fasting study ( 7.8 ±0.4 mM , 7 of 12 subjects with glucose ≥7.8 mM ) than in the 1-h postpr and ial study ( 6.7 ± 0.3 mM , 3 of 12 subjects with glucose ≥7.8 mM ) and the 2-h postpr and ial study ( 6.3 ± 0.4 mM , 3 of 12 with glucose ≥7.8 mM ) ( P < 0.01 ) . In the postpr and ial studies of control subjects , insulin and C-peptide levels were higher at the time of ingestion of the 50 g of glucose , but the early ( 1 h ) insulin secretory response was less than in the fasting study . In the diabetic patients  , glucose levels 1 h after 50-g glucose ingestion were similar in the fasting study ( 10.5 ± 0.4 mM , no subjects with glucose value < 7.8 mM ) and the 1-h postpr and ial study ( 11.0 ± 0.6 mM , 1 subject with glucose < 7.8 mM ) , but was lower in the 2-h postpr and ial study ( 9.3 ± 0.3 mM , 1 subject with glucose < 7.8 mM ) ( P < 0.03 ) . In contrast to the control subjects , the insulin secretory response to 50 g of oral glucose was greater in the two postpr and ial studies than in the fasting study . CONCLUSIONS We have reached the following conclusions . 1 ) In nondiabetic gravidas  , plasma glucose concentrations 1 h after ingestion of a 50-g oral glucose load are higher if administered in the fasting state compared with the postpr and ial state . 2 ) During normal pregnancy the Staub-Traugott Effect , i.e. , improved glucose disposal after successive glucose load administrations , occurs and appears to be caused by mechanisms other than enhanced insulin secretion with successive glucose loads . 3 ) The effect of the pr and ial state on plasma glucose response to the 50-g glucose challenge test used to screen for gestational diabetes mellitus may be of sufficient magnitude to significantly alter the operating characteristics , i.e. , sensitivity and specificity , of this test OBJECTIVE Our objective was to determine the influence of the carbohydrate content of the diet preceding the oral glucose tolerance test ( OGTT )  in pregnancy on the test results and to evaluate the necessity of the recommended preparatory high-carbohydrate diet . STUDY DESIGN Thirty-four women from our outpatient clinic were enrolled in this prospect i ve study . After giving informed consent , each women underwent a 90-min lesson ( supervised by a dietary assistant ) covering the carbohydrate , protein and fat content of different foods . Women were then r and omized and in a crossover design started a diet with either a low or a high carbohydrate content . We were aim ing at a carbohydrate intake of 40 % in the low-carbohydrate week ( LCH ) and 50 % in the high-carbohydrate week ( HCH ) . Compliance was monitored by a detailed food diary which the women kept and which included the weight of the foods they consumed . RESULTS The actual dietary intakes as calculated from the food diaries showed that the mean caloric intake was 1801 + /- 314 kcal in the LCH and 2118 + /- 312 kcal in the HCH week ( < 0.001 ) . During the LCH diet , CH intake was 39 + /- 6.1 % and 49 + /- 6.6 % in the HCH week ( P < 0.001 ) . The carbohydrate intake per kilogram bodyweight was 30 + /- 5.3 kcal vs. 35 + /- 5.2 kcal ( P < 0.001 ) . The number of patients diagnosed  with gestational diabetes was two in the LCH and three in the HCH week ( not significant ) . The sum of the OGTT values ( fasting , 1 h and 2 h ) after the LCH was 18.9 + /- 2.1 mmol/l vs. 18.8 + /- 2.1 mmol/l after the HCH ( P = 0.51 ) . No differences could be found in both groups regarding the fasting , 1-h , or 2-h glucose values . Including patients with a CH difference of at least 5 % , 10 % , and 15 % carbohydrate between the weeks , we still did not observe any differences in the OGTT sum . We also looked at a possible influence of the CH content of the diet on the day before the test and of the last meal before the OGTT results and observed there was none . CONCLUSION This is the first study which has observed the influence of the previous day 's meal on the test results . We conclude from our results that the carbohydrate percentage of the preparatory diet did not influence the results of an OGTT , even when we increased the difference in carbohydrate intake stepwise up to 15 % . This might indicate that a preparatory diet before the OGTT is not necessary for women with normal nutritional behavior OBJECTIVE To compare management based on maternal glycemic criteria with management based on relaxed glycemic criteria and fetal abdominal circumference ( AC ) measurements in order to select patients for insulin treatment of gestational diabetes mellitus ( GDM ) with fasting hyperglycemia . RESEARCH DESIGN AND METHODS In a pilot study , 98 women with fasting plasma glucose ( FPG ) concentrations of 105 - 120 mg/dl were r and omized . The st and ard group received insulin treatment . The experimental group received insulin if the AC , measured monthly , was > or = 70th percentile and /or if any venous FPG measurement was > 120 mg/dl . Power was projected to detect a 250-g difference in birth weights . RESULTS Gestational ages , maternal glycemia , and AC percentiles were similar at r and omization . After initiation of protocol , venous FPG ( P = 0.003 ) and capillary blood glucose levels ( P = 0.049 ) were significantly lower in the st and ard group . Birth weights ( 3,271 + /- 458 vs. 3,369 + /- 461 g ) , frequencies of birth weights > 90th percentile ( 6.3 vs 8.3 % ) , and neonatal morbidity ( 25 vs. 25 % ) did not differ significantly between the st and ard and experimental groups , respectively . The cesarean delivery rate was significantly lower ( 14.6 vs. 33.3 % , P = 0.03 ) in the st and ard group ; this difference was not explained by birth weights . In the experimental group , infants of women who did not receive insulin had lower birth weights than infants of mothers treated with insulin ( 3,180 + /- 425 vs. 3,482 + /- 451 g , P = 0.03 ) . CONCLUSIONS In women with GDM and fasting hyperglycemia , glucose plus fetal AC measurements identified pregnancies at low risk for macrosomia and result ed in the avoidance of insulin therapy in 38 % of patients without increasing rates of neonatal morbidity Background : The current test for gestational diabetes mellitus ( GDM ) uses a glucose monomer test beverage , which frequently causes gastrointestinal symptoms , and venipuncture . We investigated a simplified test using a beverage of glucose polymer and a capillary whole blood glucose measurement . Methods : In a r and omized , double-blind clinical trial , women at 24 to 28 weeks ’ gestation received a 50-g glucose monomer ( n = 41 ) or glucose polymer ( n = 35 ) beverage . Venous and capillary blood sample s were obtained 1 hour later . The women then completed st and ardized question naires about their symptoms . Results : The glucose polymer beverage was associated with significantly fewer symptoms than was the glucose monomer drink : the mean was 1.1 symptoms per test with the glucose monomer drink and 0.4 symptoms per test with the glucose polymer drink ( P < 0.05 ) , 51 percent of the women developed symptoms after drinking the glucose monomer beverage , and 27 percent of the women developed symptoms after drinking the glucose polymer beverage ( P < 0.05 ) . Glucose type did not affect the 1-hour plasma glucose level , mean 5.94 mmol/L ( 107 mg/dL ) for the glucose monomer and 5.76 mmol/L ( 103.8 mg/dL ) for the glucose polymer ( P = 0.79 ) . For the capillary test , sensitivity was 0.75 and specificity was 0.82 in detecting a screening test positive by the venous plasma glucose criterion . Conclusion : The results of this study indicate that a glucose polymer beverage is better tolerated than a glucose monomer beverage during GDM screening , but capillary glucose measurement might be of limited use in clinics where many personnel perform the capillary blood glucose testing Our aim was to evaluate and compare the diagnostic performance of three methods commonly used for GDM screening : fasting plasma glucose ( FPG ) , two-step 50 g glucose challenge test ( GCT ) , and 75 g glucose tolerance test ( GTT ) in a r and omized study design to predict GDM in the first trimester and determine the best approach in predicting GDM . In a non-blind , parallel-group prospect i ve r and omized controlled study ; 736 singleton pregnant women underwent FPG testing in the first trimester and r and omly assigned to two groups ; two-step 50 g GCT and 75 g GTT . GDM diagnosis was made according to Carpenter – Coustan or ADA ( American Diabetes Association ) criteria in two-step 50 g GCT and 75 g GTT groups , respectively . Subsequent testing was performed by two-step 50 g GCT at 24–28 weeks for screen negatives . After excluding the women who were lost to follow-up or withdrawn as a result of pregnancy loss , 486 pregnant women were recruited in the study . The FPG , two-step GCT , and one-step GTT methods identified GDM in 25/486 ( 5.1 % ) , 15/248 ( 6.0 % ) , and 27/238 ( 11.3 % ) women , respectively . Area under ROC curves were 0.623 , 0.708 , and 0.792 , respectively . Sensitivities were 47.17 , 68.18 , and 87.1 % , respectively . Specificities were 77.37 , 100 , and 100 % , respectively . Positive predictive values were 20.33 , 100 , and 100 % , respectively . Negative predictive values were 92.29 , 97 , and 98.1 % , respectively . Until superior screening alternatives become available , the 75 g GTT may be preferred for GDM screening in the first trimester Forty-eight of 100 pregnant women received a 100-g ( nonfasting ) glucose screening test at about 28 weeks ' gestation , followed by a 100-g glucose tolerance test . Another 52 received a 100-g ( nonfasting ) glucose polymer screening test followed by a 100-g glucose polymer tolerance test .  Mean plasma glucose one hour after the glucose screening test was significantly lower than after the glucose polymer screening test . A further 178 women received a glucose polymer screening test and a glucose polymer tolerance test ( 230 in total ) . These women and the infants they delivered were studied to derive diagnostic criteria for the 100-g glucose polymer tolerance test by correlating maternal carbohydrate tolerance with indexes of neonatal metabolic performance , and to determine an adequate method of screening for carbohydrate intolerance of pregnancy ( gestational diabetes ) . Diagnostic criteria similar to those of O'Sullivan and Mahan were also developed for the glucose polymer tolerance test . These values are up to 5 % lower than those recommended by the National Diabetes Data Group ( 1979 ) for the 100-g glucose tolerance test BACKGROUND Gestational diabetes is one of the most common diseases during pregnancy . Despite this situation , there is still no consensus on methods for screening and diagnosis of this disease . OBJECTIVE To assess perinatal outcomes of patients with gestational diabetes diagnosed using three different methods . PATIENTS AND METHODS Clinical observational , longitudinal , r and omized trial at the National Institute of Perinatology Isidro Espinosa de los Reyes . We included all patients admitted to the Institute for a period of three months without pregestational diabetes .  Patients were screened for gestational diabetes with an oral load of 50 g of glucose . Patients with a positive screen were r and omized by a computer program that r and omly chose patients and made a curve according to the criteria of the American Diabetes Association 75 g or 100 g and another group with 75 g according to the criteria of the World Health Organization . Patients with gestational diabetes were followed throughout pregnancy until its reclassification in the puerperium . RESULTS Screening was performed in 863 patients and 87 were diagnosed with gestational diabetes .  Perinatal outcomes were similar in patients with gestational diabetes diagnosed using different methods , but there was a higher frequency of pregnancy-induced hypertension in patients diagnosed with the curves of the American Diabetes Association 75 and 100 g compared with the curve of the World Health Organization . CONCLUSIONS The American Diabetes Association diagnostic method as the World Health Organization are acceptable forms to diagnose gestational diabetes OBJECTIVES To test the validity of a 75-g , 2-h oral glucose tolerance test ( OGTT ) for diagnosing  gestational diabetes mellitus ( GDM ) using the criteria and reference values suggested by the American Diabetes Association for the 100-g , 3-h OGTT . METHODS The results of a 75-g , 2-h OGTT were compared with those of a 100-g , 3-h OGTT in 42 pregnant women . The women 's mean+/-S.D. age and gestational age were 33.6+/-5.4 years and 28.2+/-4.2 weeks , respectively . Each subject was r and omly scheduled within 1 week for both the 75-g and 100-g OGTTs . RESULTS The mean plasma glucose concentrations at 1 , 2 , and 3 h during the 100-g OGTT were significantly higher than those during the 75-g OGTT . Using the Carpenter and Coustan criteria , the prevalence of GDM was 21.4 % when using the 100-g , 3-h OGTT , whereas it was found to be at only 7.1 % when using the 75-g , 2-h OGTT . CONCLUSIONS Plasma glucose responses during the 75-g OGTT were found to be lower than those during the 100-g OGTT . When using the same diagnostic criteria , the prevalence of GDM was also found lower using the 75-g glucose load . It would therefore not be appropriate to use the 75-g OGTT for diagnosing GDM using the criteria and reference values of the 100-g OGTT . To give a comparable prevalence of GDM , the threshold of abnormal plasma glucose levels of the 75-g OGTT would need to be lower than that of the 100-g OGTT OBJECTIVE This study was performed to prospect ively evaluate a screening model for gestational diabetes mellitus on the basis of clinical risk indicators . STUDY DESIGN In a prospect i ve multicenter study with 5235 consecutive pregnant women , diagnostic testing with a 2-hour 75-g oral glucose tolerance test was routinely performed in women with risk indicators and offered to women without risk indicators as part of the study . RESULTS Forty-four percent of the women underwent testing , 43 % declined participation , 6 % did not speak Danish , and 7 % could not be contacted . By extrapolation of the results from tested women to the whole group in question , a 2.4 % prevalence of gestational diabetes mellitus was calculated . Sensitivity and specificity of the model was 80.6 ( 73.7 - 87.6 ) and 64.8 ( 63.5 - 66.1 ) , respectively ( 95 % CIs ) . CONCLUSION Under ideal conditions , sensitivity of the model was comparable with universal screening by fasting glucose or a 1-hour 50-g glucose challenge test . Both screening and diagnostic testing could be avoided in two thirds of all pregnant women OBJECTIVE This study tested the hypothesis that a st and ardized dose of jelly beans could be used as an alternative sugar source to the 50-g glucose beverage to screen for gestational diabetes mellitus . STUDY DESIGN One hundred sixty pregnant women at 24 to 28 weeks ' gestation were recruited for a prospect i ve study to compare 2 sugar sources for serum glucose response , side effects , preference , and ability to detect gestational diabetes mellitus . Patients were r and omly assigned to consume 50-g glucose beverage or 28 jelly beans ( 50 g simple carbohydrate ) . Serum glucose values were determined 1 hour later . The test was later repeated with the other sugar source . Finally , a 100-g 3-hour oral glucose tolerance test was performed . Participants completed a question naire recording subjective outcome variables . American Diabetes Association criteria were used to interpret all test results . RESULTS Among 136 participants completing the study no significant differences were found between 1-hour serum glucose values ( 116.5 + /- 27 mg/dL with 50-g glucose beverage , 116.9 + /- 23.6 mg/dL with jelly beans ; P = .84 ) , frequency of discrepant results ( P = .47 ) , sensitivity , specificity , or predictive value .  Jelly beans yielded fewer side effects ( 38 % with 50-g glucose beverage , 20 % with jelly beans ; P < .001 ) and were preferred by 76 % of participants ( P < .001 ) . Five cases ( 3.7 % incidence ) of gestational diabetes mellitus were diagnosed , 3 with 50-g glucose beverage alone , 1 with jelly beans alone , and 1 with both sugar sources . CONCLUSIONS Jelly beans may be used as an alternative to the 50-g glucose beverage as a sugar source for gestational diabetes mellitus screening . The 2 sources provoke similar serum glucose responses . Patients report fewer side effects after a jelly bean challenge than after a 50-g glucose beverage challenge Purpose To create a positive step toward achieving an efficient method for gestational diabetes treatment , the present study was carried out to compare the treatment outcomes based on single impaired blood glucose versus regular method in health care centers in Iran . Methods This r and omized clinical trial was carried out in Tehran/Iran between March 2012 and August 2013 . Study sample consisted of mothers whose fasting blood sugar was disturbed or a disturbed blood sugar was seen in OGTT with 75 g glucose load , according to ADA st and ards . For each outcome , multiple logistic regressions were used to control for the effects of potential confounders . When a confounder was measured on a continuous scale ( e.g. , age ) , LOWESS ( locally weighted scatter plot smoothing ) algorithm was used to determine whether the effect of that variable was linear . We also used the fractional polynomial regression to determine the optimal transformation of continuous covariates . Results The information of 189 pregnant women was used in this study ; 87 in the interventional group ( 46 % ) and 102 in the control group ( 54 % ) . Treatment based on the new protocol has very high protective effect ( OR 0.25 , 95 % CI 0.68–0.88 ) in terms of neonatal hyperbilirubinemia . This difference was not seen in other outcomes including stillbirth , macrosomic newborn delivery , hypoglycemia , and hypocalcemia . The risk of neonatal hypoglycemia reduced after the 25th week of gestation ( OR 0.39 , 95 % CI 0.15–0.98 ) . Conclusions Although the treatment of mild gestational diabetes could not significantly decrease severe neonatal outcomes , it did significantly reduce the risk of hyperbilirubinemia and its subsequent complications Gestational diabetes mellitus ( GDM ) , defined as carbohydrate intolerance of variable degree with onset or first recognition during pregnancy , is the most common medical condition of pregnancy . GDM affects ∼190,000 ( 4–5 % ) of the > 4 million births occurring annually in the U.S. and is associated with several maternal and infant complications ( 1 ) . Worldwide , the three primary screening strategies for GDM are the sequential strategy ( initial 50-g glucose challenge test followed by , in those who test positive , a 100-g glucose tolerance test [ GTT ] ) , the 75-g GTT strategy , and the 100-g GTT strategy ( 2 ) . The efficacy of these strategies , however , is debated . There are few r and omized trials on the effectiveness of GDM screening ( 3 ) . Yet , the majority of U.S. obstetricians provide universal screening for GDM ( 4 ) . We conducted a cost-effectiveness analysis to compare four screening strategies for universal screening of GDM , including the sequential strategy , the 75- and 100-g GTT , and a no-screening strategy . We assessed the relative cost and effectiveness ( quality -adjusted life-years [ QALYs ] ) of each strategy relative to the sequential strategy using a decision model . We performed a decision and cost-effectiveness analysis from a societal perspective that incorporates all health effects and medical re sources consumed regardless of who pays ( 5 ) . Separate cost-effectiveness ratios were estimated for mothers and infants . Maternal outcomes were hypertensive disease , polyhydramnios , cesarean or vaginal delivery , OBJECTIVE To compare one hour postpr and ial glucose measurements with the one hour 50gm plasma glucose test as predictors of gestational diabetes . SUBJECTS AND METHODS One hundred women at 24 - 28 weeks ' gestation were prospect ively r and omized for both screening methods : one hour postpr and ial and one hour 50gm plasma glucose test with a one-week-interval between tests . A week later a formal 2-hour 75gm glucose tolerance test was done in each case . RESULTS Of the 95 patients who completed the study 13 had gestational diabetes ( 13.6 % ) . For a threshold of 7.1mmol/l the sensitivity of 1-hour postpr and ial plasma glucose screening test was 84.6 % with a specificity of 87.8 % . These values were respectively 84.6 % and 81.7 % for 1-hour 50 gm plasma glucose test screening test . A threshold of 7.7mmol/l yielded a sensitivity of 60.5 % with a specificity of 91.4 % for the 1-hour postpr and ial plasma glucose  screening test ( 69.2 % and 86.5 % for 1-hour 50gm plasma glucose test ) CONCLUSION In our study the 1-hour postpr and ial plasma glucose screening test was as effective as the 1-hour 50 gm plasma glucose test screening test for gestational diabetes There is little consensus in the conduct and interpretation of the oral glucose tolerance test ( OGTT ) in pregnancy . In Singapore much data has been accumulated about the 50 g OGTT while the converse is true of the 75 g OGTT . A double-blind , r and omised , crossover study of 56 subjects in the third trimester was conducted to compare both glucose challenges to determine if there was a difference in glucose h and ling in the context of a two hour OGTT . A significant difference ( p < 0.001 , t = 5.76 ) was found at two hours where the mean glucose concentrations were 5.2 + /- 0.8 mmol/L and 6.2 + /- 1.4 mmol/L for the 50 g and 75 g OGTT respectively . These findings suggest that the 75 g OGTT is potentially more effective in unmasking pregnant subjects with impaired glucose tolerance Abstract Aims /hypothesisIt is postulated that uptake rates for  gestational diabetes mellitus  ( GDM )  screening would be improved if offered in a setting more accessible to the patient . The aim of this study was to evaluate the proportion of uptake of GDM screening  in the primary vs secondary care setting , and to qualitatively explore the providers ’ experiences of primary care screening provision . Methods This mixed methods study was composed of a quantitative unblinded parallel group r and omised controlled trial and qualitative interview trial . The primary outcome was the proportion of uptake of screening  in both the primary and secondary care setting s. All pregnant women aged 18 years or over , with sufficient English and without a diagnosis or diabetes or GDM , who attended for their first antenatal appointment at one of three hospital sites along the Irish Atlantic seaboard were eligible for inclusion in this study . Seven hundred and eighty-one pregnant women were r and omised using r and om permutated blocks to receive a 2 h 75 g OGTT in either a primary ( n = 391 ) or secondary care ( n = 390 ) setting . Semi-structured interviews were conducted with 13 primary care providers . Primary care providers who provided care to the population covered by the three hospital sites involved were eligible for inclusion . Results Statistically significant differences were found between the primary care ( n = 391 ) and secondary care ( n = 390 ) arms for uptake ( 52.7 % vs 89.2 % , respectively ; effect size 36.5 percentage points , 95 % CI 30.7 , 42.4 ; p < 0.001 ) , crossover ( 32.5 % vs 2.3 % , respectively ; p < 0.001 ) and non-uptake ( 14.8 % vs 8.5 % , respectively ; p = 0.005 ) . There were no significant differences in uptake based on the presence of a practice nurse or the presence of multiple general practitioners in the primary care setting . There was evidence of significant relationship between probability of uptake of screening and age ( p < 0.001 ) . Primary care providers reported difficulties with the conduct of GDM screening , despite recognising that the community was the most appropriate location for screening . Conclusions /interpretationCurrently , provision of GDM screening in primary care in Irel and , despite its acknowledged benefits , is unfeasible due to poor uptake rates , poor rates of primary care provider engagement and primary care provider concerns . Trial registration http://is rct n.org IS RCT N02232125 Funding This study was funded by the Health Research Board ( ICE2011/03 Aims Gestational diabetes mellitus ( GDM ) is associated with adverse maternal and fetal outcome . Screening for GDM is therefore recommended but the best screening method remains controversial . This prospect i ve , r and omized study compared a risk factor‐based screening programme with a universally based one A prospect i ve investigation was performed to evaluate the necessity of a diet containing greater than or equal to 150 g/d of carbohydrate for three days before the oral glucose tolerance test ( OGTT ) . Thirty-seven obstetric patients who had a value of greater than or equal to 135 mg/dL on the one-hour , 50-g oral glucose screening test underwent a subsequent OGTT . The patients were alternately assigned to one of two groups . Nineteen of 37 ( 51 % ) were asked to precede the OGTT with a three-day diet containing greater than 150 g/d of carbohydrate . Those patients were then asked not to alter their normal dietary pattern and to repeat the OGTT in one to two weeks ( group I ) . Eighteen of 37 ( 49 % ) followed the testing scheme in reverse order ( group II ) . There were no significant differences in mean fasting or in one- , two- or three-hour plasma glucose values at either testing period between groups I and II . There were no significant differences between groups I and II in the number of patients who had an abnormal OGTT at the initial or repeat testing period . Dietary preparation for the OGTT is not necessary , and patients can be scheduled for the test when convenient Two hundred and twenty 3rd trimester pregnant women were r and omly selected to perform 50 g oral glucose tolerance screening test . Simultaneously , both capillary and venous blood sample s were obtained one hour after the glucose load . A high correlation between capillary and venous glucose levels was found ( r = 0.87 , P < 0.01 ) . From the receiver operator characteristic curve , it was found that the capillary glucose value of 9.1 mmol/L might be defined as abnormal threshold value for 100 g oral glucose tolerance test ( OGTT ) . The consistent rate between capillary and venous glucose test was 91.8 % . In 100 g OGTT , of 43 cases whose venous glucose were > or = 7.8 mmol/L , 11 were diagnosed as gestational diabetes mellitus ( GDM ) . All of these 11 patients had capillary glucose > or = 9.1 mmol/L. This results suggest that the capillary blood glucose test may be feasible for screening of gestational diabetes One hundred eight patients were prospect ively r and omized to receive 50 g of a glucose polymer , d-glucose or a c and y bar during a one-hour gestational diabetes mellitus ( GDM ) screening . The polymer had a mean serum glucose similar to that of d-glucose , with significantly fewer side effects , allowing an increased rate of examination completion . The c and y bar produced a significantly lower mean serum glucose but had the highest rating for flavor . The polymer was an inexpensive and well-tolerated alternative for GDM screening , while the use of a c and y bar needs more study Between 6 and 28 weeks of gestation , 2-hour postpr and ial blood glucose determinations were performed on 66 pregnant patients who had no history of diabetes . Each patient received two methods of carbohydrate loading on separate occasions in a r and om , crossover fashion . One group received a 100-g carbohydrate meal and then a 50-g glucose load ( Glucola ) . The order of the test regimens was reversed for the second group . The average 2-hour postpr and ial glucose value following a meal was 103.1 + /- 3.7 mg/dL , and the mean value for the 2-hour postpr and ial glucose following Glucola was 102.5 + /- 3.8 mg/dL. The difference in glucose values obtained with the two methods was not statistically significant . A 12 % incidence of emesis was encountered after Glucola but none was encountered after the meal . The 100-g carbohydrate meal is recommended as the method of testing for glucose intolerance AIMS To examine the clinical outcomes of screening for gestational diabetes mellitus ( GDM ) in primary care versus secondary care , in the Irish healthcare system . DESIGN AND METHODS A parallel group r and omised controlled trial ( RCT ) of screening for GDM in primary versus secondary care was used to examine ( i ) prevalence , ( ii ) gestational week of screen , ( iii ) time to access specialist care  , and ( iv ) maternal and neonatal outcomes . In total 781 women were recruited for screening in primary care ( n=391 ) or secondary care ( n=390 ) . RESULTS The prevalence of GDM and gestational week of screen were similar in both locations . There was a trend towards a longer time to access diabetes care in primary care ( 24days ) versus secondary care ( 19days ) , a difference of 5days ( p=0.09 ) . Women screened in primary care also showed a trend towards a higher rate of large for gestational age ( LGA ) infants ( 20 % ) than those screened in secondary care ( 14.7 % ) , ( p=0.09 ) . There were no differences between groups in maternal outcomes . CONCLUSIONS This RCT suggests that screening for GDM in secondary care may be associated with potentially faster time to access specialist antenatal diabetes care and possibly lower LGA rates . Further research is needed to clarify these findings and to improve the delay in accessing specialist care requires an urgent focus . Further research is needed to test these findings in other health systems Objective To test the hypothesis that glucose abnormality , as shown by glucose tolerance test ( GTT ) periodicity , is not affected by different glucose loads , allowing for the identification of gestational diabetes mellitus ( GDM ) under varying glucose challenges . Methods Eighty subjects were tested by multiple GTTs 1 week apart . Each woman served as her own control , undergoing a st and ard 3-hour , 100-g GTT ; then , half of the subject group r and omly underwent a 50-g and the other half a 75-g , 2-hour GTT . Subjects were classified using National Diabetes Data Group thresholds for the 100-g GTT . Those with two or more abnormal values were classified as gestational diabetic ( GDM group ) ; the rest of the women were considered to be nondiabetic . The projected time for the GTT to revert to fasting value , GTT periodicity , was then deter-mined for each glucose load in the GDM and nondiabetic groups . Results All glucose values for the nondiabetic group were significantly lower at 1 and 2 hours than those for the GDM group , regardless of the glucose load ( P < .04 ) . There was a statistically significant difference within the GDM and non-diabetic groups between glucose values of the 100- and 50-g GTTs at 1 hour ( P < .02 ) and between all loads at 2 hours ( P < .04 ) . The GTT periodicity for the 3-hour , 100-g test was significantly longer for patients with GDM , as shown previously ( 5.6 ± 1.9 versus 3.2 ± 1.7 hours , P < .0001 ) . In addition , similar values were found for nondiabetic and GDM subjects for the 75-g ( 5.1 ± 2 versus 3.6 ± 1.8 hours , P < .04 ) , but not the 50-g load ( 2.2 ± .6 versus 1.34 ± .8 hours , P < .01 ) . Conclusion Glucose tolerance test periodicity will identify subjects with GDM regardless of GTT load because the physiologic disturbance of glucose level measured by this time period remains comparably longer than in normal subjects . We speculate that the relatively shorter cycle of the 50-g load may reflect an insufficient challenge to pancreatic function Abstract Objective : The goal of this study is to compare the prevalence and clinical outcomes of a one-step with a two-step screening method , both of which are commonly used for the diagnosis of gestational diabetes mellitus ( GDM ) . Methods : Women who presented for GDM screening and who consented to participate in this study were r and omized into two groups . The women in Group 1 ( n = 386 ) were screened using a one-step method ( 2-h , 75 g oral glucose tolerance test ( OGTT ) ) and in Group 2 ( n = 400 ) by a two-step method ( the 50 g glucose challenge test ( GCT ) followed by the 100 g OGTT ) . The pregnancies were then classified into three subgroups as follows : women who had negative 2-h 75 g OGTT results according to IADPSG criteria ( IADPSG-negative ) , women with negative 50 g GCT results ( GCT-negative ) and women with positive 50 g GCT results but negative 3-h 100 g OGTT results according to C&C criteria ( C&C-negative ) . Results : The prevalence of GDM using the one-step and two-step methods was 14.5 % and 6 % , respectively . In adjusted multivariable regression models , women in the GCT-negative and the C&C-negative groups had greater risk of polyhydramnios than women in the IADPSG-negative group [ adjusted prevalence risk ratios ( aPR ) , 1.40 ; 95 % confidence intervals ( CI ) , 1.03–1.91 ; aPR , 2.76 ; 95 % CI , 1.27–6.02 , respectively ] . Women in the C&C-negative group had greater risk of pre-eclampsia than women in the IADPSG-negative group ( aPR , 3.30 ; 95 % CI , 1.57–6.91 ) . Conclusions : Women who were defined as having normal glucose tolerance by IADPSG had better perinatal outcomes than women who were defined as having normal glucose tolerance by GCT and women who were GCT-positive with a negative OGTT This study compared the results of a 75-g , 3-hour oral glucose tolerance test with those of a traditional 100-g oral glucose tolerance test . Thirty-two pregnant women participated in the study . Each patient served as her own control , undergoing both a 100- and a 75-g oral glucose tolerance test within 1 week . Despite a strong positive correlation between the results of the two tests , the 1- , 2- , and 3-hour glucose values of the 100-g glucose load were significantly higher than the comparable values of the 75-g oral glucose tolerance test . Sixteen of 32 women were diagnosed as having gestational diabetes mellitus using the National Diabetes Data Group criteria and the 100-g oral glucose tolerance test , whereas only 6 of these 16 women would have been identified with the 75-g oral glucose tolerance test . If data from one test are to be compared with the other , new thresholds of glucose abnormality need to be developed Please cite this paper as : Meltzer S , Snyder J , Penrod J , Nudi M , Morin L.  Gestational diabetes mellitus screening and diagnosis  : a prospect i ve r and omised controlled trial comparing costs of one‐step and two‐step methods . BJOG 2010;117:407–415 Forty-six pregnant patients with potential diabetes were studied to compare the use of glucose and a glucose polymer for carbohydrate tolerance testing . The first 26 patients had a  glucose tolerance test and a  glucose polymer  tolerance test in r and omized order an average of one week apart . The mean tolerance curves and insulin curves were similar for both agents . Patients preferred glucose polymer to glucose because of a lower incidence of associated nausea . A second group of 20 patients was r and omly divided so that patients had two glucose tolerance tests or two glucose polymer tolerance tests an average of one week apart . Comparison of the variability and correlation of the incremental areas under the paired tolerance curves showed that the reproducibility of the glucose polymer tolerance test exceeded that of the glucose tolerance test BACKGROUND It is uncertain whether treatment of mild gestational diabetes mellitus improves pregnancy outcomes . METHODS Women who were in the 24th to 31st week of gestation and who met the criteria for mild gestational diabetes mellitus ( i.e. , an abnormal result on an oral glucose-tolerance test but a fasting glucose level below 95 mg per deciliter [ 5.3 mmol per liter ] ) were r and omly assigned to usual prenatal care ( control group ) or dietary intervention , self-monitoring of blood glucose , and insulin therapy , if necessary ( treatment group ) . The primary outcome was a composite of stillbirth or perinatal death and neonatal complications , including hyperbilirubinemia , hypoglycemia , hyperinsulinemia , and birth trauma . RESULTS A total of 958 women were r and omly assigned to a study group--485 to the treatment group and 473 to the control group . We observed no significant difference between groups in the frequency of the composite outcome ( 32.4 % and 37.0 % in the treatment and control groups , respectively ; P=0.14 ) . There were no perinatal deaths . However , there were significant reductions with treatment as compared with usual care in several prespecified secondary outcomes , including mean birth weight ( 3302 vs. 3408 g ) , neonatal fat mass ( 427 vs. 464 g ) , the frequency of large-for-gestational-age infants ( 7.1 % vs. 14.5 % ) , birth weight greater than 4000 g ( 5.9 % vs. 14.3 % ) , shoulder dystocia ( 1.5 % vs. 4.0 % ) , and cesarean delivery ( 26.9 % vs. 33.8 % ) . Treatment of gestational diabetes mellitus , as compared with usual care , was also associated with reduced rates of preeclampsia and gestational hypertension ( combined rates for the two conditions , 8.6 % vs. 13.6 % ; P=0.01 ) . CONCLUSIONS Although treatment of mild gestational diabetes mellitus did not significantly reduce the frequency of a composite outcome that included stillbirth or perinatal death and several neonatal complications , it did reduce the risks of fetal overgrowth , shoulder dystocia , cesarean delivery , and hypertensive disorders . ( Clinical Trials.gov number , NCT00069576 .
BACKGROUND Gestational diabetes mellitus ( GDM ) is a form of diabetes that occurs in pregnancy .
Although GDM usually resolves following birth , it is associated with significant morbidities for mothers and their infants in the short and long term .
There is strong evidence to support treatment for GDM .
However , there is uncertainty as to whether or not screening all pregnant women for GDM will improve maternal and infant health and if so , the most appropriate setting for screening .
This review up date s a Cochrane Review , first published in 2010 , and subsequently up date d in 2014 .
OBJECTIVES To assess the effects of screening for gestational diabetes mellitus based on different risk profiles and setting s on maternal and infant outcomes .