Predictive Characteristics of Elevated 1-Hour Glucose Challenge Test Results for Gestational Diabetes

Alan T.N. Tita, Yinglei Lai, Mark B. Landon, Susan M. Ramin, Brian Casey, Ronald J. Wapner, Michael W. Varner, John M. Thorp, Anthony Sciscione, Patrick Catalano, Margaret Harper, George Saade, Steve N. Caritis, Yoram Sorokin, Alan M. Peaceman, Jorge E. Tolosa

Research output: Contribution to journalArticle

Abstract

Objective The objective was to estimate the optimal screen-positive 1-hour 50 g glucose challenge test (GCT) threshold for gestational diabetes (GDM) and predictive characteristics of increasing screen-positive GCT threshold values (135–199 mg/dL) for GDM. Study Design It is a secondary analysis of a multicenter mild GDM study. At 24 to 30 weeks' gestation, women with elevated GCT (135–199 mg/dL) completed a diagnostic 3-hour oral glucose tolerance test (OGTT). A novel change-point analysis method was used to compare the GDM rates for the adjacent GCT values, delineating categories of changing risk such that values within categories have equal risk for GDM. Positive (PPV) and negative (NPV) predictive values for GDM were computed for increasing GCT cut-offs. Results In 7,280 women with both GCT (135–199 mg/dL) and OGTT results, 4 GDM risk-equivalent GCT categories were identified with escalations at 144, 158, and 174 mg/dL (all p -values <0.05). The PPV for GDM increased from 33 to 64% as GCT increased from 135 to 199 mg/dL, while the NPV decreased from 80 to 67%. PPVs were only 20% and 61% for risk-equivalent categories of 135 to 143 mg/dL and 174 to 199 mg/dL, respectively. Conclusion Elevated GCT cut-off values between 135 and 143 mg/dL may carry equivalent GDM risk. No threshold GCT value <199 mg/dL alone sufficiently predicts GDM.

Original languageEnglish (US)
JournalAmerican Journal of Perinatology
DOIs
StateAccepted/In press - Jun 8 2017

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Gestational Diabetes
Glucose
Glucose Tolerance Test
Pregnancy

Keywords

  • gestational diabetes mellitus
  • glucose challenge test
  • prediction
  • screening

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Obstetrics and Gynecology

Cite this

Tita, A. T. N., Lai, Y., Landon, M. B., Ramin, S. M., Casey, B., Wapner, R. J., ... Tolosa, J. E. (Accepted/In press). Predictive Characteristics of Elevated 1-Hour Glucose Challenge Test Results for Gestational Diabetes. American Journal of Perinatology. https://doi.org/10.1055/s-0037-1604243

Predictive Characteristics of Elevated 1-Hour Glucose Challenge Test Results for Gestational Diabetes. / Tita, Alan T.N.; Lai, Yinglei; Landon, Mark B.; Ramin, Susan M.; Casey, Brian; Wapner, Ronald J.; Varner, Michael W.; Thorp, John M.; Sciscione, Anthony; Catalano, Patrick; Harper, Margaret; Saade, George; Caritis, Steve N.; Sorokin, Yoram; Peaceman, Alan M.; Tolosa, Jorge E.

In: American Journal of Perinatology, 08.06.2017.

Research output: Contribution to journalArticle

Tita, ATN, Lai, Y, Landon, MB, Ramin, SM, Casey, B, Wapner, RJ, Varner, MW, Thorp, JM, Sciscione, A, Catalano, P, Harper, M, Saade, G, Caritis, SN, Sorokin, Y, Peaceman, AM & Tolosa, JE 2017, 'Predictive Characteristics of Elevated 1-Hour Glucose Challenge Test Results for Gestational Diabetes', American Journal of Perinatology. https://doi.org/10.1055/s-0037-1604243
Tita, Alan T.N. ; Lai, Yinglei ; Landon, Mark B. ; Ramin, Susan M. ; Casey, Brian ; Wapner, Ronald J. ; Varner, Michael W. ; Thorp, John M. ; Sciscione, Anthony ; Catalano, Patrick ; Harper, Margaret ; Saade, George ; Caritis, Steve N. ; Sorokin, Yoram ; Peaceman, Alan M. ; Tolosa, Jorge E. / Predictive Characteristics of Elevated 1-Hour Glucose Challenge Test Results for Gestational Diabetes. In: American Journal of Perinatology. 2017.
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title = "Predictive Characteristics of Elevated 1-Hour Glucose Challenge Test Results for Gestational Diabetes",
abstract = "Objective The objective was to estimate the optimal screen-positive 1-hour 50 g glucose challenge test (GCT) threshold for gestational diabetes (GDM) and predictive characteristics of increasing screen-positive GCT threshold values (135–199 mg/dL) for GDM. Study Design It is a secondary analysis of a multicenter mild GDM study. At 24 to 30 weeks' gestation, women with elevated GCT (135–199 mg/dL) completed a diagnostic 3-hour oral glucose tolerance test (OGTT). A novel change-point analysis method was used to compare the GDM rates for the adjacent GCT values, delineating categories of changing risk such that values within categories have equal risk for GDM. Positive (PPV) and negative (NPV) predictive values for GDM were computed for increasing GCT cut-offs. Results In 7,280 women with both GCT (135–199 mg/dL) and OGTT results, 4 GDM risk-equivalent GCT categories were identified with escalations at 144, 158, and 174 mg/dL (all p -values <0.05). The PPV for GDM increased from 33 to 64{\%} as GCT increased from 135 to 199 mg/dL, while the NPV decreased from 80 to 67{\%}. PPVs were only 20{\%} and 61{\%} for risk-equivalent categories of 135 to 143 mg/dL and 174 to 199 mg/dL, respectively. Conclusion Elevated GCT cut-off values between 135 and 143 mg/dL may carry equivalent GDM risk. No threshold GCT value <199 mg/dL alone sufficiently predicts GDM.",
keywords = "gestational diabetes mellitus, glucose challenge test, prediction, screening",
author = "Tita, {Alan T.N.} and Yinglei Lai and Landon, {Mark B.} and Ramin, {Susan M.} and Brian Casey and Wapner, {Ronald J.} and Varner, {Michael W.} and Thorp, {John M.} and Anthony Sciscione and Patrick Catalano and Margaret Harper and George Saade and Caritis, {Steve N.} and Yoram Sorokin and Peaceman, {Alan M.} and Tolosa, {Jorge E.}",
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T1 - Predictive Characteristics of Elevated 1-Hour Glucose Challenge Test Results for Gestational Diabetes

AU - Tita, Alan T.N.

AU - Lai, Yinglei

AU - Landon, Mark B.

AU - Ramin, Susan M.

AU - Casey, Brian

AU - Wapner, Ronald J.

AU - Varner, Michael W.

AU - Thorp, John M.

AU - Sciscione, Anthony

AU - Catalano, Patrick

AU - Harper, Margaret

AU - Saade, George

AU - Caritis, Steve N.

AU - Sorokin, Yoram

AU - Peaceman, Alan M.

AU - Tolosa, Jorge E.

PY - 2017/6/8

Y1 - 2017/6/8

N2 - Objective The objective was to estimate the optimal screen-positive 1-hour 50 g glucose challenge test (GCT) threshold for gestational diabetes (GDM) and predictive characteristics of increasing screen-positive GCT threshold values (135–199 mg/dL) for GDM. Study Design It is a secondary analysis of a multicenter mild GDM study. At 24 to 30 weeks' gestation, women with elevated GCT (135–199 mg/dL) completed a diagnostic 3-hour oral glucose tolerance test (OGTT). A novel change-point analysis method was used to compare the GDM rates for the adjacent GCT values, delineating categories of changing risk such that values within categories have equal risk for GDM. Positive (PPV) and negative (NPV) predictive values for GDM were computed for increasing GCT cut-offs. Results In 7,280 women with both GCT (135–199 mg/dL) and OGTT results, 4 GDM risk-equivalent GCT categories were identified with escalations at 144, 158, and 174 mg/dL (all p -values <0.05). The PPV for GDM increased from 33 to 64% as GCT increased from 135 to 199 mg/dL, while the NPV decreased from 80 to 67%. PPVs were only 20% and 61% for risk-equivalent categories of 135 to 143 mg/dL and 174 to 199 mg/dL, respectively. Conclusion Elevated GCT cut-off values between 135 and 143 mg/dL may carry equivalent GDM risk. No threshold GCT value <199 mg/dL alone sufficiently predicts GDM.

AB - Objective The objective was to estimate the optimal screen-positive 1-hour 50 g glucose challenge test (GCT) threshold for gestational diabetes (GDM) and predictive characteristics of increasing screen-positive GCT threshold values (135–199 mg/dL) for GDM. Study Design It is a secondary analysis of a multicenter mild GDM study. At 24 to 30 weeks' gestation, women with elevated GCT (135–199 mg/dL) completed a diagnostic 3-hour oral glucose tolerance test (OGTT). A novel change-point analysis method was used to compare the GDM rates for the adjacent GCT values, delineating categories of changing risk such that values within categories have equal risk for GDM. Positive (PPV) and negative (NPV) predictive values for GDM were computed for increasing GCT cut-offs. Results In 7,280 women with both GCT (135–199 mg/dL) and OGTT results, 4 GDM risk-equivalent GCT categories were identified with escalations at 144, 158, and 174 mg/dL (all p -values <0.05). The PPV for GDM increased from 33 to 64% as GCT increased from 135 to 199 mg/dL, while the NPV decreased from 80 to 67%. PPVs were only 20% and 61% for risk-equivalent categories of 135 to 143 mg/dL and 174 to 199 mg/dL, respectively. Conclusion Elevated GCT cut-off values between 135 and 143 mg/dL may carry equivalent GDM risk. No threshold GCT value <199 mg/dL alone sufficiently predicts GDM.

KW - gestational diabetes mellitus

KW - glucose challenge test

KW - prediction

KW - screening

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DO - 10.1055/s-0037-1604243

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