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Clinical Care/Education/Nutrition
High probability of false-positive gestational diabetes mellitus diagnosis during early pregnancy
  1. Sayuri Nakanishi1,
  2. Shigeru Aoki1,
  3. Junko Kasai2,
  4. Ryosuke Shindo1,
  5. Soichiro Obata1,
  6. Yoshimi Hasegawa3,
  7. Aya Mochimaru4,
  8. Etsuko Miyagi5
  1. 1Perinatal Center for Maternity and Neonate, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan
  2. 2Department of Obstetrics and Gynecology, Yokohama Rosai Hospital, Yokohama, Kanagawa, Japan
  3. 3Department of Obstetrics and Gynecology, Saiseikai Yokohama-shi Nanbu Byoin, Yokohama, Kanagawa, Japan
  4. 4Department of Obstetrics and Gynecology, Fujisawa City Hospital, Fujisawa, Kanagawa, Japan
  5. 5Department of Obstetrics and Gynecology, Yokohama City University Hospital, Yokohama, Kanagawa, Japan
  1. Correspondence to Dr Shigeru Aoki; smyyaoki{at}yahoo.co.jp

Abstract

Introduction This study aimed to assess the validity of applying the International Association of Diabetes and Pregnancy Study Group (IADPSG) criteria for the diagnosis of gestational diabetes mellitus (GDM) at any time during pregnancy.

Research design and methods This multicenter cohort study was conducted at five Japanese facilities from January 2018 to April 2019. The study cohort included women at a high risk of GDM who met one or more of the following IADPSG criteria during early pregnancy: fasting plasma glucose (FPG) ≥92 mg/dL and 75 g oral glucose tolerance test (OGTT) value of ≥180 mg/dL at 1 hour, or ≥153 mg/dL at 2 hour (hereafter early-onset GDM). Women diagnosed with early-onset GDM were followed up without therapeutic intervention and underwent the 75 g OGTT again during 24–28 weeks of gestation. Those exhibiting the GDM patterns on the second 75 g OGTT were diagnosed with true GDM and treated, whereas those exhibiting the normal patterns were diagnosed with false positive early GDM and received no therapeutic intervention.

Results Of the 146 women diagnosed with early-onset GDM, 69 (47%) had normal 75 g OGTT values at 24–28 weeks of gestation, indicating a false-positive result. FPG levels were significantly higher in the first 75 g-OGTT test than in the second 75 g-OGTT test (93 mg/dL and 87.5 mg/dL, respectively; p<0.001). FPG levels were high in 86 (59%) women with early-onset GDM during early pregnancy but in only 39 (27%) women during mid-pregnancy. Compared with false positive early GDM, true GDM was more frequently associated with adverse pregnancy outcomes.

Conclusions Although women with early-onset GDM were followed up without treatment, the results of repeated 75 g OGTT during mid-pregnancy were normal in about 50%. Our data did not support the adoption of IADPSG thresholds for the diagnosis of GDM prior to 20 weeks of gestation.

  • gestational diabetes mellitus
  • diagnostic criteria
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjdrc-2020-001234

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    Footnotes

    • Contributors SN researched data and wrote the manuscript. SA contributed to study design and wrote the manuscript. JK contributed to study design and researched data. RS and SO researched data. YH and AM researched data and recruited the subjects. EM finalized the manuscript.

    • Funding The research was partially supported by JSPS KAKENHI (grant number JP1919K18675).

    • Competing interests The facilities (participating investigators) that participated in this study included the Yokohama City Medical Center (SN, SA, RS, and SO), Yokohama City University Hospital (EM), Yokohama Rosai hospital (JK), Fujisawa City Hospital (AM and Haruya Saji), and Saiseikai Yokohama Nanbu Hospital (YH and Masaya Endo).

    • Patient consent for publication Not required.

    • Ethics approval The study protocol was approved by the Ethics Committee of the Yokohama City University Medical Center (approval no. B171102004).

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement No data are available.