BES2021 Belgian Endocrine Society 2021 Abstracts (26 abstracts)
Fasting plasma glucose level to determine the need for an OGTT to screen for gestational diabetes mellitus
Beunen Kaat , Neys Astrid 2 , Van Crombrugge Paul 3 , Moyson Carolien 1 , Verhaeghe Johan 4 , Vandeginste Sofie 5 , Verlaenen Hilde 5 , Vercammen Chris 6 , Maes Toon 6 , Dufraimont Els 7 , De Block Christophe 8 , Jacquemyn Yves 9 , Mekahli Farah 10 , De Clippel Katrien 11 , Van Den Bruel Annick 12 , Loccufier Anne 13 , Laenen Annouschka 14 , Devlieger Roland 4 , Mathieu Chantal 1 & Benhalima Katrien 1
1Department of Endocrinology, UZ Gasthuisberg, KU Leuven, Belgium; 2Medicine, KU Leuven, Belgium; 3Department of Endocrinology, OLV ziekenhuis Aalst- Asse-Ninove, Belgium; 4Department of Obstetrics & Gynecology, UZ Gasthuisberg, KU Leuven, Belgium; 5Department of Obstetrics & Gynecology, OLV ziekenhuis Aalst-Asse-Ninove, Belgium; 6Department of Endocrinology, Imelda ziekenhuis, Belgium; 7Department of Obstetrics & Gynecology, Imelda ziekenhuis, Belgium; 8Department of Endocrinology-Diabetology-Metabolism, Antwerp University Hospital, Belgium; 9Department of Obstetrics & Gynecology, Antwerp University Hospital, Belgium; 10Department of Endocrinology, Kliniek St-Jan Brussel, Belgium; 11Department of Obstetrics & Gynecology, Kliniek St-Jan Brussel, Belgium; 12Department of Endocrinology, AZ St Jan Brugge, Belgium; 13Department of Obstetrics & Gynecology, AZ St Jan Brugge, Belgium; 14Center of Biostatics and Statistical bioinformatics, Leuven, Belgium
Aims: To determine the fasting plasma glucose (FPG) level at which an oral glucose tolerance test (OGTT) could be avoided to screen for gestational diabetes (GDM) and to evaluate the characteristics of women across this FPG threshold.
Methods: A multi-centric prospective cohort study (BEDIP-N) with 1843 women receiving screening for GDM with a 75g OGTT.
Results: A FPG < 78 mg/dl was the FPG cut-off with the best trade-off to limit the number of missed GDM cases [19.0% (44)] with a negative predictive value (NPV) of 97.3% (95% CI 96.5-98.0) for GDM, while avoiding 52.2% (1048) OGTT’s. The area under thereceiver operating characteristic curve was 0.76 (95% CI 0.72-0.80) for FPG at the OGTT. Of all 231 (12.5%) women with GDM, 44 (19.0%) had FPG < 78 mg/dl, 112 (48.5%) had FPG 78-91 mg/dl and 75 (32.5%) FPG ≥92 mg/dl. GDM women with low FPG (< 78) had significantly lower BMI (early pregnancy: 24.7±4.7 vs. 27.0±5.4 Kg/m2, P = 0.007; at OGTT: 27.1±4.5 vs. 29.6±5.2 Kg/m2, P = 0.003), had lower insulin resistance (IR) [early pregnancy HOMA-IR: 8.2 (7.2-13.7) vs. 11.1 (8.5-17.6), P = 0.020; at OGTT: HOMA-IR 11.1 (8.2-15.0) vs. 19.0 (12.6-29.9), P < 0.001; Matsuda index 0.4 (0.4-0.7) vs. 0.3 (0.2- -cell function [ISSI-2 at OGTT: 0.13 (0.08-0.25) vs. 0.09 (0.04-0.15), P = 0.004] than GDM women with higher FPG (≥78). There were no differences in pregnancy outcomes and postpartum rate of glucose intolerance. Of the 1612 normal glucose tolerant (NGT) women, 766 had FPG < 78 mg/dl (47.5%) and 846 had FPG ≥78 mg/dl (52.5%). Compared to NGT women with higher FPG, those with low FPG had lower BMI (early pregnancy: 23.5±3.9 vs. 25.2±4.8 Kg/m2, P < 0.001; at OGTT: 26.0±3.9 vs. 27.8±4.7 Kg/m2, P < 0.001), lower blood pressure (BP) [early pregnancy: systolic BP (SBP) 114.1±10.1 vs. 115.4±10.6 mmHg, P = 0.009; diastolic BP (DBP) 69.7±7.7 vs. 70.9±8.3 mmHg, P = 0.003; at OGTT: SBP 112.6±9.8 vs. 113.6±10.3 mmHg, P = 0.033; DBP 66.3±7.9 vs. 67.7±7.9 mmHg, P < 0.001], less IR [early pregnancy HOMA-IR: 8.1 (5.9-11.5) vs. 10.1 (7.2-14.0), P < 0.001; at OGTT: HOMA-IR 9.6 (7.1-13.4) vs. 14.2 (10.6-19.9), P < 0.001; Matsuda 0.7 (0.5-0.9) vs. 0.5 (0.4- -cell function [ISSI-2 at OGTT: 0.17 (0.10-0.30) vs. 0.12 (0.07-0.21), P < 0.001]. Infants of NGT women with low FPG had less often macrosomia [6.8% (52) vs. 11.8% (99), P < 0.001] and were less often large-for- gestational age [9.2% (70) vs. 16.2% (136), P < 0.001] than infants of women with higher FPG. The rate of small-for-gestational age infants was similar between both groups.
Conclusions: FPG < 78 mg/dl has a high NPV for GDM and can be used to avoid OGTT’s for GDM screening. In the GDM and NGT groups, women with low FPG had a better metabolic profile and in the NGT group also less fetal overgrowth.
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