COMPARISON OF 2 HOUR 75 GM ORAL GLUCOSE TOLERANCE TEST WITH A SINGLE TEST 75 GRAM GLUCOSE CHALLENGE TEST FOR UNIVERSAL SCREENING OF GESTATIONAL DIABETES MELLITUS.
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Keywords
Gestational diabetes mellitus, Oral glucose challenge test, Dipsi, Oral glucose tolerance test
Abstract
INTRODUCTION: Around 3-5% of pregnancies are affected by pre-existing diabetes or gestational diabetes. The 75g OGTT is the standard test used worldwide to screen for gestational diabetes (GDM). According to the Diabetes in Pregnancy Study Group India (DIPSI), the 75g GCT is a simple one-step procedure for diagnosing GDM.
Aim: Evaluation of the efficacy of 75 gm GCT ( DIPSI) with that of 75 gm OGTT for screening of GDM.
Materials and methods: The study was conducted on 400 pregnant women who visited the antenatal clinic at the Department of Obstetrics and Gynaecology, Government Medical College, Amritsar, from February 2010 to August 2011, after approval from the ethics committee. The women were assessed based on their history and clinical profile, after giving informed consent. The data collected included age, number of pregnancies, weight, height, gestational age at diagnosis, uterine size, whether they lived in urban or rural areas, and family history. For the 75g GCT (DIPSI), the women were given a 75g glucose solution at random times, and their blood glucose was measured 2 hours later. After 72 hours, the 75g OGTT was done by first taking a fasting blood sample, then giving the woman 75g of glucose to drink, and measuring her blood glucose 2 hours later.
Result: 3.8% of women were GDM positive with 75 gm, GC( DIPSI), However, true incidence was 2 % ( according to 75 gm OGTT). Sensitivity and specificity of 75 gm GCT:100 % and 98.47 % respectively. Positive and negative predictive values came out to be 57.14 % and 100% respectively.
Gestational diabetes is more common in urban women and in those with positive family history of diabetes.
Conclusion: 75 gm GCT (DIPSI) done between 16 to 28 weeks of gestation with a cut-off value of >/= 140 mg/dl cannot act as both screening and diagnostic test for GDM since it has very low positive predictive value.
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Dr Umang
Assistant Professor, Department of Obstetrics and Gynaecology, SRI GURU RAMDAS INSTITUTE OF MEDICAL SCIENCES AND RESEARCH VALLAH