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Repeated random blood glucose measurements as universal screening test for Gestational Diabetes Mellitus
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health. (Obstetrisk forskning/Axelsson)
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health. (Obstetrisk forskning/Axelsson)
2004 (English)In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 83, no 1, 46-51 p.Article in journal (Refereed) Published
Abstract [en]


To determine the value of repeated random blood glucose (R-B-glucose) measurements alone or in combination with traditional risk factors [family history of diabetes, obesity, prior large-for-gestational-age (LGA) infant or prior gestational diabetes mellitus (GDM)] to predict the outcome of the oral glucose tolerance test (OGTT).


A prospective population-based study was undertaken in a Swedish county. All pregnant nondiabetic women (n = 4918) visiting the maternal health care clinics over a 2-year period were offered a 75-g OGTT in gestational weeks 28-32. Traditional risk factors and values of repeated R-B-glucose measurements were registered, as well as the results of the OGTT, in terms of fasting B-glucose and 2-h B-glucose.


A total of 3616 women (73.5%) had an OGTT. Of these, 1.7% had GDM, 1.3% impaired glucose tolerance (IGT) and 0.4% diabetes mellitus (DM). An R-B-glucose cut-off level > or =8.0 mmol/L as the only indicator for an OGTT was optimal for detecting GDM with regard to sensitivity (47.5%) and specificity (97.0%). It has the same sensitivity for detecting GDM as using traditional risk factors, but reduces the need to carry out the OGTT from 15.8% to 3.8% of the population. Combined with prior LGA infant or prior GDM as indications for the OGTT in the present study, all women with DM and 44.7% of those with IGT will be identified. Only 7.3% of the population will have to take the OGTT.


A random B-glucose level > or = 8.0 mmol/L prior LGA infant or prior GDM as an indicator for taking the OGTT is a simple and effective first step in a two-step screening model for GDM.

Place, publisher, year, edition, pages
2004. Vol. 83, no 1, 46-51 p.
Keyword [en]
Adult, Blood Glucose/*metabolism, Diabetes; Gestational/*blood/*diagnosis/epidemiology, Female, Gestational Age, Glucose Tolerance Test/*standards, Humans, Mass Screening/standards, Predictive Value of Tests, Pregnancy, Prenatal Diagnosis/*standards, Prevalence, Prospective Studies, Reproducibility of Results, Research Support; Non-U.S. Gov't, Sensitivity and Specificity, Sweden/epidemiology
National Category
Medical and Health Sciences
URN: urn:nbn:se:uu:diva-90097DOI: 10.1111/j.1600-0412.2004.00267.xPubMedID: 14678085OAI: oai:DiVA.org:uu-90097DiVA: diva2:162287
Available from: 2003-01-16 Created: 2003-01-16 Last updated: 2013-05-17Bibliographically approved
In thesis
1. Aspects of Gestational Diabetes: Screening System, Maternal and Fetal Complications
Open this publication in new window or tab >>Aspects of Gestational Diabetes: Screening System, Maternal and Fetal Complications
2003 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The appropriateness of universal screening for gestational diabetes mellitus (GDM) has been strongly questioned, since it does not satisfy ethical principles for screening.

The aims of these studies were to determine the prevalence of GDM, expressed in terms of impaired glucose tolerance (IGT) and diabetes mellitus (DM), to evaluate different screening models using traditional anamnestic risk factors and repeated random B-glucose, to determine whether GDM increases risks for maternal complications such as preeclampsia, and to determine whether IGT during pregnancy, if left untreated, is associated with increased maternal or neonatal morbidity.

Of 4,918 pregnant non-diabetic women attending maternal health care, 73.5% agreed to have a 75 g oral glucose tolerance test (OGTT). GDM was diagnosed in 1.7%, IGT in 1.3% and DM in 0.4%. Traditional risk factor criteria were fulfilled by 15.8%. Prior GDM and a prior macrosomic infant showed the highest association with GDM. No selective or two-step universal screening model would have detected all cases of GDM. A constructed model comprising prior GDM, a prior LGA/macrosomic infant, or a cut-off random B-glucose level of 8 mmol/l as an indication for OGTT reduced the need for OGTT to 7.3% compared to the selective screening model with traditional risk factors. Such a universal two-step screening model had 100% sensitivity for DM, and 44.7% sensitivity for IGT.

The Swedish Medical Birth Register was used to evaluate GDM as risk factor for preeclampsia. GDM occurred in 0.8% and preeclampsia in 2.9% of 430,852 singleton pregnancies. There is an independent and significant association between GDM and preeclampsia. Obesity is a major confounding factor, but cannot explain the total excess risk.

In a prospective population-based case-control study 213 women with untreated IGT during pregnancy were identified. For each case, four controls were recruited from the same delivery department. The analyses confirmed that maternal and fetal morbidity were increased in the cases in terms of cesarean section rate, pre-term delivery, Erb’s palsy and admission to NICU. There was a marked, independent increase in the proportion of LGA infants (OR 7.3; 95% CI 4.1-12.7). To determine whether treatment has an effect when IGT is diagnosed during pregnancy, a randomized study is required.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2003. 38 p.
Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 0282-7476 ; 1220
Obstetrics and gynaecology, Gestational diabetes, screening, preeclampsia, random B-glucose, impaired glucose tolerance, macrosomia, Obstetrik och kvinnosjukdomar
National Category
Obstetrics, Gynecology and Reproductive Medicine
Research subject
Obstetrics and Gynaecology
urn:nbn:se:uu:diva-3267 (URN)91-554-5511-5 (ISBN)
Public defence
2003-02-07, Wilandersalen, Universitetssjukhuset Örebro, Uppsala, 09:15
Available from: 2003-01-16 Created: 2003-01-16Bibliographically approved

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