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Early Glucose Challenge Testing Identifies Diabetes Versus Gestational Diabetes

In women in whom prenatal care is the first medical care they receive, screening for gestational diabetes before they are 24 weeks pregnant could help identify those with pre-gestational diabetes mellitus.

A 1-hour glucose challenge test was performed at the first visit in women obtaining prenatal and delivery care. If the test was positive, further appropriate testing was undertaken, then subsequent testing at 24 to 28 gestational weeks, if necessary.

Data collected included age, parity, ethnicity, body mass index, gestational age at delivery, fetal weight and mode of delivery.

A total of 756 patients were eligible for enrollment, and average gestational age at first visit was 14 2/7 weeks. Subjects were predominantly Hispanic or South Asian.

Gestational diabetes was diagnosed in 6.7%. Of these patients, 64.7% had an abnormal first visit test (P <.05) and 45% were diagnosed with gestational diabetes based on their early screening test alone.

Maternal ages were significantly higher and birth weights lower in women with abnormal first-visit glucose challenge tests than screen-negative controls (P <.04). Almost 50% of gestational diabetics were South Asian, and more South Asians were diagnosed with gestational diabetes based on early screening tests alone.

In her presentation on May 9th, Dr. Venkatachalam concluded, "Certain populations are at increased risk of pre-gestational diabetes mellitus. In pregnancy, it’s important to know whether this is the case because the mothers are at higher risk of preterm labor, and newborns [are at risk] of fetal demise or congenital abnormalities. Gestational diabetes does not carry such a serious risk profile."

[Presentation title: Utility of the 1-Hour Glucose Challenge Test at the First Prenatal Visit to Screen for Pregestational Diabetes. Abstract p. 37S] Results from a retrospective review performed at an inner-city public hospital were presented here by Seema Venkatachalam, MD, MPH, clinical instructor, department of gynecology/obstetrics, Emory Healthcare, Atlanta, Georgia, at the 54th Annual Clinical Meeting of the American College of Obstetricians and Gynecologists (ACOG).

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