First trimester prediction of maternal glycemic status

2015 ◽  
Vol 43 (3) ◽  
Author(s):  
Rinat Gabbay-Benziv ◽  
Lauren E. Doyle ◽  
Miriam Blitzer ◽  
Ahmet A. Baschat
Keyword(s):  
Risk Score ◽  
Predictive Value ◽  
Challenge Test ◽  
Area Under The Curve ◽  
First Trimester ◽  
Tolerance Test ◽  
Oral Glucose ◽  
Operating Characteristics ◽  
Maternal Characteristics ◽  
Predictive Algorithm

AbstractTo predict gestational diabetes mellitus (GDM) or normoglycemic status using first trimester maternal characteristics.We used data from a prospective cohort study. First trimester maternal characteristics were compared between women with and without GDM. Association of these variables with sugar values at glucose challenge test (GCT) and subsequent GDM was tested to identify key parameters. A predictive algorithm for GDM was developed and receiver operating characteristics (ROC) statistics was used to derive the optimal risk score. We defined normoglycemic state, when GCT and all four sugar values at oral glucose tolerance test, whenever obtained, were normal. Using same statistical approach, we developed an algorithm to predict the normoglycemic state.Maternal age, race, prior GDM, first trimester BMI, and systolic blood pressure (SBP) were all significantly associated with GDM. Age, BMI, and SBP were also associated with GCT values. The logistic regression analysis constructed equation and the calculated risk score yielded sensitivity, specificity, positive predictive value, and negative predictive value of 85%, 62%, 13.8%, and 98.3% for a cut-off value of 0.042, respectively (ROC-AUC – area under the curve 0.819, CI – confidence interval 0.769–0.868). The model constructed for normoglycemia prediction demonstrated lower performance (ROC-AUC 0.707, CI 0.668–0.746).GDM prediction can be achieved during the first trimester encounter by integration of maternal characteristics and basic measurements while normoglycemic status prediction is less effective.

scholarly journals The Influence of First Trimester Maternal Glucose on Fetal Growth and Possible Implications in Pregnancy Evolution

2013 ◽  
Vol 20 (2) ◽  
pp. 141-148
Author(s):  
Monica Vereş ◽  
Szidonia Lacziko ◽  
Aurel Babeş
Keyword(s):  
Birth Weight ◽  
Area Under The Curve ◽  
First Trimester ◽  
Tolerance Test ◽  
Fetal Macrosomia ◽  
Control Group ◽  
Oral Glucose ◽  
Third Trimester ◽  
Maternal Characteristics ◽  
Fetal Birth Weight

AbstractBackground and Aims: Maternal hyperglycemia during the first trimester of pregnancy is frequently associated with the appearance of maternal and fetal complications. The aim of our study was to analyze the influence of the first trimester blood glucose on the glycemic values from the second and third trimester and on fetal birth weight. Material and method: We performed an observational study on a group of 46 pregnant women who finally delivered on due date. We determined glycemia values in the first and third trimester of pregnancy while an Oral Glucose Tolerance Test (OGTT) was performed during the second trimester (24 - 28 weeks of pregnancy). We divided the pregnancies in two groups: with normal glucose or hyperglycemia during the first trimester. Finally we analyzed the influence of first trimester hyperglycemia on different maternal characteristics and on fetal birth weight. Results: Third trimester glycemia was significantly increased in women with first trimester hyperglycemia in comparison with the control group (p= 0.04) but no effect of the last on OGTT values was recorded. The ROC curve for the influence of first trimester glycemia on fetal macrosomia had an Area Under the Curve (AUC) of 0.551. Conclusions: Firsttrimester glycemia has a low diagnostic accuracy in the appreciation of fetal macrosomia risk.

Incorporating first trimester analytes to predict delivery of a large for gestational infant in women with impaired glucose tolerance

2015 ◽  
Vol 43 (3) ◽  
Author(s):  
Rinat Gabbay-Benziv ◽  
Sertac Esin ◽  
Ahmet A. Baschat
Keyword(s):  
Glucose Tolerance ◽  
Impaired Glucose Tolerance ◽  
Univariate Analysis ◽  
Challenge Test ◽  
Prediction Rule ◽  
First Trimester ◽  
Oral Glucose ◽  
Maternal Height ◽  
Maternal Characteristics ◽  
Β Hcg

AbstractTo investigate first trimester maternal characteristics of women with impaired glucose tolerance that deliver large for gestational age (LGA) infants.Nested analysis from a prospective study of singleton pregnancies enrolled at first trimester. We studied women with an abnormal 1 h glucose challenge test that had normal follow-up oral glucose tolerance testing. Maternal characteristics, ultrasound parameters and serum analytes were stratified by subsequent delivery of an LGA infant. Parameters identified as significant on univariate analysis were used for a derivation of prediction by logistic regression. Odds ratio and prediction performance was determined using receiver operator curve (ROC) statistics.A total of 33/114 (28.9%) women meeting the criteria delivered LGA infants. Maternal height (cm), and first trimester pregnancy-associated protein-A and free β-hCG (MoM) predicted delivery of an LGA infant (ROC area under curve 0.73; 95% CI 0.63–0.83). At a cutoff value of 0.172 the prediction rule achieved 91% sensitivity, 44% specificity, 41% positive predictive and 92% negative predictive value.Maternal height and first trimester high free β-hCG and PAPP-A levels may be used as predictors for delivery of LGA infants in women with impaired glucose tolerance.

scholarly journals Mid-Pregnancy Fructosamine Measurement—Predictive Value for Gestational Diabetes and Association with Postpartum Glycemic Indices

Nutrients ◽  
2018 ◽  
Vol 10 (12) ◽  
pp. 2003 ◽  
Author(s):  
Véronique Gingras ◽  
Sheryl Rifas-Shiman ◽  
Karen Switkowski ◽  
Emily Oken ◽  
Marie-France Hivert
Keyword(s):  
Gestational Diabetes ◽  
Glucose Tolerance ◽  
Predictive Value ◽  
Glycated Hemoglobin ◽  
Characteristic Curve ◽  
Challenge Test ◽  
Tolerance Test ◽  
Oral Glucose ◽  
Second Trimester ◽  
Glycemic Indices

Screening for gestational diabetes mellitus (GDM) during pregnancy is cumbersome. Measurement of plasma fructosamine may help simplify the first step of detecting GDM. We aimed to assess the predictive value of mid-pregnancy fructosamine for GDM, and its association with postpartum glycemic indices. Among 1488 women from Project Viva (mean ± SD: 32.1 ± 5.0 years old; pre-pregnancy body mass index 24.7 ± 5.3 kg/m2), we measured second trimester fructosamine and assessed gestational glucose tolerance with a 50 g glucose challenge test (GCT) followed, if abnormal, by a 100 g oral glucose tolerance test (OGTT). Approximately 3 years postpartum (median 3.2 years; SD 0.4 years), we measured maternal glycated hemoglobin (n = 450) and estimated insulin resistance (HOMA-IR; n = 132) from fasting blood samples. Higher glucose levels 1 h post 50 g GCT were associated with higher fructosamine levels (Pearson’s r = 0.06; p = 0.02). However, fructosamine ≥222 µmol/L (median) had a sensitivity of 54.8% and specificity of 48.6% to detect GDM (area under the receiver operating characteristic curve = 0.52); other fructosamine thresholds did not show better predictive characteristics. Fructosamine was also weakly associated with 3-year postpartum glycated hemoglobin (per 1 SD increment: adjusted β = 0.03 95% CI [0.00, 0.05] %) and HOMA-IR (per 1 SD increment: adjusted % difference 15.7, 95% CI [3.7, 29.0] %). Second trimester fructosamine is a poor predictor of gestational glucose tolerance and postpartum glycemic indices.

scholarly journals Simple and non-invasive screening method for diabetes based on myoinositol levels in urine samples collected at home

2020 ◽  
Vol 8 (1) ◽  
pp. e000984
Author(s):  
Misaki Takakado ◽  
Yasunori Takata ◽  
Fumio Yamagata ◽  
Michiko Yaguchi ◽  
Go Hiasa ◽  
...  
Keyword(s):  
Test Meal ◽  
Screening Method ◽  
Area Under The Curve ◽  
Tolerance Test ◽  
Urine Samples ◽  
Oral Glucose ◽  
Operating Characteristics ◽  
Non Invasive ◽  
Before And After ◽  
At Home

ObjectiveTo establish a simple screening method for diabetes based on myoinositol (MI) in urine samples collected at home.Research design and methodsInitially, we evaluated the stability of urinary MI (UMI) at room temperature (RT; 25°C) and 37°C in 10 outpatients with type 2 diabetes. We then enrolled 115 volunteers without a current or history of diabetes. In all subjects, glucose intolerance was diagnosed by 75 g oral glucose tolerance test (75gOGTT). To assess the association between UMI or urine glucose (UG) and plasma glucose (PG), urine samples were also collected at 0 and 2 hours during 75gOGTT. All the subjects collected urine samples at home before and 2 hours after consuming the commercially available test meal. UMI levels at wake-up time (UMIwake-up), before (UMIpremeal) and 2 hours after the test meal (UMI2h-postprandial) were measured using an enzymatic method. ΔUMI was defined as UMI2h-postprandial minus UMIpremeal.ResultsDiffering from UG, UMI was stable at RT and 37°C. UMI was increased linearly along with an increase in PG, and no threshold for UMI was observed. UMI was closely associated with blood glucose parameters obtained from a 75gOGTT and hemoglobin A1c (HbA1c) at hospital after adjustment for age, sex, body mass index and serum creatinine. UMIwake-up, UMIpremeal, UMI2h-postprandial and ΔUMI at home were higher in diabetic subjects than non-diabetic subjects even after the above adjustment. Receiver operating characteristics curve (ROC) analyses revealed that for the screening of diabetes, the area under the curve for ROC for UMI2h-postprandial and ΔUMI (0.83 and 0.82, respectively) were not inferior to that for HbA1c ≥48 mmol/mol, which is the American Diabetes Association (ADA) criteria for diabetes.ConclusionsMI measurement in urine samples collected at home before and after the meal would be a simple, non-invasive and valuable screening method for diabetes.

scholarly journals The Utility of Glycated Hemoglobin, Determined in the Second Trimester of Pregnancy, in Diagnosing Gestational Diabetes

2015 ◽  
Vol 22 (3) ◽  
pp. 233-240
Author(s):  
Monica Vereș ◽  
Doru Ioan Crăiuț ◽  
Johann Trutz ◽  
Aurel Babeș
Keyword(s):  
Gestational Diabetes ◽  
Area Under The Curve ◽  
First Trimester ◽  
Tolerance Test ◽  
Oral Glucose ◽  
Second Trimester ◽  
Mortality And Morbidity ◽  
Average Value ◽  
Study Results ◽  
First Trimester Of Pregnancy

Abstract Background and Aims: Gestational diabetes (GD) identifies a pregnancy with high obstetrical risk due to the possible complications that may appear and which are associated with significant perinatal mortality and morbidity. The role of HbA1c in diagnosing GD is still debatable. Our aim was to evaluate the clinical utility of HbA1c assessed in the second trimester of pregnancy (before performing the oral glucose tolerance test - OGTT) in establishing the macrosomia risk, and also for diagnosing GD. Material and methods: This was an observational study on a group of 165 pregnant women followed from the first trimester of pregnancy in whom we measured HbA1c in the second trimester, before running an OGTT with 100 grams of glucose and who delivered at term (37 - 41 weeks of pregnancy). Finally, HbA1c and OGTT were performed only in 132 women, these being the subjects of our study. Results: The average value of HbA1c was 4.85±1.23%. HbA1c was higher in the group having gestational diabetes (6.58±0.74%) in comparison to the group not having GD (4.52±0,80%). The Receiver Operating Characteristic (ROC) curve for HbA1c determined in the second trimester, for diagnosis of GD, has an area under the curve (AUC) of 0.939. Conclusions: HbA1c value could be considered as a sensitive and specific predictive factor in appreciating the macrosomia risk and could be set as an extra criterion in GD diagnosis.

scholarly journals Gestational Diabetes: Comparison of Random and Fasting Plasma Glucose as Modalities of Screening

EMJ Diabetes ◽  
2020 ◽  
pp. 110-117
Author(s):  
Chibuike F. Chukwunyere ◽  
David O. Awonuga ◽  
Olubiyi F. Adesina ◽  
Ifeoma C. Udenze
Keyword(s):  
Gestational Diabetes ◽  
Plasma Glucose ◽  
Predictive Value ◽  
Gold Standard ◽  
Glucose Tolerance Test ◽  
Area Under The Curve ◽  
Tolerance Test ◽  
Oral Glucose ◽  
Oral Glucose Tolerance ◽  
Pregnant Females

Objective: Gestational diabetes is glucose intolerance of varying severity with onset in the index pregnancy. This study aimed to compare fasting plasma glucose (FPG) with random plasma glucose (RPG) among pregnant females as methods of screening for gestational diabetes. Methods: A cross-sectional study of 100 pregnant females selected to have screening for gestational diabetes between gestational ages of 24 and 28 weeks using RPG and FPG. All the subjects had 75 g oral glucose tolerance test as the gold standard. Venous plasma glucose assay was performed using glucose oxidase method. Results: The prevalence of gestational diabetes was 29% using FPG cut-off ≥5.1 mmol/L and 6% using RPG cut-off ≥7.8 mmol/L. The RPG cut-off ≥11.1 mmol/L gave the lowest prevalence rate of 2%, while 75 g oral glucose tolerance test (gold standard test) gave the highest prevalence rate of 30%. RPG cut-off ≥7.8 mmol/L revealed a positive-predictive value of 66.7%, negative-predictive value of 72.3%, and area under the curve of 0.845 compared with FPG level at threshold of 5.1 mmol/L, which gave positive-predictive value of 93.1%, negative-predictive value of 95.8%, and area under the curve 0.920. Conclusion: This study revealed that FPG threshold of 5.1 mmol/L alone performed excellently as a screening test.

scholarly journals New screening approach to detecting congenital syphilis in China: a retrospective cohort study

2020 ◽  
pp. archdischild-2020-320549
Author(s):  
Fang Hu ◽  
Shuai-Jun Guo ◽  
Jian-Jun Lu ◽  
Ning-Xuan Hua ◽  
Yan-Yan Song ◽  
...  
Keyword(s):  
Predictive Value ◽  
Congenital Syphilis ◽  
Area Under The Curve ◽  
Diagnostic Tools ◽  
Operating Characteristics ◽  
Loss To Follow Up ◽  
Sensitivity Specificity ◽  
Mother To Child ◽  
Rule Out

BackgroundDiagnosis of congenital syphilis (CS) is not straightforward and can be challenging. This study aimed to evaluate the validity of an algorithm using timing of maternal antisyphilis treatment and titres of non-treponemal antibody as predictors of CS.MethodsConfirmed CS cases and those where CS was excluded were obtained from the Guangzhou Prevention of Mother-to-Child Transmission of syphilis programme between 2011 and 2019. We calculated sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) using receiver operating characteristics (ROC) in two situations: (1) receiving antisyphilis treatment or no-treatment during pregnancy and (2) initiating treatment before 28 gestational weeks (GWs), initiating after 28 GWs or receiving no treatment for syphilis seropositive women.ResultsAmong 1558 syphilis-exposed children, 39 had confirmed CS. Area under the curve, sensitivity and specificity of maternal non-treponemal titres before treatment and treatment during pregnancy were 0.80, 76.9%, 78.7% and 0.79, 69.2%, 88.7%, respectively, for children with CS. For the algorithm, ROC results showed that PPV and NPV for predicting CS were 37.3% and 96.4% (non-treponemal titres cut-off value 1:8 and no antisyphilis treatment), 9.4% and 100% (non-treponemal titres cut-off value 1:16 and treatment after 28 GWs), 4.2% and 99.5% (non-treponemal titres cut-off value 1:32 and treatment before 28 GWs), respectively.ConclusionsAn algorithm using maternal non-treponemal titres and timing of treatment during pregnancy could be an effective strategy to diagnose or rule out CS, especially when the rate of loss to follow-up is high or there are no straightforward diagnostic tools.

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