Saturday, 1 December 2012

Study clarifies gestational diabetes diagnostic values for Chinese women

Fasting plasma glucose should be measured at the first prenatal visit, with 6.1mmol/L as the diagnostic cutoff for GDM
by Michael Woodhead
A major study has confirmed the value of screening for gestational diabetes in early pregnancy, but shows that international blood glucose level benchmarks for diagnosis are not appropriate for Chinese women.
Researchers at the Peking University First Hospital evaluated the value of fasting plasma glucose (FPG) testing at the first prenatal visit to diagnose gestational diabetes mellitus in 17,186 pregnant women who attended prenatal clinics in 13 hospitals in China.
They found that the fasting plasma glucose level at the first prenatal visit was strongly correlated with gestational diabetes diagnosed at 24–28 gestational weeks. The incidences of gestational diabetes were 37%, 53%, and 66%, respectively, for women with fasting plasma glucose at the first prenatal visit between 5.10 and 5.59, 5.60 and 6.09, and 6.10–6.99 mmol/L.
The researchers say diabetes is a major problem in China, with a prevalence of 8.8% for women and a prediabetes prevalence rate of 15% for women. And in addition, in 60% of women with diabetes, the condition had not previously been diagnosed.
"Early diagnosis and early intervention for diabetes are necessary to improve pregnancy outcomes. While not the gold standard for diagnosing type 2 diabetes, fasting plasma glucose  measurement at first prenatal visit or at the time of booking could be critical to screen for previously undiagnosed preexisting diabetes."
The researchers conclude that: "Based on our study, we recommend that a fasting plasma glucose test be performed for all pregnant women at the time of booking and first prenatal visit, that a fasting plasma glucose  value of 7.00 mmol/L be considered diagnostic of previous undiagnosed diabetes, and that women with fasting plasma glucose  between 6.10 and 6.99 mmol/L be treated as gestational diabetes mellitus  to improve outcomes of both mothers and offspring."
They suggest  that pregnant women (6.10 ≤ FPG < 7.00 mmol/L) should be considered and treated as gestational diabetes to improve outcomes; for women with fasting plasma glucose between 5.10 and 6.09 mmol/L, nutrition and exercise advice should be provided. An oral glucose tolerance test should be performed at 24–28 weeks to confirm or rule out gestational diabetes. Based on our data, we cannot support an fasting plasma glucose value ≥5.10 mmol/L at the first prenatal visit as the criterion for diagnosis of gestational diabetes.
"Two-thirds of the pregnant women with fasting plasma glucose of over 6.10 mmol/L at the first prenatal visit quite likely will progress to gestational diabetes without further intervention," they warn.
"If blood glucose is not controlled for this group, we probably will miss the opportunity for reducing
risks for poor outcomes."
However say they they do not recommend the international fasting plasma glucose cutoff of 5.10 mmol/L at first visit as the criteria to diagnose gestational diabetes.
"If we use 5.10 mmol/L as the cutoff value to diagnose gestational diabetes at any time during pregnancy, even more women will be diagnosed; this will not only burden the already overstretched health system but also create stress and psychological burden for patients, which in itself may not be good for their overall wellbeing during pregnancy."
Source: Diabetes Care

1 comment:

  1. Quite interesting that these Chinese women needs more attention than others.

    Gestational diabetes


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