Jump to ContentJump to Main Navigation
Show Summary Details
More options …

Clinical Chemistry and Laboratory Medicine (CCLM)

Published in Association with the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM)

Editor-in-Chief: Plebani, Mario

Ed. by Gillery, Philippe / Greaves, Ronda / Lackner, Karl J. / Lippi, Giuseppe / Melichar, Bohuslav / Payne, Deborah A. / Schlattmann, Peter


IMPACT FACTOR 2018: 3.638

CiteScore 2018: 2.44

SCImago Journal Rank (SJR) 2018: 1.191
Source Normalized Impact per Paper (SNIP) 2018: 1.205

Online
ISSN
1437-4331
See all formats and pricing
More options …
Volume 44, Issue 1

Issues

The clinical usefulness of glucose tolerance testing in gestational diabetes to predict early postpartum diabetes mellitus

Rob N.M. Weijers
  • Department of Clinical Chemistry and Hematology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Dik J. Bekedam
  • Department of Obstetrics and Gynecology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Henk M.J. Goldschmidt / Yvo M. Smulders
  • Department of Internal Medicine, Academisch Ziekenhuis Vrije Universiteit, Amsterdam, The Netherlands
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
Published Online: 2011-09-21 | DOI: https://doi.org/10.1515/CCLM.2006.019

Abstract

We examined the clinical usefulness of antepartum clinical characteristics, along with measures of glucose tolerance, in Dutch multiethnic women with gestational diabetes mellitus (GDM) for their ability to predict type 2 diabetes within 6months of delivery (early postpartum diabetes). The present study comprised a cross-sectional 5-year investigation (1998–2003) of a consecutive series of 168 women with GDM identified by a two-stage protocol at 16–33weeks of gestation. The following data were collected for all women: age and gestational age at entry into the study; prepregnancy body mass index (BMI); ethnicity; obstetric and clinical history, including the onset of early postpartum diabetes; pregnancy outcome; level of fasting C-peptide; and glycemic parameters of 50-g 1-h glucose challenge test and 100-g 3-h oral glucose tolerance test (diagnostic OGTT). We used receiver operating characteristic (ROC) curve analysis to test the clinical usefulness of the glycemic parameters. A total of 11 women (6.5%) developed early postpartum diabetes. Apart from family history of diabetes (p=0.052), anthropometric, maternal, and neonatal clinical parameters showed no association with early postpartum diabetes in univariate analyses. The level of fasting glucose, and both the glucose challenge test and diagnostic OGTT post-load glucose levels and glucose areas were associated with early postpartum diabetes. ROC curve analysis identifiedall three glucose challenge-test parameters, including fasting glucose concentration, as poor diagnostic tests, with a positive predictive value of ∼22%, whereas the positive predictive value associated with the area under the diagnostic OGTT curve increased progressively over monitoring time from 20.6% to 100%. Using a 3-h OGTT glucose area threshold of 35.7mmol·h/L resulted in 100% sensitivity and 100% specificity, identifying the 11 women who developed early postpartum diabetes. In summary, we can conclude from the present analysis that early postpartum diabetes is rare in GDM women (6.5%), and that the clinical usefulness of the total area under the diagnostic 3-h OGTT is superior to all other glycemic parameters for detecting early postpartum diabetes.

Keywords: early postpartum diabetes; gestational diabetes mellitus; 50-g glucose challenge test; 100-g oral glucose tolerance test; receiver operating characteristic curve analysis

References

  • 1.

    Kjos SL, Peters RK, Xiang A, Henry OA, Montoro M, Buchanan TA. Predicting future diabetes in Latino women with gestational diabetes: utility of early postpartum glucose tolerance testing. Diabetes 1995; 44:586–91.CrossrefGoogle Scholar

  • 2.

    Schaefer-Graf UM, Buchanan TA, Xiang AH, Peters RK, Kjos SL. Clinical predictors for a high risk for the development of diabetes mellitus in the early puerperium in women with recent gestational diabetes mellitus. Am J Obstet Gynecol 2002; 186:751–6.Google Scholar

  • 3.

    Kjos SL, Buchanan TA, Greenspoon JS, Montoro M, Bernstein GS, Mestman JH. Gestational diabetes mellitus: the prevalence of glucose intolerance and diabetes mellitusin the first two months post partum. Am J Obstet Gynecol 1990; 163:93–8.Google Scholar

  • 4.

    Buchanan TA, Xiang A, Kjos SL, Lee WP, Trigo E, Nader I, et al. Gestational diabetes: antepartum characteristics that predict postpartum glucose intolerance and type 2 diabetes in Latino women. Diabetes 1998; 47:1302–10.Google Scholar

  • 5.

    Metzger BE, Cho NH, Roston SM, Radvany R. Prepregnancy weight and antepartum insulin secretion predict glucose tolerance five years after gestational diabetes mellitus. Diabetes Care 1993; 16:1598–605.CrossrefGoogle Scholar

  • 6.

    Damm P, Kuhl C, Bertelsen A, Molsted-Pedersen L. Predictive factors for the development of diabetes in women with previous gestational diabetes mellitus. Am J Obstet Gynecol 1992; 167:607–16.Google Scholar

  • 7.

    Cousins L, Baxi L, Chez R, Coustan D, Gabbe S, Harris J, et al. Screening recommendations for gestational diabetes mellitus. Am J Obstet Gynecol 1991; 165:493–6.Google Scholar

  • 8.

    Metzger BE, Coustan DR. Summary and recommendations of the Fourth International Workshop-Conference on Gestational Diabetes Mellitus. Diabetes Care 1998; 21(Suppl 2):B161–7.Google Scholar

  • 9.

    Alberti KG, Skrabalo Z. Standardization of biochemical methods in the diagnosis and management of diabetes. IDF Bulletin 1982; 27:17–24.Google Scholar

  • 10.

    World Health Organization. Definition, diagnosis, and classification of diabetes mellitus and its complications. Report of a WHO consultation. Geneva: World Health Organization, 1999.Google Scholar

  • 11.

    Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Report of the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Diabetes Care 1997;20:1183–97.PubMedGoogle Scholar

  • 12.

    Weijers RN, Bekedam DJ, Smulders YM. Determinants of mild gestational hyperglycemia and gestational diabetes mellitus in a large Dutch multiethnic cohort. Diabetes Care 2002; 25:72–7.CrossrefGoogle Scholar

  • 13.

    Guzick DS. Polycystic ovary syndrome. Obstet Gynecol 2004; 103:181–93.Google Scholar

  • 14.

    Waldhäusl W, Bratusch-Marrain P, Gasic S, Korn A, Nowotny P. Schätzung der Insulinproduktion während oraler Glucosebelastung mittels Lebervenenkathedertechnik und Bestimmung von C-Peptid. In: Grüneklee D, Herzog W, editors. Die Bedeutung der C-Peptidbestimmung für die Diagnostik. Konstanz, Germany: Schnetztor Verlag, 1979:49–57.Google Scholar

  • 15.

    Treskes M, Adriaansen HJ, van der Leur SJ, Idema RN, Péquériaux N, Pronk C. Multicentre evaluation of the EBIO plus glucose analyser. Eur J Clin Chem Clin Biochem 1996; 34:777–84.Google Scholar

  • 16.

    Boyd JC. Mathematical tools for demonstrating the clinical usefulness of biochemical markers. Scand J Lab Invest 1997; 57(Suppl 227):46–63.CrossrefGoogle Scholar

  • 17.

    Hanna FW, Peters JR. Screening for gestational diabetes; past, present and future. Diabet Med 2002; 19:351–8.CrossrefGoogle Scholar

  • 18.

    Yogev Y, Langer O, Xenakis EM, Rosenn B. Glucose screening in Mexican-American women. Obstet Gynecol 2004; 103:1241–5.Google Scholar

  • 19.

    Campbell MJ, Machin D. Medical statistics. A commonsense approach. Chichester: John Wiley & Sons, 1993:7–31.Google Scholar

  • 20.

    Greenberg LR, Moore TR, Murphy H. Gestational diabetes: antenatal variables as predictors of postpartum glucose intolerance. Obstet Gynecol 1995; 86:97–101.Google Scholar

  • 21.

    Engelgau MM, Herman WH, Smith PJ, German RR, Aubert RE. The epidemiology of diabetes and pregnancy in the US, 1988. Diabetes Care 1995; 18:1029–33.CrossrefGoogle Scholar

About the article

Corresponding author: R.N.M. Weijers, PhD, Department of Clinical Chemistry and Hematology, Onze Lieve Vrouwe Gasthuis, 1e Oosterparkstraat 279, P.O. Box 95500, Amsterdam 1090 HM, The Netherlands


Received: 2005-08-18

Accepted: 2005-10-05

Published Online: 2011-09-21

Published in Print: 2006-01-01


Citation Information: Clinical Chemistry and Laboratory Medicine (CCLM), Volume 44, Issue 1, Pages 99–104, ISSN (Online) 1437-4331, ISSN (Print) 1434-6621, DOI: https://doi.org/10.1515/CCLM.2006.019.

Export Citation

©2006 by Walter de Gruyter Berlin New York.Get Permission

Citing Articles

Here you can find all Crossref-listed publications in which this article is cited. If you would like to receive automatic email messages as soon as this article is cited in other publications, simply activate the “Citation Alert” on the top of this page.

[1]
Rob NM Weijers and Dick J Bekedam
Clinical Chemistry, 2007, Volume 53, Number 3, Page 377
[2]
Ravi Retnakaran, Ying Qi, Mathew Sermer, Philip W. Connelly, Anthony J. G. Hanley, and Bernard Zinman
The Journal of Clinical Endocrinology & Metabolism, 2009, Volume 94, Number 3, Page 840
[4]
Kathrine Frey Frøslie, Jo Røislien, Elisabeth Qvigstad, Kristin Godang, Jens Bollerslev, Nanna Voldner, Tore Henriksen, and Marit B Veierød
BMC Medical Research Methodology, 2013, Volume 13, Number 1
[5]
U. M. Schaefer-Graf, S. Klavehn, R. Hartmann, H. Kleinwechter, N. Demandt, M. Sorger, S. L. Kjos, K. Vetter, and M. Abou-Dakn
Diabetes Care, 2009, Volume 32, Number 11, Page 1960
[6]
Anita L. Nelson, Monica Hau Hien Le, Zuhra Musherraf, and Anje VanBerckelaer
American Journal of Obstetrics and Gynecology, 2008, Volume 198, Number 6, Page 699.e1
[7]
Baris Akinci, Aygul Celtik, Sinan Genc, Serkan Yener, Tevfik Demir, Mustafa Secil, Levent Kebapcilar, and Sena Yesil
Gynecological Endocrinology, 2011, Volume 27, Number 5, Page 361

Comments (0)

Please log in or register to comment.
Log in