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A Modified Two-Step Screening Strategy for Gestational Diabetes Mellitus Based on the 2013 WHO Criteria by Combining the Glucose Challenge Test and Clinical Risk Factors

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Department of Endocrinology, University hospital Gasthuisberg, KU Leuven, 3000 Leuven, Belgium
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Department of Endocrinology, OLV ziekenhuis Aalst-Asse-Ninove, 9300 Aalst, Belgium
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Department of Obstetrics & Gynecology, University Hospital Gasthuisberg, KU Leuven, 3000 Leuven, Belgium
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Department of Obstetrics & Gynecology, OLV Ziekenhuis Aalst-Asse-Ninove, 9300 Aalst, Belgium
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Department of Endocrinology, Imelda ziekenhuis, 2820 Bonheiden, Belgium
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Department of Obstetrics & Gynecology, Imelda Ziekenhuis, 2820 Bonheiden, Belgium
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Department of Endocrinology-Diabetology-Metabolism, Antwerp University Hospital, 2560 Edegem, Belgium
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Department of Obstetrics & Gynecology, Antwerp University Hospital, 2560 Edegem, Belgium
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Department of Endocrinology, Kliniek St-Jan Brussel, 1000 Brussel, Belgium
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Department of Obstetrics & Gynecology, Kliniek St-Jan Brussel, 1000 Brussel, Belgium
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Department of Endocrinology, AZ St Jan Brugge, 8000 Brugge, Belgium
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Department of Obstetrics & Gynecology, AZ St Jan Brugge, 8000 Brugge, Belgium
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Center of Biostatics and Statistical bioinformatics, KU Leuven, 3000 Leuven, Belgium
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Author to whom correspondence should be addressed.
J. Clin. Med. 2018, 7(10), 351; https://doi.org/10.3390/jcm7100351
Received: 10 September 2018 / Revised: 3 October 2018 / Accepted: 11 October 2018 / Published: 13 October 2018
(This article belongs to the Section Obstetrics & Gynecology)
This study determines if a modified two-step screening strategy with a glucose challenge test (GCT) ≥ 7.2 mmol/L and clinical risk factors improves the diagnostic accuracy for gestational diabetes mellitus (GDM), based on 2013 WHO criteria, while limiting the number of oral glucose tolerance tests (OGTT). This was a prospective multicentric cohort study with 1811 participants receiving both GCT and 75 g OGTT in pregnancy. Participants and health care providers were blinded for GCT. Characteristics were analyzed across four glucose tolerance groups: abnormal (≥7.2 mmol/L), GCT GDM (n = 165), normal GCT GDM (n = 63), abnormal GCT normal glucose tolerant (NGT) (n = 472); normal GCT NGT (n = 1113). Compared to normal GCT NGT women, normal GCT GDM women had increased rates of obesity (23.8% vs. 10.5%, p < 0.001), ethnic minority background (19.3% vs. 8.2%, p < 0.001) and a history of GDM (13.8% vs. 4.6%, p = 0.03). By combined screening of GCT ≥ 7.2 mmol/L with these risk factors, sensitivity increased to respectively, 74.1–78.1% using one risk factor, and to 82.9% using any of these risk factors with a specificity of 57.5%. By using a modified two-step screening strategy, the number of women needing both a GCT and OGTT would be reduced to 25.5%, and 52.6% of all OGTTs could be avoided, compared to a universal one-step approach. View Full-Text
Keywords: gestational diabetes mellitus; 2013 WHO criteria; risk factors; screening gestational diabetes mellitus; 2013 WHO criteria; risk factors; screening
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MDPI and ACS Style

Benhalima, K.; Van Crombrugge, P.; Moyson, C.; Verhaeghe, J.; Vandeginste, S.; Verlaenen, H.; Vercammen, C.; Maes, T.; Dufraimont, E.; De Block, C.; Jacquemyn, Y.; Mekahli, F.; De Clippel, K.; Van Den Bruel, A.; Loccufier, A.; Laenen, A.; Minschart, C.; Devlieger, R.; Mathieu, C. A Modified Two-Step Screening Strategy for Gestational Diabetes Mellitus Based on the 2013 WHO Criteria by Combining the Glucose Challenge Test and Clinical Risk Factors. J. Clin. Med. 2018, 7, 351. https://doi.org/10.3390/jcm7100351

AMA Style

Benhalima K, Van Crombrugge P, Moyson C, Verhaeghe J, Vandeginste S, Verlaenen H, Vercammen C, Maes T, Dufraimont E, De Block C, Jacquemyn Y, Mekahli F, De Clippel K, Van Den Bruel A, Loccufier A, Laenen A, Minschart C, Devlieger R, Mathieu C. A Modified Two-Step Screening Strategy for Gestational Diabetes Mellitus Based on the 2013 WHO Criteria by Combining the Glucose Challenge Test and Clinical Risk Factors. Journal of Clinical Medicine. 2018; 7(10):351. https://doi.org/10.3390/jcm7100351

Chicago/Turabian Style

Benhalima, Katrien, Paul Van Crombrugge, Carolien Moyson, Johan Verhaeghe, Sofie Vandeginste, Hilde Verlaenen, Chris Vercammen, Toon Maes, Els Dufraimont, Christophe De Block, Yves Jacquemyn, Farah Mekahli, Katrien De Clippel, Annick Van Den Bruel, Anne Loccufier, Annouschka Laenen, Caro Minschart, Roland Devlieger, and Chantal Mathieu. 2018. "A Modified Two-Step Screening Strategy for Gestational Diabetes Mellitus Based on the 2013 WHO Criteria by Combining the Glucose Challenge Test and Clinical Risk Factors" Journal of Clinical Medicine 7, no. 10: 351. https://doi.org/10.3390/jcm7100351

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