11.1Gestational diabetes

Clinical question: What is the diagnostic value and effectiveness of screening tests to identify women at risk of diabetes in pregnancy?

StudyRef.PopulationInterventionOutcomesResultsCommentsStudy typeEL
Gribble, 1995494Pregnant women with at least 2 urinalysis tests during first 2 trimesters were included
Women with preexisting
DM, multiple gestation excluded
Sample size 2965
All women were screened with 50 g GCT at 24–28 weeks. Positive screens (cut-off 7.78 mmol/litre (140 mg/100 ml)) started a 3 day CHO load, and fasting 100 g GTT.
Categorised into 2 groups, negative or positive glycosuria groups
Threshold 2 or more ≥ fasting 105; 1 hour 190;
2 hour 165 and 3 hour
8.1 mmol/litre (145 mg/100 ml)
Negative screens comparison of the 2 glycosuria groups in terms of outcomes
Prediction of gestational diabetesHigher incidence of GDM in women with positive glycosuria in the first two trimesters (12.8% vs 2.9% for negative screens).
Sensitivity of glycosuria in first trimester as a predictor of GD was 7.1%
Specificity 98.5%
PPV 12.8%
NPV 97.1%
Routine dipstick urinalysis for glucose can identify pregnant women at increased risk for GD and diagnose them earlier than 24–28 weeks.Retrospective observational studyII
Watson, 1990493Pregnant women, Military dependants, unrestricted access to medical care without monetary cost
Those with previous DM excluded
Sample size 500
All women given random urinalysis for glucose at each antenatal visit (mean 10.8, SD
2.6).
Diagnosis glycosuria if trace, 1+, 2+ or 3+ found on at least 2 visits. Severe glycosuria if ≥ 2+ on two visits
At 28 weeks (no range given) 50 g GCT without regard to ingestion state. Threshold ≥ 7.78 mmol/litre (140 mg/100 ml)
Diagnostic test fasting 100 g GTT, after 3 days high CHO diet
Thresholds 2 or more values:
fasting 105; 1 hour 190; 2 hour 165 and 3 hour 8.1 mmol/litre (145 mg/100 ml
Prediction of gestational diabetes22 (4.4%) incidence
of GD 85 (17%) showed glycosuria and 19 (3.8%) severe glycosuria
10 patients with glycosuria with GD (6 glycosuria, 4 severe glycosuria)
Routine random urine testing is a poor screening method but recommend that those classed as severe
glycosuria before 24 weeks should have an earlier 50 g GCT
Non randomised population-based studyII
Ostlund, 2004837All pregnant women without diabetes
Sample size 3616
Random blood glucose (proposed every 4–6 weeks) and Risk factors (family history of diabetes, obesity, a prior LGA infant or prior GD) assessed.
All were offered diagnostic test, 75 g OGTT between 28–32 weeks of gestation
Diagnostic value61/3616 or 1.7% had GD
At a cut-off level of ≥ 8 mmol/litre
Sensitivity: 47.5%
Specificity: 97%
RBG measurement has the same sensitivity for detecting GD as using traditional risk factors, but reduces the need to carry out the OGTT from 15.8% to 3.8% of the population
Traditional risk factors have poor sensitivity for GD.
Prospective
population-based study
II
Nasrat, 1988838Healthy pregnant women
Sample size 250
Random plasma glucose determined in 276 women and 250/276 women given a standard 75 g OGTTDiagnostic value3/250 or 1.2% had GD
Using Lind and Anderson threshold
(7.0 mmol/litre < 2 hour 6.4 mmol/litre > 2 hours) for random plasma glucose
Sens: 16%
Spec: 96%
PPV: 47%
Using 90th percentile of study group
Sens: 29%
Spec: 89%
PPV: 38%
Random plasma glucose has limited predictive valueProspective studyII
Seshiah, 2004840Consecutive pregnant women
Sample size 1251
1 hour 50 g GCT, 2 hour 75 g OGTT, given to all during second and third trimestersDiagnostic valuePositive screens 891
168/891 or 18.9% had GD
Sens: 79.8%, Spec: 42.7%, PPV: 24.5%, NPV: 90.1%
Using 2 hour plasma glucose ≥ 7.78 mmol/litre (140 mg/100 ml) as once step procedure is simple and economical for countries more prone to GDProspective consecutive population-based studyII
Perucchini, 1999499All pregnant women with singleton pregnancy giving birth after 28 weeks of gestation
Exclusion criteria: pre- existing diabetes mellitus, lack of examination before24 weeks of gestation.
772 eligible 558
consented 520
completed study
FPG, 50 g GCT, 3 hour 100 g OGTT, given to allDiagnostic value52/520 or 10.2% had GD
FPG at 4.8 mmol/litre, 50 g GCT 7.8 mmol/litre
Sens: FPG 81%, 50 g GCT 59%
Spec: FPG 76%, 50 g GCT 91%
Sample representative of general population.
Measuring FPG is easier than 50 g GCT and allows 70% of women to avoid the GCT.
Prospective population based observational study
Cetin and Cetin, 1997841Pregnant women included if examined < 20 weeks of gestation
Exclusion criteria:
pre-existing diabetes mellitus, multiple pregnancy, preterm premature rupture of membranes, pre- eclampsia, birth ≤ 28 weeks, regular ingestion of any drug. 291/344 eligible, 274/291 completed study
1 hour 50 g GCT, 100 g OGTT, given to all between 24–28 weeks of gestationDiagnostic value17/274 or 6.2% had GD
Sens:
< 2 hour cut-off
7.78 mmol/litre (140 mg/100 ml) 75%, cut-off
8.22 mmol/litre (148 mg/100 ml) 63% 2–3 hour cut-off 7.78 mmol/litre (140 mg/100 ml) 60%, cut-off
7.89 mmol/litre (142 mg/100 ml) 60%
> 3 hour cut-off
7.78 mmol/litre (140 mg/100 ml) 50%, cut-off
8.33 mmol/litre (150 mg/100 ml) 50%
Spec:
< 2 hour cut-off
7.78 mmol/litre (140 mg/100 ml) 86%, cut-off
8.22 mmol/litre (148 mg/100 ml) 91%
2–3 hour cut-off
7.78 mmol/litre (140 mg/100 ml) 89% cut-off
7.89 mmol/litre (142 mg/100 ml) 92%
7.78 mmol/litre (140 mg/100 ml) 89%, cut-off
8.33 mmol/litre (150 mg/100 ml) 92%
PPV:
< 2 hour cut-off
7.78 mmol/litre (140 mg/100 ml) 27%, cut-off
8.22 mmol/litre (148 mg/100 ml) 33%
2–3 hour cut-off
7.78 mmol/litre (140 mg/100 ml) 30% cut-off
7.89 mmol/litre (142 mg/100 ml) 30%
> 3 hour cut-off
7.78 mmol/litre (140 mg/100 ml) 25%, cut-off
8.33 mmol/litre (150 mg/100 ml) 33%
Sample too small. Standard cut- off 7.78 mmol/litre (140 mg/100 ml) Sens 65% Spec 88% PPV 27%
Suggested cut-off Sens 59% spec 92% PPV 32%.
Prospective studyII
O’Sullivan, 1973842Prenatal women 752/ 986 (76%) eligible1 hour 50 g GCT, 3 hour OGTT given to all Weeks of gestation not reportedDiagnostic value1 hour 50 g GCT ≥ 130 mg/100 ml cut-off
Sens: 78.9%
Spec: 87.2%
PPV: 13.8%
NPV: 99.4%
Timing of testing in relation to stage of pregnancy not reported

No quantity of glucose stated for GTT

Sample collected between 1956 and 1957
Cohort studyIII
Buhling, 2003843Pregnant women
Sample size 193
Comparison of 50 g GCT with five portable metersDiagnostic value of 5 portable metersSens:
Accu-Chek 84%
EuroFlash 100%
GlucoTouch 98%
HemoCue 57%
OneTouch 92% Precision Plus 90%
Spec:
Accu-Chek 98%
EuroFlash 79% GlucoTouch 86%
HemoCue 100%
OneTouch 92% Precision Plus 91%
The accuracy of Accu-Chek, GlucoTouch, OneTouch and precision was acceptable for use in GD screening.Prospective studyII
Murphy, 1994844Pregnant women
No other data given
Sample size 124
3 groups, no control
Tested at 24–28 weeks
Non-fasting screening test:
Group 1: 50 g glucose polymer
Group 2: standard 50 g glucose solution
Group 3: milk chocolate bar 50 g
Blood test at 1 h
Diagnostic test:
3 hour 100 g GTT
Serum glucose response, side effects and women’s subjective acceptance of the polymer or a candy bar (3 Musketeers, Mars) to the standard d- glucose solution5/108 or 4.6% diagnosed with GD.
Glucose ≥ 7.5 mmol/litre
Sens:
overall 60% standard
glucose 33.3%
polymer 100%
Spec:
overall 84% standard
glucose 73.6%
polymer 92.8%
PPV:
overall 16% standard
glucose 9% polymer
49%
The polymer is an inexpensive and well tolerated but the use of candy bar needs further research.Randomised trial with no controlII
Court, 1985845Pregnant women
Sample size:
100 women randomised to glucose screening test (48) and glucose polymer test (52) glucose polymer test given to additional 178 women so total 230 women received polymer test.
100 g glucose screening test and 100 g glucose polymer screening test,
No cut-off value used, Diagnostic test: 3 hour 100 g OGTT
Improvement of screening of GD with the use of glucose polymer rather than glucose12/230 or 5.2% diagnosed with GD
8 mmol/litre or 144 mg/100 ml,
For glucose polymer
Sens:
89%
Spec:
81%
PPV:
29%
The glucose polymer is preferable to glucose for CHO loading in pregnancy because of lower rates of nausea, better reproducibility of test results.RCTII
Reichelt, 1998498Inclusion criteria: women aged
≥ 20 years, with no diagnosis
of DM and between 21 and
28 weeks on enrolment
Sample size 5,579, 5,010 remaining in the study
FPG
Diagnostic test given to all, 2 hour 75 g OGTT
Diagnostic value379/5,010 or 7.6% diagnosed with GD
At cut-off value of 81 mg/100 ml or 4.5 mmol/litre
Sens: 94%
Spec: 51%
PPV: 0.6
NPV: 100

At cut-off value of 85 mg/100 ml or 4.7 mmol/litre
Sens: 94%
Spec: 66%
PPV: 0.9
NPV: 100

At cut-off value of 89 mg/100 ml or 4.9 mmol/litre
Sens: 88%
Spec: 78%
PPV: 1.3
NPV: 100
FPG is a useful screening test for GD, a threshold of 4.94 mmol/litre or 89 mg/100 ml maximises sensitivity and specificity.Cohort studyII
Fadl, 2006846Pregnant women
Sample size 3616
Fasting plasma glucose
Diagnostic test given to all 2 hour 75 g OGTT
between 28–32 weeks
Diagnostic value55/3616 or 1.52% diagnosed with GD
FPG Cut-off values between 4.0 and 5.0 mmol/litre,
Sensitivity 87% to 47%
Specificity 51% and 96%.
LR+ and LR − best at ≥5.0 mmol/litre.
Fasting plasma glucose was found to be an acceptable and useful screening test for gestational diabetesCross-sectional population based studyII
Lamar, 1999847Pregnant women
Women with diabetes mellitus
were excluded
Sample size 160, 136 completed the study
Jelly beans vs standard glucose (randomisation done),
Blood glucose ≥7.78 mmol/litre (140 mg/100 ml)
3 hour 100 g fasting GTT used as diagnostic test
Diagnostic value using jelly beans5/136 or 3.7% diagnosed with GD
Using cut-off 7.78 mmol/litre (140 mg/100 ml),
standard glucose:
Sens: 80% Spec: 82% PPV: 15% NPV: 99%
Jelly beans:
Sens: 40% Spec: 85% PPV: 9%
NPV: 97%
There is no significant difference in screening performance for jelly beans and the standard glucose.
Patients report fewer side effects after a jelly bean challenge than after a 50 g glucose beverage test.
So jelly beans may be used an alternative to the 50 g glucose beverage test.
Prospective studyII
Boyd, 1995848Pregnant women
Exclusion criteria:
Insulin dependent diabetics, women with a history of insulin usage for GD in a prior pregnancy and previously diagnosed gestational diabetics
Sample size 157
Cola beverage vs Jelly beans,
Diagnostic test given to all participants
3 hour 100 g GTT used as diagnostic test
Diagnostic value using jelly beans13/157 or 8.3% diagnosed with GD
Using cut-off 7.78 mmol/litre (140 mg/100 ml for cola beverage
Sens: 46%
Spec: 81%
PPV: 18%

Using cut-off 6.67 mmol/litre (120 mg/100 ml) for jelly beans
Sens: 54%
Spec: 81%
PPV: 20%
Patient tolerance was greater for jelly beans as compared with the 50 g cola beverage.
Jelly beans may serve as an alternative to a cola beverage containing 50 g of glucose.
Prospective studyII
Griffin, 2000832Pregnant women
Risk factor group has one or more risk factors for GD
The risk factor group had a 3 hour 100 g OGTT at 32 weeks if any risk factor for GD was present. The universal group had a 50 g GCT and if their plasma glucose at 1 hour was ≥ 7.8 mmol/litre, a formal 3 hour 100 g OGTT was then performed.Spontaneous vaginal delivery, macrosomia, caesarean section, prematurity, pre-eclampsia and admission to neonatal intensive care unitUniversal screening detected a GD prevalence of 2.7%, significantly 1.45% more than in the risk factor screened group.
Universal screening group had higher rates of spontaneous vaginal delivery at term, lower rates of macrosomia, caesarean section, prematurity, pre- eclampsia and admission to neonatal intensive care unit.
Universal screening for GD was found to be superior to risk factor based screening as it detected more cases, facilitated early diagnosis and is associated with improved pregnancy outcomes.RCT2+
Schytte, 2004833Pregnant women who accepted screening for GD
Sample size
1392
Capillary fasting blood glucose measurements between 20 and 32 weeks of gestation
If levels ≥ 4.1 mmol/litre and < 6.7 mmol/litre a 3 hour 75 g OGTT was offered
Clinical outcome of pregnant women in relation to separate components of the pre-screening procedure, presence of GD and the capillary blood glucose 120 minutes after glucose load (cBG120 min) concentration after a 75 g glucose loadScreening cFBG of 4.1 mmol/litre unable to predict GD and adverse outcome
Best predictor of complicated delivery was a high BMI.
Best predictor of fetal adverse outcome was cBG120 min ≥ 9.0 mmol/litre after a 75 g glucose load Identical fraction complications were present in GD and non-GD.
Screening procedure for GD needs to be refinedRetrospective study2−
Weijers, 2006834Pregnant women Sample size 2031The following data were collected for all women: age and gestational age at entry into the study; pre-pregnancy 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 hour glucose challenge test and 100 g 3 hour oral glucose tolerance test (diagnostic OGTT)Diagnostic value of antepartum clinical characteristics11/168 or 6.6% of women developed early postpartum diabetes. Family history of diabetes showed association with early postpartum diabetes. ROC curve analysis identified all three glucose challenge-test parameters, including fasting glucose concentration, as poor diagnostic tests, with a PPV of 22%, whereas PPV associated with the area under the diagnostic OGTT curve increased progressively over monitoring time from 20.6% to 100%. Using a 3 hour OGTT glucose area threshold of 35.7 mmol·h/l resulted in 100% sensitivity and 100% specificity, identifying the 11 women who developed early postpartum diabetes.Early postpartum diabetes is rare in GD women (6.5%), and that the clinical usefulness of the total area under the diagnostic 3 hour OGTT is superior to all other glycemic parameters for detecting early postpartum diabetes.Cross-sectional study2−
Rajab, 1998849Pregnant women
Sample size
3400
Screening test used was blood glucose 1 hour after 50 g glucose load (GCT) given in fasting state between 28 and 32 weeks. If blood glucose was ≥ 7.7 mmol/litre then 3 hour GTT was givenPregnancy outcomes were compared for the following groups:
  1. GCT > 7.7 and < 8.3 mmol/litre (194 women)
  2. GCT ≥ 8.3 mmol/litre (194 women)
  3. GCT < 7.7 mmol/litre (194 women matched for age, parity and weight with group B)
197/3400 or 5.8% of women were considered to have abnormal GTT plus 199/3400 or 5.8% had impaired glucose tolerance. There was no significant difference in pregnancy-induced hypertension between groups. Preterm delivery was significantly more in group B. Birthweight > 4.5 kg was 4% in group C, 6% in group A and 9% in group B. The APGAR > 6 at 1 minute found no significant differences between groups.Study was on a small scale but it suggests that it is possible to raise the cut-off level requiring full GTT from 7.7 to 8.3 mmol/litre without a serious adverse effect on pregnancy outcomeProspective cohort study2+
Yogev, 2005850Pregnant women
Sample size
6854
A 50 g GCT was performed at 24–28 weeks of gestation and a screening value of ≥ 7.22 mmol/litre (130 mg/100 ml) was followed by a 100 g OGTTWomen were categorised by pre- pregnancy BMI and by different GCT thresholds. Maternal outcome was defined by rate of pre-eclampsia, gestational age at delivery, cesarean section (CS) rate and the need for labor induction. Neonatal outcome was defined by fetal size (macrosomia/LGA), arterial cord pH, respiratory complications and neonatal intensive care unit (NICU) admission.A positive GCT result (GCT ≥ 7.22 mmol/litre (130 mg/100 ml)) was identified in 2541/6854 or 37% of women. 464/6854 or 6.8% of women were diagnosed with GD. In both groups of screening results (> 7.22 mmol/litre (130 mg/100 ml) and < 7.22 mmol/litre (130 mg/100 ml)), the obese women were significantly older, gained more weight during pregnancy and had a lower rate of nulliparity in comparison with the non obese women. The obese women had higher rates of macrosomia, LGA and induction of labor. No difference was found in mean birthweight, the total rate of cesarean section, preterm delivery, 5 minute Apgar score ≤ 7, mean arterial cord pH, NICU admission and a need for respiratory support in comparison with non obese women in both groups of screening results. A gradual increase in the rate of macrosomia, LGA and cesarean section was identified in both obese and non-obese women in relation to increasing GCT severity categories.Fetal size and cesarean section are associated with the degree of carbohydrate intolerance. Obesity remains the main contributor impacting fetal size.Prospective cohort study2+
Dietrich, 1987851Middle-class, healthy, Caucasian pregnant women
Sample size 2000
Screening test involved a 50 g GCT followed by a 3 hour OGTT if necessaryCompared the value of routine versus selective diabetes screening1. Those to undergo routine screening between 24 and 28 weeks of gestation
2. Those to be tested selectively in the presence of standard risk factors.
Incidence of GD in the selectively screened group was twice (19/453, 4.2%) that in routinely screened group (21/1000, 2.1%). Glucose intolerance without a risk factor was found in only one case (1/1000, 0.1%) in the routinely screened group.This assessment has allowed clinical practice to safely eliminate the need for diabetes screening in more than half of their private patients, which reduces office time, patient inconvenience, and expense.Prospective study2+
Sun, 1995852Pregnant women, no history of diabetes mellitus before pregnancy
Sample size 622
50 g GCT and a 75 g OGTT was performed if screening tests value was ≥ 7.78 mmol/litreRelationship between the 50 g GCT and pregnancy outcomes103/622 or 16.56% of women underwent the diagnostic test, among whom, 32 were identified as having gestational impaired glucose tolerance (GIGT) and 12 as GD. The sensitivity of 50 gGCT was 42.72% (44/103). The incidences of edema-proteinuria- hypertension syndrome (EPH-syndrome), premature rupture of membranes, fetal macrosomia, operative deliveries and perinatal morbidity were higher in women with GIGT/GD than in women without GIGT/GD.50 gGCT is an ideal method of screening for GD and should be performed on all pregnant women.Prospective randomised study2+
Rumbold, 2002853Total of 158 women participated in the study whereas 51 women participated after being screenedThey tested the hypothesis that women with a positive result on the screen test will experience a reduction in quality of life, their health and that of their baby when compared with women with a normal screening resultWomen’s experiences of being screened for GD
A Spielberger State-Trait Anxiety Inventory, Edinburgh Postnatal Depression Scale and Short Form 36 Item Health Survey were used to study the main outcome measures: anxiety, depression, health status, concerns about the health of the baby and perceived health
No differences in the levels of anxiety, depression or the women’s concerns about the health of their babies. When positively screened women for GD were compared with negatively screened women, the positively screened group had significantly lower health perceptions, were significantly less likely to rate their health as ‘much better than one year ago’ and were significantly more likely to rate their health as ‘fair’ rather than ‘very good’ or ‘excellent’.There is a negative impact on the health perceptions in women screened positive for GD.Prospective survey2−
Kerbel, 1997854Women between 12 and 14 weeks of gestation with no previous history of diabetes mellitus or GD were included 809 women completed questionnaires at baseline, 32 weeks, and 36 weeks of gestation50 g glucose challenge testWhether false positive results of 50 g glucose challenge test for GD are associated with adverse psychological effects.At 32 weeks, 20% of women with false positive GCT results significantly perceived their health as excellent as compared to 38% of women with negative results or not tested. These results were sustained at 36 weeks. The study showed no significant association between false positive test result and anxiety levels, depression or woman’s concern for health of baby. These results were neither significant between baseline and 32 weeks nor at 36 weeks.False positive screening for GD is associated with a decreased perception of maternal health persisting at 36 weeks of gestation and this should be taken into account when setting a policy of screening all pregnant women for GD.Prospective cohort study2+
Naylor, 1997855Pregnant women Sample size 31313131 women randomly divided into two groups – a derivation group and a validation group. The screening strategies were derived from the derivation group data which were then tested in the validation group by comparing the effectiveness and efficiency with those of usual care. The strategies used were; no screening for low-risk women, usual care for intermediate-risk women, and universal screening with lower thresholds – plasma glucose values of 130 mg per deciliter (7.2 mmol per liter) or 128 mg per deciliter (7.1 mmol per liter) – for high-risk women.Using clinical characteristics for assessing women’s risks of gestational diabetes could enhance the efficiency of screeningThere was a 34.6% reduction (95% CI 32.3 to 37.0) in the number of screening tests performed after using the new strategies. The detection rate of gestational diabetes with new strategies was 81.2 to 82.6 % compared with the 78.3% detected through usual care. There was a significant reduction in the percentage of false positive screening tests from 17.9 % with usual care to 16.0 % or 15.4 % (P< 0.001) with the new strategies, depending on the threshold values for high-risk women.The consideration of women’s clinical characteristics allows efficient selective screening for gestational diabetes.Prospective study2+
Scott, 2002483Risk factors for gestational diabetes included obesity, advanced maternal age advanced maternal age, family history of diabetes, minority ethnic background, increased weight gain in early adulthood and current smoker.Systematic review2+
Dornhorst, 1992829frequency of gestational diabetes according age, BMI, parity and ethnic origin in women without known pre-existing diabetes mellitus and to analyse the influence of risk factors separately for each ethnic group170/11 205 (1.5%) women were diagnosed with gestational diabetes. Women with gestational diabetes were significantly older (32.3 versus 28.3 years; P < 0.001) had higher BMI (27.7 versus 23.8; P < 0.001) and more likely to be from an ethnic minority (55.4% versus 15.3%; P < 0.0001). Rates of gestational diabetes by ethnicity were: white 0.4% (26/6135), Black 1.5% (29/1977); South East Asian 3.5% (20/572); Indian 4.4% (54/1218). After adjusting for age, BMI and parity the RR (with white as the reference category) was as follows: Black 3.1 (95% CI 1.8 – 5.5); South East Asian 7.6 (95% CI 4.1 – 14.1); Indian 11.3 (95% CI 6.8–18.8).Retrospective study2−
Moses, 1995830the proportion of women with gestational diabetes missed if testing was confined to risk factorsWomen without GD were significantly younger (26.4:28.1, P < 0.02) and had a lower BMI (24.2:25.9, P < 0.05) than women with GD. 31 women (39.2%) with GD had no historical risk factors and would have been missed if only selective testing undertaken.Observational study3
Ostlund, 2003835Traditional risk factors used were family history of diabetes (first-degree relative), obesity (≥ 90 kg), prior large for gestational age baby (≥ 4500 g) or prior GDWomen who did not take the OGTT were more likely to be multiparous and of non-nordic origin but were less likely to have a family history of diabetes, prior macrosomic baby or prior gestational diabetes. 1.7% of women who were given OGTT were diagnosed with gestational diabetes. The risk factors with the strongest association were prior gestational diabetes (12/61, OR 23.6, 95% CI 11.6–48.0) and prior macrosomic baby (9/61, OR 5.59, 95% CI 2.68–11.7). Other risk factors were family history of diabetes (13/61, OR 2.74, CI 1.47–5.11) non-nordic origin (13/61, OR 2.19, 95% CI 1.18–4.08) weight (≥ 90 kg: 8/61, OR 3.33, 95% CI 1.56–7.13) BMI (≥ 30: 11/61, OR 2.65, 95% CI 1.36–5.14) and age (≥ 25: 55/61, OR 3.37, 95% CI 1.45–7.85).Prospective population-based study2+
Kim, 200783613 studies were includedRecurrence rates and risk factors for gestational diabetesThe recurrence rate of glucose intolerance during subsequent pregnancies varied markedly across studies. The most consistent predictor of future recurrence appeared to be nonwhite race/ethnicity, although the racial breakdowns within a study were not always clearly described. The recurrence rates varied between 30 and 84% after the index pregnancy. The recurrence rates were higher in the minority populations (52–69%) as compared to lower rates found in non-Hispanic white populations (30–37%). No other risk factors were consistently associated with recurrence of GD across studies. Other risk factors, such as maternal age, parity, BMI, OGTT levels, and insulin use inconsistently predicted development of recurrent GD across studies.Systematic review2++

From: Evidence tables

Cover of Antenatal Care
Antenatal Care: Routine Care for the Healthy Pregnant Woman.
NICE Clinical Guidelines, No. 62.
National Collaborating Centre for Women's and Children's Health (UK).
London: RCOG Press; 2008 Mar.
Copyright © 2008, National Collaborating Centre for Women’s and Children’s Health.

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