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Screening tests for gestational diabetes: a systematic review for the U.S. Preventive Services Task Force.
Ann Intern Med 2013; 159(2):115-22AIM

Abstract

BACKGROUND

A 50-g oral glucose challenge test (OGCT) is a widely accepted screening method for gestational diabetes mellitus (GDM), but other options are being considered.

PURPOSE

To systematically review the test characteristics of various screening methods for GDM across a range of recommended diagnostic glucose thresholds.

DATA SOURCES

15 electronic databases from 1995 to May 2012, reference lists, Web sites of relevant organizations, and gray literature.

STUDY SELECTION

Two reviewers independently identified English-language prospective studies that compared any screening test for GDM with any reference standard.

DATA EXTRACTION

One reviewer extracted and a second reviewer verified data from 51 cohort studies. Two reviewers independently assessed methodological quality.

DATA SYNTHESIS

The sensitivity, specificity, and positive and negative likelihood ratios for the OGCT at a threshold of 7.8 mmol/L (140 mg/dL) were 70% to 88%, 69% to 89%, 2.6 to 6.5, and 0.16 to 0.33, respectively. At a threshold of 7.2 mmol/L (130 mg/dL), the test characteristics were 88% to 99%, 66% to 77%, 2.7 to 4.2, and 0.02 to 0.14, respectively. For a fasting plasma glucose threshold of 4.7 mmol/L (85 mg/dL), they were 87%, 52%, 1.8, and 0.25, respectively. Glycated hemoglobin level had poorer test characteristics than fasting plasma glucose level or the OGCT. No studies compared the OGCT with International Association of the Diabetes and Pregnancy Study Groups (IADPSG) diagnostic criteria.

LIMITATIONS

The lack of a gold standard for confirming GDM limits comparisons. Few data exist for screening tests before 24 weeks' gestation.

CONCLUSION

The OGCT and fasting plasma glucose level (at a threshold of 4.7 mmol/L [85 mg/dL]) by 24 weeks' gestation are good at identifying women who do not have GDM. The OGCT is better at identifying women who have GDM. The OGCT has not been validated for the IADPSG diagnostic criteria.

Authors+Show Affiliations

University of Calgary, Calgary, Canada. lois.donovan@albertahealthservices.caNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, U.S. Gov't, P.H.S.
Review
Systematic Review

Language

eng

PubMed ID

23712349

Citation

Donovan, Lois, et al. "Screening Tests for Gestational Diabetes: a Systematic Review for the U.S. Preventive Services Task Force." Annals of Internal Medicine, vol. 159, no. 2, 2013, pp. 115-22.
Donovan L, Hartling L, Muise M, et al. Screening tests for gestational diabetes: a systematic review for the U.S. Preventive Services Task Force. Ann Intern Med. 2013;159(2):115-22.
Donovan, L., Hartling, L., Muise, M., Guthrie, A., Vandermeer, B., & Dryden, D. M. (2013). Screening tests for gestational diabetes: a systematic review for the U.S. Preventive Services Task Force. Annals of Internal Medicine, 159(2), pp. 115-22. doi:10.7326/0003-4819-159-2-201307160-00657.
Donovan L, et al. Screening Tests for Gestational Diabetes: a Systematic Review for the U.S. Preventive Services Task Force. Ann Intern Med. 2013 Jul 16;159(2):115-22. PubMed PMID: 23712349.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Screening tests for gestational diabetes: a systematic review for the U.S. Preventive Services Task Force. AU - Donovan,Lois, AU - Hartling,Lisa, AU - Muise,Melanie, AU - Guthrie,Alyssa, AU - Vandermeer,Ben, AU - Dryden,Donna M, PY - 2013/5/29/entrez PY - 2013/5/29/pubmed PY - 2013/12/16/medline SP - 115 EP - 22 JF - Annals of internal medicine JO - Ann. Intern. Med. VL - 159 IS - 2 N2 - BACKGROUND: A 50-g oral glucose challenge test (OGCT) is a widely accepted screening method for gestational diabetes mellitus (GDM), but other options are being considered. PURPOSE: To systematically review the test characteristics of various screening methods for GDM across a range of recommended diagnostic glucose thresholds. DATA SOURCES: 15 electronic databases from 1995 to May 2012, reference lists, Web sites of relevant organizations, and gray literature. STUDY SELECTION: Two reviewers independently identified English-language prospective studies that compared any screening test for GDM with any reference standard. DATA EXTRACTION: One reviewer extracted and a second reviewer verified data from 51 cohort studies. Two reviewers independently assessed methodological quality. DATA SYNTHESIS: The sensitivity, specificity, and positive and negative likelihood ratios for the OGCT at a threshold of 7.8 mmol/L (140 mg/dL) were 70% to 88%, 69% to 89%, 2.6 to 6.5, and 0.16 to 0.33, respectively. At a threshold of 7.2 mmol/L (130 mg/dL), the test characteristics were 88% to 99%, 66% to 77%, 2.7 to 4.2, and 0.02 to 0.14, respectively. For a fasting plasma glucose threshold of 4.7 mmol/L (85 mg/dL), they were 87%, 52%, 1.8, and 0.25, respectively. Glycated hemoglobin level had poorer test characteristics than fasting plasma glucose level or the OGCT. No studies compared the OGCT with International Association of the Diabetes and Pregnancy Study Groups (IADPSG) diagnostic criteria. LIMITATIONS: The lack of a gold standard for confirming GDM limits comparisons. Few data exist for screening tests before 24 weeks' gestation. CONCLUSION: The OGCT and fasting plasma glucose level (at a threshold of 4.7 mmol/L [85 mg/dL]) by 24 weeks' gestation are good at identifying women who do not have GDM. The OGCT is better at identifying women who have GDM. The OGCT has not been validated for the IADPSG diagnostic criteria. SN - 1539-3704 UR - https://www.unboundmedicine.com/medline/citation/23712349/full_citation L2 - https://www.annals.org/article.aspx?doi=10.7326/0003-4819-159-2-201307160-00657 DB - PRIME DP - Unbound Medicine ER -