Alternative pathways to oral glucose tolerance test for Chinese pregnant women

Roxana Yin Tung Lau; Lin Wai Chan

doi:10.12809/hkjgom.24.2.368

Authors

Roxana Yin Tung Lau PYNEH
Lin Wai Chan PYNEH

DOI:

https://doi.org/10.12809/hkjgom.24.2.368

Keywords:

Diabetes, gestational, Glucose tolerance test, Infection control

Abstract

Objectives: To compare the gold standard pathway of universal second-trimester oral glucose tolerance test (OGTT) with eight alternative pathways to determine the optimal pathway that can reduce the number of OGTTs performed but still maintains high sensitivity and specificity for gestational diabetes mellitus (GDM) diagnosis in the Chinese population.

Methods: We retrospectively reviewed medical records of pregnant women who underwent an OGTT during 26+0 to 29+6 weeks of gestation between January 2021 and June 2021 at the Pamela Youde Nethersole Eastern Hospital. The gold standard pathway of universal second-trimester OGTT were compared with eight alternative pathways (which considered fasting glucose levels, a history of GDM, and/or any risk factors) in terms of the estimated percentage reduction in the number of OGTTs performed, sensitivity and specificity of detecting GDM, and estimated percentage of women with composite adverse outcomes (CAO).

Results: Of 769 women who underwent the OGTT, 96 (12.5%) had GDM. The need for an OGTT was reduced 100% in pathway 3, 87.1% in pathway 9, 84.9% in pathway 5, 80.8% in pathway 8, 78.5% in pathway 4, 46.3% in pathway 7, 41.4% in pathway 2, 4.8% in pathway 6, and 0% in pathway 1. Specificity was high (97% to 100%) for all pathways, as were negative predictive values (90% to 100%). However, sensitivity was low (20% to 59%) for all pathways, except for pathways 1 and 6 (100%). In all pathways, the estimated percentage of women with CAO was higher in true-positive groups than in false-negative groups.

Conclusion: In Chinese women, compared with the universal second-trimester OGTT, alternative pathways could reduce the number of OGTTs performed, but the detection rate of GDM was poor. Obstetricians should encourage pregnant women to undergo the OGTT to reduce maternal and neonatal complications, even in the event of pandemic. In situations when infection control measures are ineffective, pathway 3 can be considered because it detects the highest percentage of women with CAO and eliminates the need for OGTTs.

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