Glucose screening in Mexican-American women

OBJECTIVE: We sought to describe the predictive value for gestational diabetes mellitus (GDM) using different glucose challenge test thresholds in Mexican-American women. METHODS: A prospective population-based study of 6,857 gravid women, who were tested with a 50-g glucose challenge test at 24-28 weeks of gestation, was performed. A screening value of 130 mg/dL or greater was followed by a 3-hour, 100-g oral glucose tolerance test. Gestational diabetes mellitus was diagnosed by 2 or more abnormal values using the Carpenter and Coustan criteria. For purpose of analysis, GDM diagnosis was categorized with glucose challenge test values in 10-mg/dL increments. A comparison between Carpenter-Coustan and the National Diabetic Data Group criteria for GDM diagnosis was performed for each glucose challenge test threshold category. Sensitivity and specificity for GDM diagnosis were further calculated for different glucose challenge test thresholds (130, 135, and 140 mg/dL). RESULTS: Overall, GDM was diagnosed in 469 of 6,857 (6.8%) women, and one abnormal oral glucose tolerance test value was tested in 351 of 6,857 women (5.1%). Normal glucose challenge test results (threshold less than 130 mg/dL) were obtained in 4,316 of 6,857 women. An elevated glucose challenge test value increases the risk of GDM, but even in high glucose challenge test thresholds (more than 180 mg/dL), the predictive value for GDM was only 50%. The sensitivity and specificity for GDM diagnosis using 3 different glucose challenge test thresholds were as follows: threshold 130 mg/dL or more: 97% and 63%; threshold 135 mg/dL or more: 91% and 73%; and threshold 140 mg/dL or more: 85% and 78%, respectively. CONCLUSION: Data suggests that an elevated glucose challenge test level cannot be used as a single diagnostic tool for GDM even in high test thresholds. A threshold of 130 mg/dL may be recommended as a screening threshold for GDM in Mexican-American women.