Gestational diabetes mellitus: Screening with fasting plasma glucose

Table 1 Diagnostic criteria for gestational diabetes mellitus (by country)

Organization	Use prevalent in	Year	Glucose load (g)	F mmol/L	1-h mmol/L	2-h mmol/L	3-h mmol/L	Values for diagnois
NDDG1	United States/North America	1979	100	5.8	10.6	9.2	8.1	≥ 2
ADA (C and C)	United States/North America	2003 (1982)	100	5.3	10.0	8.6	7.8	≥ 2
ADA2	United States/North America	2011	75	5.1	10.0	8.5	--	≥ 1
CDA	Canada	2013	75	5.3	10.6	9.0	--	≥ 1
EASD	Europe	1991	75	6.0	--	9.0	--	≥ 1
NICE	United Kingdom	2015	75	5.6	--	7.8	--	≥ 1
ADIPS2	Australasia	2014	75	5.1	10.0	8.5	--	≥ 1
NZSSD	New Zealand	1998	75	5.5	--	9.0	--	≥ 1
JDS2	Japan	2013	75	5.1	10.0	8.5	--	≥ 1
IADPSG	Multiple countries	2010	75	5.1	10.0	8.5	--	≥ 1
WHO2	Multiple countries	2013	75	5.1	10.0	8.5	--	≥ 1

¹Endorsed by American College of Obstetricians and Gynecologists;

²Same as IADPSG. ADA: American Diabetes Association; ADIPS: Australasian Diabetes in Pregnancy Society; CDA: Canadian Diabetes Association; C and C: Carpenter-Coustan; EASD: European Association for the Study of Diabetes; JDS: Japan Diabetes Society; NDDG: National Diabetes Data Group; NICE: National Institute for Health and Care Excellence; NZSSD: New Zealand Society for the study of diabetes; WHO: World Health Organization; IADPSG: International Association of Diabetes and Pregnancy Study Groups.

Table 2 Studies about fasting plasma glucose as a screening test

n	Cut-off mmol/L	Se (%)	Sp (%)	GDM (%)	AUC	Glucose load (g)	OG criteria1	Ref.
Without selection bias
5010	4.5	81.5	54	7.6	--	75	WHO-1985	Reichelt et al[37]
558	4.8	81	76	10.2	0.897	100	ADA	Perucchini et al[27]
942	4.1	> 70		13	0.766	75	WHO-1985	Tam et al[38]
1685	4.7	78.1	32.2	19.8	0.639	75	WHO-1999	Agarwal et al[39]
500	4.7	88	95	7.2	--	100	C and C-1982	Poomalar et al[41]
In early pregnancy
4507	4.6	80	43	6.7	0.7	75	Sacks	Sacks et al[46]
708	4.7	79.9	27.5	25.9	0.579	75	WHO-1999	Agarwal et al[47]
4876	4.4	79	46.9	2.8	0.72	100	C and C 100-g OGTT	Riskin-Mashiah et al[49]
17186	4.3	84	29	12.4	--	75	IADPSG	Zhu et al[51]
486	--	47.2	77.4	10.9	0.623	--	FPG > 5.1 mmol/L	Yeral et al[53]

¹Fasting plasma glucose (FPG) threshold with Specificity (Sp) corresponding to Sensitivity (Se) about 80%. AUC: Area under receiver operating characteristic curve; C and C: Carpenter-Coustan; ADA: American Diabetes Association; WHO: World Health Organization; IADPSG: International Association of Diabetes and Pregnancy Study Groups; OGTT: Oral glucose tolerance test; GDM: Gestational diabetes mellitus.

Table 3 Studies using fasting glucose to avoid oral glucose tolerance test

OGTTs circumvented (n, %)	Thresholds (lower and higher) mmol/L	OGTT (g)	Diagnostic criteria	Comments	Ref.
50.9	4.4 and 5.3	100	ADA (C and C)	Biased sampling: Preselected by clinical/GCT	Agarwal et al[32]
30.1	4.7 and --	75	WHO-1999	Only lower threshold used to rule out GDM	Agarwal et al[39]
63.8	4.9 and 7.0	75	ADA (C and C)	FPG screening dependent on GDM criteria	Agarwal et al[40]
68.5	4.9 and 7.0	75	ADA (C and C)	Glucometer used for FPG	Agarwal et al[60]
50.1	4.7 and 7.0	75	ADA (C and C)	Fasting capillary glucose used	Agarwal et al[57]
50.6	4.4 and 5.1	75	IADPSG	Pooled data from 4 studies	Agarwal et al[61]
50.3	4.4 and 5.1	75	IADPSG	Data from China corroborating UAE data	Zhu et al[62]
61.0	4.4 and 5.1	75	IADPSG	Data from Brazil corroborating UAE data	Trujillo et al[63]
57.0	4.4 and 5.1	75	IADPSG	Thresholds applied to HAPO Study	Agarwal et al[77]

OGTT: Oral glucose tolerance test; ADA: American Diabetes Association; WHO: World Health Organization; IADPSG: International Association of Diabetes and Pregnancy Study Groups; C and C: Carpenter-Coustan; GCT: Glucose challenge test; GDM: Gestational diabetes mellitus; FPG: Fasting plasma glucose; UAE: United Arab Emirates; HAPO: Hyperglycemia and Adverse Pregnancy Outcome.