Use of fasting plasma glucose to determine the approach for diagnosing gestational diabetes mellitus
Open accessAbstract
Aims Estimate the impact of OGTTs only on women with a screening FPG of 4.5-5.0 mmol/L using data from HAPO. Methods HAPO participants had 75-g OGTTs (24-32 weeks' gestation). At follow-up, children had adiposity assessed (overweight/obesity, obesity) and mothers and children had OGTTs. GDM was defined retrospectively using IADPSG criteria. Odds for neonatal (birthweight, percent neonatal fat, sum of skinfolds, cord C-peptide > 90th percentiles) and follow-up outcomes were assessed in those with HAPO FPG ≤ 4.4 or > 4.4 mmol/L and GDM or no GDM focusing on women with FPG > 4.4 and no GDM (Group 3) vs women with GDM and FPG ≤ 4.4 (Group 2). Results This strategy would miss a diagnosis of GDM in 14.7%. Odds for neonatal outcomes in Groups 2 and 3 were not different (ORs: 1.14 to 1.29). Odds at follow-up for type 2 diabetes and disorders of glucose metabolism in mothers were higher in Group 2 (ORs: 3.51, 2.57). Odds for childhood impaired glucose tolerance or adiposity outcomes were not different for Groups 2 and 3. Conclusions HAPO mothers whose GDM diagnosis would be missed were not at greater risk for adverse neonatal and childhood outcomes than mothers with FPG of 4.5-5.0 without GDM.
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Further analysis from HAPO showed that women with FPG ≤ 4.4 mmol/L but meeting the one-hour or two-hour glucose criteria for gestational diabetes mellitus, compared with women with FPG > 4.4 mmol/L who did not meet any IADPSG glucose thresholds for gestational diabetes mellitus, had children with similar neonatal outcomes, childhood impaired glucose tolerance, and adiposity.
“Further analysis from HAPO showed that women with FPG ≤ 4.4 mmol/L but meeting the one‐hour or two‐hour glucose criteria for gestational diabetes mellitus, compared with women with FPG > 4.4 mmol/L who did not meet any IADPSG glucose thresholds for gestational diabetes mellitus, had children with similar neonatal outcomes, childhood impaired glucose tolerance, and adiposity.”
Women with FPG ≤ 4.4 mmol/L but meeting the one-hour or two-hour glucose criteria for gestational diabetes mellitus had higher rates of type 2 diabetes at ten to 14 years' follow-up (aOR, 3.51; 95% CI, 1.41-8.75) compared with women with FPG > 4.4 mmol/L who did not meet any IADPSG glucose thresholds.
“However, women in the former group had higher rates of type 2 diabetes at ten to 14 years’ follow‐up (aOR, 3.51; 95% CI, 1.41–8.75). 34”
Cites
Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study
The HAPO Study Cooperative Research Group (2009) · Diabetes · doi:10.2337/db08-1112 · Cited by 702 · see citing works
Lowe, W. L., Scholtens, D. M., Kuang, A., Linder, B., Lawrence, J. M., Lebenthal, Y., McCance, D., Hamilton, J., Nodzenski, M., Talbot, O., et al. (2019) · Diabetes Care · doi:10.2337/dc18-1646 · Cited by 574 · see citing works
Self-citationon behalf of the HAPO Follow-up Study Cooperative Research Group, Lowe, W. L., Lowe, L. P., Kuang, A., Catalano, P. M., Nodzenski, M., Talbot, O., Tam, W.-H., Sacks, D. A., McCance, D., et al. (2019) · Diabetologia · doi:10.1007/s00125-018-4809-6 · Cited by 294 · see citing works
Self-citationHyperglycemia and Adverse Pregnancy Outcome (HAPO) study: preeclampsia
(2010) · American Journal of Obstetrics and Gynecology · doi:10.1016/j.ajog.2010.01.024 · Cited by 155 · see citing works
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Sweeting, A., Hare, M. J., de Jersey, S. J., Shub, A. L., Zinga, J., Foged, C., Hall, R. M., Wong, T., & Simmons, D. (2025) · Medical Journal of Australia · doi:10.5694/mja2.52696 · Cited by 26 · see citing works
- Authors
- Metzger, B. E., Kuang, A., Lowe, W. L., Scholtens, D. M., Lowe, L. P., & Dyer, A. R.
- Affiliations
- Northwestern University (US)
- Corresponding author
- Metzger, Boyd E.
- Venue
- Diabetes Research and Clinical Practice
- Publisher
- Elsevier BV
- Published
- 2023-11
- Volume
- 205
- Pages
- 110952
- ISSN
- 0168-8227 (ISSN-L)
- PMC
- PMC10842388
- OpenAlex
- W4387566275
- Cited by
- 4
- References
- 4
- Citations by year
- 2026: 1 · 2025: 3
- FWCI
- 1.25
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- www.elsevier.com/tdm/userlicense/1.0/ (tdm)
- www.elsevier.com/legal/tdmrep-license (tdm)
- www.elsevier.com/open-access/userlicense/1.0/ (am, 351 d)
- doi.org/10.15223/policy-017 (stm-asf)
- doi.org/10.15223/policy-037 (stm-asf)
- doi.org/10.15223/policy-012 (stm-asf)
- doi.org/10.15223/policy-029 (stm-asf)
- doi.org/10.15223/policy-004 (stm-asf)
- Locations
- Diabetes Research and Clinical Practice (acceptedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health
- National Institute of Diabetes and Digestive and Kidney Diseases
- National Center for Advancing Translational Sciences (UL1TR001422)
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (1U01DK094830, R01-HD-34243, R01-HD-34242)
- Topics
- Health Sciences › Medicine › Obstetrics and Gynecology › Gestational Diabetes Research and Management
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Keywords
- gestational diabetes mellitus, fasting blood glucose, oral glucose tolerance test, GDM screening, missed diagnosis, neonatal outcomes, childhood adiposity, type 2 diabetes risk, impaired glucose tolerance, HAPO study, IADPSG criteria
- MeSH terms
- Blood Glucose, Child, Diabetes Mellitus, Type 2, Fasting, Female, Humans, Infant, Newborn, Obesity, Pregnancy, Retrospective Studies, Diabetes, Gestational
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