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Glucose challenge test for detecting gestational diabetes mellitus: a systematic review
Author(s) -
van Leeuwen M,
Louwerse MD,
Opmeer BC,
Limpens J,
Serlie MJ,
Reitsma JB,
Mol BWJ
Publication year - 2012
Publication title -
bjog: an international journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.157
H-Index - 164
eISSN - 1471-0528
pISSN - 1470-0328
DOI - 10.1111/j.1471-0528.2011.03254.x
Subject(s) - gestational diabetes , medicine , confidence interval , diabetes mellitus , receiver operating characteristic , likelihood ratios in diagnostic testing , gestation , glucose tolerance test , gastroenterology , obstetrics , pregnancy , insulin resistance , endocrinology , biology , genetics
Please cite this paper as: van Leeuwen M, Louwerse M, Opmeer B, Limpens J, Serlie M, Reitsma J, Mol B. Glucose challenge test for detecting gestational diabetes mellitus: a systematic review. BJOG 2012;119:393–401. Background The best strategy to identify women with gestational diabetes mellitus (GDM) is unclear. Objectives To perform a systematic review to calculate summary estimates of the sensitivity and specificity of the 50‐g glucose challenge test for GDM. Search strategy Systematic search of MEDLINE, EMBASE and Web of Science. Selection criteria Articles that compared the 50‐g glucose challenge test with the oral glucose tolerance test (OGTT, with a 75‐ or 100‐g reference standard) before 32 weeks of gestation. Data collection and analysis Summary estimates of sensitivity and specificity, with 95% confidence intervals and summary receiver operating characteristic curves, were calculated using bivariate random‐effects models. Two reviewers independently selected articles that compared the 50 g glucose challenge test to the oral glucose tolerance test (OGTT, 75 or 100 gram, reference standard) before 32 weeks of gestation. Main results Twenty‐six studies were included (13 564 women). Studies that included women with risk factors showed a pooled sensitivity of the 50‐g glucose challenge test of 0.74 (95% CI 0.62–0.87), a pooled specificity of 0.77 (95% CI 0.66–0.89) (threshold value of 7.8 mmol/l), a derived positive likelihood ratio (LR) of 3.2 (95% CI 2.0–5.2) and a negative LR of 0.34 (95% CI 0.22–0.53). In studies with consecutive recruitment, the pooled sensitivity was 0.74 (95% CI 0.62–0.87) for a specificity of 0.85 (95% CI 0.80–0.91), with a derived positive LR of 4.9 (95% CI 3.5–7.0) and negative LR of 0.31 (95% CI 0.20–0.47). Increasing the threshold for disease (OGTT result) increased the sensitivity of the challenge test, and decreased the specificity. Author’s conclusions The 50‐g glucose challenge test is acceptable to screen for GDM, but cannot replace the OGTT. Further possibilities of combining the 50‐g glucose challenge test with other screening strategies should be explored.