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Fasting Plasma Glucose Test at the First Prenatal Visit as a Screen for Gestational Diabetes

From the Department of Obstetrics and Gynecology, Kaiser Foundation Hospital, Bellflower; Department of Research, Southern California Permanente Medical Group, Pasadena; and Departments of Internal Medicine, Obstetrics and Gynecology, and Physiology and Biophysics, University of Southern California Keck School of Medicine, Los Angeles, California.

Address reprint requests to: David A. Sacks, MD, Department of Obstetrics and Gynecology, Kaiser Foundation Hospital, 9400 East Rosecrans Avenue, Bellflower, CA 90740; E-mail: david.a.sacks{at}kp.org.

OBJECTIVE: To determine whether the fasting plasma glucose test administered at the first prenatal visit could serve as an efficient screen for gestational diabetes.

METHODS: A total of 5557 women not known to have diabetes were offered a fasting plasma glucose test at their first prenatal visit. Results less than 100 mg/dL were blinded. A glucose tolerance test was requested immediately of those whose screening test result was 100–125 mg/dL and of all women not identified as having diabetes by their 23rd gestational week.

RESULTS: A total of 4507 women (81%) complied with the protocol. Of the 302 women found to have gestational diabetes, 46 (15%) were detected before 24 weeks. A false-positive rate of 57% was found at a threshold fasting glucose concentration giving a sensitivity of 80% for the detection of gestational diabetes.

CONCLUSION: The fasting plasma glucose screening test at the first prenatal visit has good patient compliance. However, its poor specificity (high false-positive rate) makes it an inefficient screening test for gestational diabetes.

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				K. V. Smirnakis, A. Martinez, K. H. Blatman, M. Wolf, J. L. Ecker, and R. Thadhani Early Pregnancy Insulin Resistance and Subsequent Gestational Diabetes Mellitus Diabetes Care, May 1, 2005; 28(5): 1207 - 1208. [Full Text] [PDF]