Impact of Time since Last Meal on the False Positive Result of 50 grams Glucose Challenge Test in the Pregnancy with Gestational Diabetes Mellitus Risk: A prospective cohort study

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Suphawan Pattamathamakul
Srisuda Songthamwat
Ueamporn Summart
Angkana Hansri
Metha Songthamwat

Abstract

Objectives: To study the impact of time since last meal to the rate of false positive 50 grams glucose challenge test (GCT) during pregnancy with gestational diabetes mellitus (GDM) risk.
Materials and Methods: This prospective observational study was conducted in a tertiary care from December 2019 to August 2020. The participants were the singleton who had risks of GDM. The screening test was done using 50 grams GCT and then 100 grams oral glucose tolerance test (OGTT) used for diagnosis of GDM if GCT was ≥ 140 mg/dL. The participants’ information, time and type of last meal, time of 50 grams glucose intake and blood drawing, result of GCT and OGTT were recorded. The time since last meal was categorized to < 1, < 2 and < 3 hours. Bivariate and multivariable regression analysis were applied to evaluate the effect of time since last meal to GCT.
Results: There were 426 pregnant women completed study: 30.75% had positive GCT and 19% of these were diagnosis for GDM. The time since last meal < 1, < 2, and < 3 hours group had 36.0, 29.8, and 25.8 % false-positive CGT compared with 20.8, 18.2, 20.3% of ≥ 1, ≥ 2, and ≥ 3 hours group. The adjusted risk ratio (95% confidence interval) were 1.60 (1.14-2.24), 1.53 (1.06-2.22) and 1.23 (0.75-2.04) and p value were 0.006, 0.023, and 0.397, respectively.
Conclusion: The interval between the last meal and GCT less than 2 hours significantly increased a false positive rate of the test.

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References

American College of Obstetricians and Gynecologists. Committee on Practice Bulletin No. 190: Gestational Diabetes Mellitus. Obstet Gynecol 2018;131:e49-e64.

Cunningham FG, Leveno KJ, Bloom SL, Dashe JS, Hoffman BL, Casey BM, et al. Williams Obstetrics. 25th ed. McGraw-Hill education, New York 2018:1097-1114.

Serirat S, Deerochanawong C, Sunthornthepvarakul T, Jinayon P. Gestational diabetes mellitus. Thai J Obstet Gynaecol 1992;75:315-9.

Boriboonhirunsarn D, Sunsaneevithayakul P, Nuchangrid M. Incidence of gestational diabetes mellitus diagnosed before 20 weeks of gestation. Thai J Obstet Gynaecol 2004;87:1017-21.

Chanprapaph P, Sutjarit C. Prevalence of gestational diabetes mellitus (GDM) in women screened by glucose challenge test (GCT) at Maharaj Nakorn Chiang Mai Hospital. J Med Assoc Thai 2004;87:1141-6.

Sunsaneevithayakul P, Boriboohirunsarn D, Sutanthavibul A, Ruangvutilert P, Kanokpongsakdi S, Singkiratana D, et al. Risk factor-based selective screening program for gestational diabetes mellitus in Siriraj Hospital: result from clinical practice guideline. Thai J Obstet Gynaecol 2003;86:708-14.

Arora D, Arora R, Sangthong S, Leelaporn W, Sangratanathongchai J. Universal screening of gestational diabetes mellitus: prevalence and diagnostic value of clinical risk factors. J Med Assoc Thai 2013;96:266-71.

DeSisto CL, Kim SY, Sharma AJ. Prevalence estimates of gestational diabetes mellitus in the United States, Pregnancy Risk Assessment Monitoring System (PRAMS), 2007-2010. Prev Chronic Dis 2014;11:E104.

Saccone G, Khalifeh A, Al-Kouatly HB, Sendek K, Berghella V. Screening for gestational diabetes mellitus: one step versus two step approach. A meta-analysis of randomized trials. J Matern Fetal Neonatal Med 2020;33:1616-24.

Li-zhen L, Yun X, Xiao-Dong Z, Shu-bin H, Zi-lian W, Adrian Sandra D, et al. Evaluation of guidelines on the screening and diagnosis of gestational diabetes mellitus: systematic review. BMJ Open 2019;9:e023014.

Farrar D, Duley L, Dowswell T, Lawlor DA. Different strategies for diagnosing gestational diabetes to improve maternal and infant health. Cochrane Database Syst Rev 2017;8:Cd007122.

Palatnik A, Swanson K, Churchill T, Bilski A, Grobman WA, Miller ES. Association between type of screening for gestational diabetes mellitus and cesarean delivery. Thai J Obstet Gynaecol 2017;130:539.

Grotegut CA, Tatineni H, Dandolu V, Whiteman VE, Katari S, Geifman-Holtzman O. Obstetric outcomes with a false-positive one-hour glucose challenge test by the Carpenter-Coustan criteria. J Matern Fetal Neonatal Med 2008;21:315-20.

Kim C, Newton KM, Knopp RH. Gestational diabetes and the incidence of type 2 diabetes: a systematic review. Diabetes Care 2002;25:1862-8.

England LJ, Dietz PM, Njoroge T, Callaghan WM, Bruce C, Buus RM, et al. Preventing type 2 diabetes: public health implications for women with a history of gestational diabetes mellitus. Am J Obstet Gynecol 2009;200:365.e1-.e8.

Sivaraman SC, Vinnamala S, Jenkins D. Gestational diabetes and future risk of diabetes. J Clin Med Res 2013;5:92.

Figueroa D, Landon MB, Mele L, Spong CY, Ramin SM, Casey B, et al. Relationship between 1-hour glucose challenge test results and perinatal outcomes. Obstet Gynecol 2013;121:1241-7.

Kemal Akpak Y, Gün I, Kaya N, Atay V. A comparison of pregnant subgroups with positive 50-gram glucose challenge test results to those with negative results in terms of obstetric and perinatal outcomes. Med Glas (Zenica) 2012;9:262-7.

Stamilio DM, Olsen T, Ratcliffe S, Sehdev HM, Macones GA. False-positive 1-hour glucose challenge test and adverse perinatal outcomes. Obstet Gynecol 2004;103:148-56.

Thananyai A, Panchalee T, Borriboonhiransan D. Prevalence of false positive 50-g glucose challenge test in risk-based ccreening before 20 weeks of gestation and relationship with adverse pregnancy outcomes. Thai J Obstet Gynaecol 2020;28:34-43.

Moebus S, Göres L, Lösch C, Jöckel K-H. Impact of time since last caloric intake on blood glucose levels. Eur J Epidemiol 2011;26:719-28.

Poirier P, Tremblay A, Catellier C, Tancrède G, Garneau C, Nadeau A. Impact of time interval from the last meal on glucose response to exercise in subjects with type 2 diabetes. J Clin Endocrinol Metab 2000;85:2860-4.

Reynolds AN, Venn BJ. The timing of activity after eating affects the glycaemic response of healthy adults: A randomised controlled trial. Nutrients 2018;10:1743.

Meng H, Matthan NR, Ausman LM, Lichtenstein AH. Effect of prior meal macronutrient composition on postprandial glycemic responses and glycemic index and glycemic load value determinations. Am J Clin Nutr 2017;106:1246-56.

Sermer M, Naylor CD, Gare DJ, Kenshole AB, Ritchie J, Farine D, et al. Impact of time since last meal on the gestational glucose challenge test: the Toronto Tri-Hospital Gestational Diabetes Project. Am J Obstet Gynecol 1994;171:607-16.

Cetin M, Cetin A. Time-dependent gestational diabetes screening values. Int J Gynaecol Obstet 1997;56:257-61.

Goldberg RJ, Ye C, Sermer M, Connelly PW, Hanley AJ, Zinman B, et al. Circadian variation in the response to the glucose challenge test in pregnancy: implications for screening for gestational diabetes mellitus. Diabetes Care 2012;35:1578-84.

Wang P, Lu M-C, Yu C-W, Yan Y-H. Influence of the time of day and fasting duration on glucose level following a 1-hour, 50-gram glucose challenge test in pregnant women. PloS one 2014;9:e112526.

The Royal Thai College of Obstetricians and Gynaecologists. Diabetes mellitus screening in pregnancy. In: Clinical Practice Guidelines. RTCOG 2017;1.170-84.

Medical complications in elderly gravida. Srinagarind Med J 2007;22:39-42.

Kimberley E. How many calories are in a low calorie meal? In: The spruce eats; 2019.

Ferrara A, Hedderson MM, Quesenberry CP, Selby JV. Prevalence of gestational diabetes mellitus detected by the national diabetes data group or the carpenter and coustan plasma glucose thresholds. Diabetes Care 2002;25:1625-30.

Cheng YW, Block-Kurbisch I, Caughey AB. Carpenter-Coustan criteria compared with the national diabetes data group thresholds for gestational diabetes mellitus. Obstet Gynecol 2009;114:326-32.

Behboudi-Gandevani S, Amiri M, Yarandi RB, Tehrani FR. The impact of diagnostic criteria for gestational diabetes on its prevalence: a systematic review and meta-analysis. Diabetol Metab Syndr 2019;11:11.

Gumus II, Turhan NO. Are patients with positive screening but negative diagnostic test for gestational diabetes under risk for adverse pregnancy outcome? J Obstet Gynaecol Res 2008;34:359-63.

Lu M-C, Huang S-S, Yan Y-H, Wang P. Use of the National Diabetes Data Group and the Carpenter-Coustan criteria for assessing gestational diabetes mellitus and risk of adverse pregnancy outcome. BMC Pregnancy Childbirth 2016;16:231.

Wong VW, Garden F, Jalaludin B. Hyperglycaemia following glucose challenge test during pregnancy: When can a screening test become diagnostic? Diabetes Res Clin Pract 2009;83:394-6.

McElduff A, Hitchman R. Screening for gestational diabetes: the time of day is important. Med J Aust 2002;176:136.

Southgate KM. The effect of a low glycemic index diet on glucose challenge test results in women at risk for gestational diabetes mellitus. University of Toronto 2012:1-124.