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Screening for gestational diabetes mellitus: the Sri Lankan experience

Authors:

CN Wijeyaratne ,

Professor in Reproductive Medicine, Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Colombo, LK
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S Ginige,

Senior Registrar in Community Medicine, Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Colombo, LK
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A Arasalingam,

Demonstrators in Obstetrics and Gynaecology, Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Colombo, LK
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C Egodage,

Demonstrators in Obstetrics and Gynaecology, Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Colombo, LK
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L Wijewardhena

Professor, Department of Community Medicine, Faculty of Medical Sciences, University of Sri Jayawardhenapura, LK
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Abstract

Objective To evaluate tests used for screening and confirmation of gestational diabetes mellitus (GDM) in Sri Lanka.

Methods Field based: Consecutive pregnant women in Homagama DDHS area (n = 853), were assessed for risk factors and subjected to random and postprandial urinary Benedict's and Dipstick® tests, fasting and 2 hour post 75 g glucose capillary blood glucose (FBG and 2 hBG) which were validated against 75 g oral glucose tolerance test (OGTT) performed at 24-28 weeks (WHO criteria).

Hospital based: Retrospective analysis of consecutive high-risk women (n = 999) and prospective study of randomly selected GDM women (n = 66) to assess predictive value of the OGTT.

Results Field based: Sensitivity and specificity respectively of random urine Benedict's, 10%, 99.2%; postprandial urine Benedict's, 52.2%, 94.5%; postprandial urine Dipstick®, 68.7%, 90%; capillary FBG threshold 4.1 mmol/l, 62.6%, 73%; capillary 2 hBG threshold 7.2 mmol/l, 98.5%, 95.2%; risk factors, 93.1%, 22.2%.

Hospital based: OGTT-11.6% lag curves, 16.3% abnormal, FPG accuracy at 4.7 mmol/l; predictive value of 2hPG≥8.9 mmol/l for insulin treatment-sensitivity 97.2%, specificity 71.4%.

Conclusions Current practice of random urine testing in community screening for gestational diabetes is unreliable, and glucose specific postprandial urine test improves sensitivity. FPG is unsuitable for screening, the 2 hour post 75 g blood glucose at a threshold of >7.2 mmol/l is sensitive and specific. In laboratory confirmation using 75 g OGTT the fasting plasma glucose has low predictive value, 2 hour test performed alone is liable to false positives and 2 hour glucose >8.9 mmol/l following a peak at 1 hour suggests the need for insulin treatment.  

Keywords: Commuity Screening; OGTT cut-off values

doi: 10.4038/cmj.v51i2.1353

Ceylon Medical Journal Vol.51(2) 2006 53-58

DOI: https://doi.org/10.4038/cmj.v51i2.1353
How to Cite: Wijeyaratne, C., Ginige, S., Arasalingam, A., Egodage, C. and Wijewardhena, L., 2009. Screening for gestational diabetes mellitus: the Sri Lankan experience. Ceylon Medical Journal, 51(2), pp.53–58. DOI: http://doi.org/10.4038/cmj.v51i2.1353
Published on 07 Dec 2009.
Peer Reviewed

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