COMPARISON OF SINGLE-STEP VERSUS TWO-STEP TEST FOR SCREENING AND DIAGNOSIS OF GDM AND FETO-MATERNAL OUTCOME

Pratima Agarwal, Dr Navin Kumar, P. Sujatha

Abstract


OBJECTIVE 

To evaluate the effectiveness and predictive value of single step Diabetes in Pregnancy Study Group India (DIPSI) test in comparison to two step 100gram oral glucose tolerance test (OGTT) for screening and diagnosis of Gestational Diabetes Mellitus (GDM).

METHODS

Total 245 singleton pregnant women between gestation age 24 to 28 weeks attended antenatal clinic of RGGWCH, Puducherry were included for this prospective comparative study. They were divided into low and high risk groups. All women included in the study underwent DIPSI test followed by 100gmOGTT after one week irrespective of DIPSI test result. They were followed throughout pregnancy till delivery and perinatal outcomes were noted.

RESULT- The prevalence of GDM in low and high risk group was 4.08%(CI:1.12-10.12) and 10.20%(CI:5.46-14.17) respectively.The overall prevalence was 7.76%(CI:4.73-11.85). Age >25years, BMI >25, PCOS and high and middle socioeconomic status had significant correlation with occurrence of GDM. In comparison to 100gm-OGTT, DIPSI test had sensitivity of 100%(CI:82.35-100), Specificity-92.04%(CI:87.70-95.21), PPV-51.35%(CI:34.40-68.08), NPV-100%(CI:98.24-100), PLR-12.56(CI:8.06-19.56), NLR-zero and Area under ROC curve (AUC) -0.96(CI:0.93-0.98) in our study. DIPSI test had not only picked up those entire tested positive for GDM by 100gm OGTT, but also proved sensitive enough to pick up twice as more GDM cases in ethnic Indian women, who have high prevalence of diabetes. There were favourable feto-maternal outcomes, in terms of mode of delivery, birth weight and neonatal complications.

 CONCLUSION

Single step DIPSI test was found to be inexpensive, simple, feasible, patient friendly does not require fasting state and reliable method for universal screening of pregnant women in developing countries like India.


Keywords


DIPSI, GDM, OGTT, Risk factors

Full Text:

PDF

References


Kayal A, Anjana RM, Mohan V. Gestational diabetes—an update from India. Diabetes Voice. 2013; 58(2): 30–4

Magon N. Chauhan M. Diagnosing GDM: Role of Simple, Cost Effective, and Sensitive DIPSI Test

J Obstet Gynecol India. 2014; 64 (4): 299-300

Agarwal MM. Gestational diabetes mellitus: An update on the current international diagnostic criteria.World J Diabetes. 2015;6:782–91. Epub 2015 Jun 25

Mishra S, Rao CR, Shetty A, Trends in the Diagnosis of Gestational Diabetes Mellitus. Scientifica (Cairo) 2016, Article ID 5489015. doi:10.1155/2016/5489015 Epub 2016 Apr 12

Gupta Y, Kalra B, Baruah MP, Singla R, Kalra S. Updated guidelines on screening for gestational diabetes. International Journal of Women’s Health. 2015;7:539-550. doi:10.2147/IJWH.S82046. Epub 2015 May 19

Abu-Heija A, Al-Bash M, Ishrat,N, Al-Kharausi L. J Obstet Gynecol India (2016) 66(Suppl 1): 7.

Mishra S: fogsi.org/screening-for-gestational-diabetes/ Updated 29-06-2015. Accessed 06.08.2017

Singh A, Kujur A. Single-Step First Trimester Screening “Sooner the Better” J Obstet Gynecol India 2016; 66 (S 1): 77

Kalra P, Kachhwaha CP, Singh HV.Prevalence of gestational diabetes mellitus and its outcome in western Rajasthan. Indian Journal of Endocrinology and Metabolism. 2013; 17(4): 677-80. doi:10.4103/2230-8210.113760. Epub 2013 Jun 20

Nielson KK, Damm P, Kapur A, Balaji V, Balaji MS, Seshiah V, et al. (2016) Risk Factors for Hyperglycaemia in Pregnancy in Tamil Nadu, India. PLoS ONE 11(3): e0151311. doi:10.1371/journal.pone.0151311 Epub 2016 Mar 18

Nilofer AR, Raju VS, Dakshayini BR, Zaki SA.Screening in high-risk group of gestational diabetes mellitus with its maternal and fetal outcomes. Indian Journal of Endocrinology and Metabolism . 2012;16(Suppl1):S74-S78. doi:10.4103/2230-8210.94268. Epub 2012 Mar 24

Bhatt AA, Dhore PB, Purandare VB, Sayyad MG, Mandal MK, Unnikrishnan AG.Gestational diabetes mellitus in rural population of Western India-Results of a community survey. Indian J Endocr Metab 2015; 19: 507-10

Seshiah V, Banerjee S, Balaji V, Muruganathan A, Das AK.; Consensus evidence-based guidelines for management of gestational diabetes mellitus in India. J Assoc Physicians India. 2014; 62(Suppl7): S55–62.

Yu, Hai-Feng MS; Chen, Hong-Su MS; Rao, Da-Pang MS; Gong, Jian MS. Association between polycystic ovary syndrome and the risk of pregnancy complications: A PRISMA-compliant systematic review and meta-analysis. Medicine.2016;2016:e4863. doi: 10.1097/MD.0000000000004863. Epub 2016 Dec

Rajput R, Yadav Y, Nanda S, Rajput M. Prevalence of gestational diabetes mellitus & associated risk factors at a tertiary care hospital in Haryana. Indian J Med Res. 2013; 137(4): 728–33

Cullinan J, Gillespie P, Owens L, Avalos G, Dunne FP, Atlantic DIP collaborations. Is there a socioeconomic gradient in the prevalence of GDM? Ir Med J. May 2012; 105 (S 5): 21-3

Sharma K, Wahi P, Gupta A, Jandial K, Bhagat R, Gupta R, Gupta S, Singh J. Single Glucose Challenge Test Procedure for Diagnosis of Gestational Diabetes Mellitus: A Jammu Cohort Study. J Assoc Physicians India 2013; 61: 558-9

Veerasamy S, Kapur A Balaji V, Divakar H.A perspective on testing for gestational diabetes mellitus. Indian J Endocr Metab 2015; 19: 529-32 doi: 10.4103/2230-8210.159064 Epub 2017 Feb 12

Sharma A, Gupta M, Agrawal A.Comparison of diagnostic accuracy of two one step procedures for screening of gestational diabetes mellitus.Int J Reprod Contracept Obstet Gynecol 2015; 4: 81-5. DOI: 10.5455/2320-1770.ijrcog20150216 Epub 2015 Feb


Refbacks

  • There are currently no refbacks.