Lois Donovan, MD; Lisa Hartling, PhD; Melanie Muise, MA; Alyssa Guthrie, MSSc; Ben Vandermeer, MSc; Donna M. Dryden, PhD
Disclaimer: The findings and conclusions in this document are those of the authors, who are responsible for its content, and do not necessarily represent the views of AHRQ. No statement in this report should be construed as an official position of AHRQ or the U.S. Department of Health and Human Services.
Acknowledgment: The authors thank the following individuals for their contributions to this project: Tamara Durec (searching), Andrea Milne (searching and technical support), Teodora Radisic (article retrieval), Jocelyn Shulhan (screening), Annabritt Chisholm (research support and reference management), and Noah Toppings (Table 1).
Financial Support: By AHRQ (contract 290-2007-10021-I).
Potential Conflicts of Interest: Dr. Donovan: Grant (money to institution): AHRQ, International Diabetes Federation, Eli Lilly. Ms. Muise: Grant (money to institution): AHRQ. Mr. Vandermeer: Grant (money to institution): AHRQ. All other authors have no disclosures. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M13-0188.
Requests for Single Reprints: Lois Donovan, MD, Richmond Road Diagnostic and Treatment Centre, 1820 Richmond Road SW, Calgary, Alberta T2T 5C7, Canada; e-mail, firstname.lastname@example.org.
Current Author Addresses: Dr. Donovan: Richmond Road Diagnostic and Treatment Centre, 1820 Richmond Road SW, Calgary, Alberta T2T 5C7, Canada.
Dr. Hartling: University of Alberta, ECHA 4-472, 11405-87 Avenue, Edmonton, Alberta T6G 1C9, Canada.
Ms. Muise: University of Alberta, Department of Pediatrics, 4-482C Edmonton Clinic Health Academy, 11405-87 Avenue, Edmonton, Alberta T6G 1C9, Canada.
Ms. Guthrie: Alberta Health, 18th Floor, Telus Plaza North Tower, 10025 Jasper Avenue, Edmonton, Alberta T5J 1S6, Canada.
Mr. Vandermeer: University of Alberta, Edmonton Clinic Health Academy, Room 4-496B, 11405-87 Avenue, Edmonton, Alberta T6G 1C9, Canada.
Dr. Dryden: University of Alberta, Department of Pediatrics, 4-474 ECHA, 11405-87 Avenue, Edmonton, Alberta T6G 1C9, Canada.
Author Contributions: Conception and design: L. Donovan, L. Hartling, D.M. Dryden.
Analysis and interpretation of the data: L. Donovan, L. Hartling, M. Muise, A. Guthrie, B. Vandermeer, D.M. Dryden.
Drafting of the article: L. Donovan, L. Hartling, M. Muise, A. Guthrie, D.M. Dryden.
Critical revision of the article for important intellectual content: L. Donovan, L. Hartling, M. Muise, A. Guthrie, B. Vandermeer, D.M. Dryden.
Final approval of the article: L. Donovan, L. Hartling, M. Muise, B. Vandermeer, D.M. Dryden.
Statistical expertise: B. Vandermeer.
Obtaining of funding: L. Donovan, L. Hartling, D.M. Dryden.
Administrative, technical, or logistic support: L. Hartling, A. Guthrie, D.M. Dryden.
Collection and assembly of data: L. Hartling, M. Muise, A. Guthrie, D.M. Dryden.
Donovan L, Hartling L, Muise M, Guthrie A, Vandermeer B, Dryden DM. Screening Tests for Gestational Diabetes: A Systematic Review for the U.S. Preventive Services Task Force. Ann Intern Med. 2013;159:115-122. doi: 10.7326/0003-4819-159-2-201307160-00657
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Published: Ann Intern Med. 2013;159(2):115-122.
A 50-g oral glucose challenge test (OGCT) is a widely accepted screening method for gestational diabetes mellitus (GDM), but other options are being considered.
To systematically review the test characteristics of various screening methods for GDM across a range of recommended diagnostic glucose thresholds.
15 electronic databases from 1995 to May 2012, reference lists, Web sites of relevant organizations, and gray literature.
Two reviewers independently identified English-language prospective studies that compared any screening test for GDM with any reference standard.
One reviewer extracted and a second reviewer verified data from 51 cohort studies. Two reviewers independently assessed methodological quality.
The sensitivity, specificity, and positive and negative likelihood ratios for the OGCT at a threshold of 7.8 mmol/L (140 mg/dL) were 70% to 88%, 69% to 89%, 2.6 to 6.5, and 0.16 to 0.33, respectively. At a threshold of 7.2 mmol/L (130 mg/dL), the test characteristics were 88% to 99%, 66% to 77%, 2.7 to 4.2, and 0.02 to 0.14, respectively. For a fasting plasma glucose threshold of 4.7 mmol/L (85 mg/dL), they were 87%, 52%, 1.8, and 0.25, respectively. Glycated hemoglobin level had poorer test characteristics than fasting plasma glucose level or the OGCT. No studies compared the OGCT with International Association of the Diabetes and Pregnancy Study Groups (IADPSG) diagnostic criteria.
The lack of a gold standard for confirming GDM limits comparisons. Few data exist for screening tests before 24 weeks’ gestation.
The OGCT and fasting plasma glucose level (at a threshold of 4.7 mmol/L [85 mg/dL]) by 24 weeks’ gestation are good at identifying women who do not have GDM. The OGCT is better at identifying women who have GDM. The OGCT has not been validated for the IADPSG diagnostic criteria.
Agency for Healthcare Research and Quality.
Table 1. Comparison of Diagnostic Thresholds for Gestational Diabetes Mellitus
Appendix Table 1. MEDLINE Search Strategy
Summary of evidence search and selection.
KQ = key question.
* This systematic review was part of a larger technical report. The search was done to identify relevant studies for all objectives of the full report, which is available at http://effectivehealthcare.ahrq.gov/index.cfm/search-for-guides-reviews-and-reports/?productid=1295&pageaction=displayproduct.
QUADAS-2 risk of bias and applicability assessment, by domain.
QUADAS-2 = Quality Assessment of Diagnostic Accuracy Studies 2.
Table 2. Diagnostic Characteristics of Screening Tests for Gestational Diabetes Mellitus
HSROC for the 50-g OGCT at thresholds of 7.8 mmol/L (140 mg/dL) and 7.2 mmol/L (130 mg/dL), with Carpenter–Coustan criteria used to confirm GDM.
The HSROC with the 95% confidence ellipse graphically compares the sensitivity and specificity for all studies comparing a particular screening test with GDM diagnostic criteria. CC = Carpenter–Coustan; GDM = gestational diabetes mellitus; HSROC = hierarchical summary receiver-operating characteristic curve; OGCT = oral glucose challenge test.
Appendix Table 2. Diagnostic Characteristics of Other Screening Tests for Gestational Diabetes Mellitus
Forest plot of sensitivity and specificity of risk factor screening for gestational diabetes, by diagnostic criteria (Carpenter–Coustan, American Diabetes Association [2000–2010], National Diabetes Data Group, and World Health Organization).
Threshold values were author-defined. FN = false-negative; FP = false-positive; TN = true-negative; TP = true-positive.
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