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<strong>KCE</strong> reports vol. 6A Prenatale zorg 172 Study Ref Population Intervention hour, GTT for glucose Outcomes Results Comments Study type EL levels > 135 mg/dl from 50-g test Specificity 98.5% Watson, 4 [493] 500 consecutive Urinanalysis compared GDM 22/500 (4.4%) diagnosed with GDM CH 2b 1990 patients at an with 50g, 1 hour, GCT antenatal clinic in at 28 weeks gestation Glycosuria 85/500 (17%) showed some degree of glycosuria Germany followed by 100 g, 3 (defined as present at at least two antenatal visits) hour, OGTT for Sensitivity and glucose levels >140 mg/dl from 50g test specificity 6/22 (27%) of women with GDM showed glycosuria Sensitivity 27.3% McElduff et al., 1994 Jowett et al., 1987 Reichelt et al., 1998 4 [496] 714 women attending antenatal clinic in New South Wales, Australia 4 [497] 110 pregnant women with suspected GDM in England 4 [498] 5010 pregnant women in Brazil RPG (random plasma glucose) measured within two hours of a meal (º 6.1 mmol/l considered positive) compared with 1-hour, 50-g GCT at 28 weeks GDM diagnoses confirmed by 100-g GTT RPG levels tested over 24hour period (08:00, 12:00, 15:00, 17:00, 22:00 hours) and 75-g GTT administered FPG (fasting plasma glucose) at 24 to 28 GDM Sensitivity and specificity of RPG Sensitivities and specificities at various thresholds and at various times of day of RPG test GDM Specificity 83.5% 28/714 (3.9%) with GDM Sensitivity 46% Specificity 86% At threshold 5.6 mmol/l: sensitivity range 29% to 80%; specificity range 74% to 80% At threshold 6.1 mmol/l: sensitivity range 41% to 58%, specificity range 74% to 96% Highest sensitivities reported at 15:00 hours 379/5010 (7.6%, 95% CI 6.8 to 8.3) women with GDM Period of fasting not CH 2b TES 3 CH 2b
<strong>KCE</strong> reports vol. 6A Prenatale zorg 173 Study Ref Population Intervention Outcomes Results Comments Study type EL from 1991 to weeks of gestation was Optimal threshold specified 1995 with no compared with 2-hour, for maximising At 89 mg/dl (4.9 mmol/l), sensitivity and specificity prior diagnosis of 75-g GTT (used for sensitivity and maximised at 88% and 78%, respectively diabetes diagnosis) specificity of FPG Perucchini 4 [499] 520 women in FPG compared with 1- GDM 53/520 (10.2%) women with GDM Results CH 2b et al., Switzerland from hour, 50-g GCT were 1999 1995 to 1997 between 24 and 28 Optimal threshold At 4.8 mmol/l, sensitivity and specificity for FPG irrespective weeks of gestation for maximising maximised at 81% and 76%, respectively, (155/520 of last time sensitivity and (30%) of women would have had to proceed to GTT women had One week later, all specificity of FPG for diagnosis) eaten patients also took 3- and 1hour, 50-g hour, 100-g GTT GCT At 7.0 mmol/l, sensitivity and specificity maximised at 68% and 82%, respectively Lewis et 4 [500] 10 women with Between 26 and 32 Plasma glucose Cases: fasting = 10.5 mM plasma glucose, 1-hour = TES 2b al., 1993 GDM and 12 weeks of gestation, levels after each test 11.0 mM plasma glucose, 2-hour = 9.3 mM plasma controls from each person underwent for women with glucose (p < 0.03) Chicago, USA 3 GCT tests within a 2- GDM vs. controls week period (order of Controls: fasting = 7.8 mM plasma glucose, 1-hour = tests was randomised 6.7 mM plasma glucose (p < 0.01), 2-hour = 6.4 mM for each person) plasma glucose Stamilio et al., 2004 87 1825 eligible patients at the University of Test 1: 50-g GCT in fasting state Test 2: 50-g GCT 1 hour after a meal Test 3: 50-g GCT 2 hours after a meal Comparison of a negative GCT and a false-positive GCT 7/12 (58%) controls with glucose º 7.8 mM in fasting state Perinatal outcomes The false-positive GCT cohort had more frequently adverse perinatal outcome, including: A falsepositive GCT was CH 2b
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NATIONALE RICHTLIJN PRENATALE ZORG:
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Nationale richtlijn prenatale zorg:
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KCE reports 1. Effectiviteit en kos
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