TITLE:
Analysing the Diagnostic Potency of Oral Glucose Tolerance Test at 20 Weeks of Gestation in High-Risk Pregnancies
AUTHORS:
Madugalle Edirisinghe Mudiyanselage Yasassri Devinda Bandara Madugalle, Rathnayake Mudiyanselage Chathura Rathnayake, Tharunya Rajayohan, Dhanushka Srikantha Kotigala, Susil Anura Ruwanpathirana
KEYWORDS:
Gestational Diabetes Mellitus (GDM), High-Risk Pregnancies, Early Diagnosis of GDM, GDM at 20 Weeks, Oral Glucose Tolerance Test (OGTT)
JOURNAL NAME:
Open Journal of Obstetrics and Gynecology,
Vol.14 No.12,
December
25,
2024
ABSTRACT: Background: Gestational Diabetes Mellitus (GDM) poses significant risks to both mothers and fetuses, with an escalating global prevalence. This study addresses the critical need for timely GDM detection in high-risk pregnancies. By comparing the efficacy of the standard 28-week oral glucose tolerance test with an early 20-week screening, the research aims to enhance preventive interventions and minimise complications, contributing valuable insights for optimal GDM management in high-risk populations. Methodology: Conducted at Teaching Hospital Peradeniya, Sri Lanka, this prospective cohort study investigated early GDM diagnosis using a 20-week OGTT in high-risk pregnancies with negative booking screens. The research involved 385 singleton pregnancies, assessing risk factors like GDM history, family history of diabetes, macrosomia, BMI > 30 kg/m2, polycystic ovary syndrome, and advanced maternal age. The study included evaluating GDM incidence at 20 and 28 weeks, analysing risk factor associations, and determining the efficacy of early OGTT compared to routine testing. The data analysis aimed to establish the significance of a 20-week OGTT, identify the main contributory risk factors, and propose an optimal timing for GDM screening in high-risk pregnancies. Results: In the study involving 385 high-risk pregnant women, the incidence of gestational diabetes mellitus (GDM) was 7.27% at 20 weeks, 10.91% at 28 weeks, and 81.82% without GDM. Significant associations were found between GDM at 20 weeks, a history of GDM (78.57%), and a family history of diabetes (28.57%) (p = 0.011, 0.010 respectively). Notably, the McNemar test revealed no significant association between GDM cases at 20 and 28 weeks. Discussion and Conclusion: This study emphasises early diagnosis of GDM and evaluates outcomes of screening at 20 weeks in high-risk pregnancies. Effective GDM management mitigates short-term complications but raises concern about long-term impacts on offspring. Limited evidence prompts a call for further research to determine the optimal intervention window. Risk factors for early GDM include family history and prior GDM. Recommendations include refining screening protocols and conducting additional randomised trials. The study’s strengths lie in its comprehensive analysis, but limitations include its single-cohort nature. Future research should focus on personalised screening approaches and improve gestational age assessments. Overall, this study contributes to the ongoing discourse on early GDM management, highlighting the need for tailored prenatal care.