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Related Experiment Videos

Can glucose tolerance test predict fetal hyperinsulinism?

P A Weiss1, M Haeusler, K Tamussino

  • 1Department of Obstetrics and Gynaecology, University of Graz, Austria.

BJOG : an International Journal of Obstetrics and Gynaecology
|February 24, 2001
PubMed
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Establishing new oral glucose tolerance test cutoffs using fetal hyperinsulinism as an endpoint can improve gestational diabetes mellitus detection. A single one-hour blood glucose test may suffice for diagnosing severe cases indicated by elevated amniotic fluid insulin.

Area of Science:

  • Obstetrics and Gynecology
  • Endocrinology
  • Perinatal Medicine

Background:

  • Gestational diabetes mellitus (GDM) diagnosis relies on oral glucose tolerance tests (OGTT).
  • Fetal hyperinsulinism is a significant complication of poorly controlled GDM.
  • Current OGTT criteria may not accurately identify GDM leading to fetal hyperinsulinism.

Purpose of the Study:

  • To determine optimal OGTT cutoff levels for pregnancy.
  • To use fetal hyperinsulinism, indicated by elevated amniotic fluid insulin, as a clinical endpoint.
  • To establish a more sensitive diagnostic threshold for GDM.

Main Methods:

  • Analysis of capillary blood glucose levels at 0, 1, and 2 hours post-glucose ingestion.
  • Inclusion of 220 pregnant women with elevated amniotic fluid insulin and 220 non-diabetic controls.

Related Experiment Videos

  • Inclusion of women at 28 weeks gestation, with glucose loads of 1 g/kg or 75 g.

    • Main Results:

    • Women with elevated amniotic fluid insulin showed mean (SD) glucose levels of 5.2 (1.0), 10.5 (1.4), and 8.2 (2.0) mmol/L at 0, 1, and 2 hours, respectively.
    • The one-hour glucose measurement demonstrated the highest sensitivity for predicting elevated amniotic fluid insulin.
    • The 5th centile of one-hour blood glucose, achieving 95% detection rate, was 8.9 mmol/L (160 mg/dL).

    Conclusions:

    • Established OGTT glucose cutoff levels are often too high to detect amniotic fluid hyperinsulinism.
    • A single one-hour OGTT may be adequate for identifying fetal hyperinsulinism.
    • A proposed one-hour cutoff of 8.9 mmol/L (160 mg/dL) is suggested for diagnosing GDM associated with fetal hyperinsulinism, irrespective of glucose load or blood sample type.