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Underestimation of risk for large babies in rural and remote Australia: Time to change plasma glucose collection

Emma L Jamieson1, Erica P Spry2,3, Andrew B Kirke1

  • 1The University of Western Australia, The Rural Clinical School of Western Australia, Building 3 Edith Cowan University Campus, Robertson Drive, PO Box 412, Bunbury 6230, Australia.

Journal of Clinical & Translational Endocrinology
|February 1, 2021
PubMed

Insights

Preanalytical glycolysis in oral glucose tolerance tests (OGTT) significantly underestimates gestational diabetes mellitus (GDM) and large-for-gestational-age (LGA) risk. Correcting for glycolysis improves LGA risk prediction in rural Australian women.

Area of Science:

  • Obstetrics and Gynecology
  • Endocrinology
  • Clinical Chemistry

Background:

  • Preanalytical glycolysis in oral glucose tolerance tests (OGTT) can lead to underdiagnosis of gestational diabetes mellitus (GDM).
  • This underdiagnosis poses a risk for adverse pregnancy outcomes, such as large-for-gestational-age (LGA) babies.
  • Accurate glucose measurement is crucial for timely GDM identification and management.

Purpose of the Study:

  • To quantify the impact of preanalytical glycolysis on the identification of LGA risk.
  • To compare different methods of correcting for glycolysis in OGTT.
  • To evaluate the diagnostic accuracy of corrected OGTT results for GDM and LGA risk.

Main Methods:

  • Prospective cohort study of 495 women in rural and remote Australia.
  • OGTT samples collected in fluoride-oxalate (FLOX) tubes at room temperature.
  • Algorithmic correction of OGTT results for estimated glycolysis, compared to HAPO protocol (FLOX tubes in ice) and fluoride-citrate (FC) tubes.
  • GDM diagnosed using International Association of the Diabetes and Pregnancy Study Groups (IADPSG) criteria.
  • Association between unadjusted and corrected OGTT results and LGA outcome analyzed.

Main Results:

  • Correction for glycolysis using FC tubes increased GDM incidence from 9.7% to 44.6%.
  • Correction using the HAPO protocol resulted in 27.7% GDM incidence and improved LGA risk prediction (RR 1.82) compared to unadjusted rates (RR 1.12).
  • A +0.2 mmol/L adjustment to IADPSG criteria with FC tube correction yielded similar LGA risk prediction (RR 1.81).

Conclusions:

  • Fluoride-citrate (FC) tubes are a practical alternative to the HAPO protocol in remote settings, though they yield slightly higher glucose readings (+0.2 mmol/L).
  • Modifying IADPSG criteria could mitigate perceived 'overdiagnosis' of GDM.
  • Adjusted IADPSG criteria improve LGA risk assessment in women undergoing OGTT with FC tubes.
Abstract

Keywords:
DiagnosticsGestational diabetesGlycolysisIndigenous healthPregnancy outcomesRural and remote health

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