Underestimation of risk for large babies in rural and remote Australia: Time to change plasma glucose collection protocols
Aims: Preanalytical glycolysis in oral glucose tolerance tests (OGTT) leads to substantial underestimation of gestational diabetes mellitus (GDM) and hence risk for large-for-gestational-age (LGA) babies. This paper quantified the impact of glycolysis on identification of LGA risk in a prospective r...
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2021-03-01
|
| Series: | Journal of Clinical & Translational Endocrinology |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2214623720301010 |
| _version_ | 1818615103230050304 |
|---|---|
| author | Emma L. Jamieson Erica P. Spry Andrew B. Kirke Carly Roxburgh David N. Atkinson Julia V. Marley |
| author_facet | Emma L. Jamieson Erica P. Spry Andrew B. Kirke Carly Roxburgh David N. Atkinson Julia V. Marley |
| author_sort | Emma L. Jamieson |
| collection | DOAJ |
| description | Aims: Preanalytical glycolysis in oral glucose tolerance tests (OGTT) leads to substantial underestimation of gestational diabetes mellitus (GDM) and hence risk for large-for-gestational-age (LGA) babies. This paper quantified the impact of glycolysis on identification of LGA risk in a prospective rural and remote Australian cohort. Methods: For 495 women, OGTT results from room temperature fluoride-oxalate (FLOX) tubes were algorithmically corrected for estimated glycolysis compared to 1) the Hyperglycaemia and Adverse Pregnancy Outcomes (HAPO) study protocol (FLOX tubes in ice-slurry); and 2) room temperature fluoride-citrate (FC) tubes. GDM was defined by International Association of the Diabetes and Pregnancy Study Groups (IADPSG) criteria. Unadjusted and corrected OGTT were related to LGA outcome. Results: Correction for FC tubes increased GDM incidence from 9.7% to 44.6%. After correction for HAPO protocol, GDM incidence was 27.7% and prediction of LGA risk (RR 1.82, [1.11–2.99]) improved compared to unadjusted rates (RR 1.12, [0.51–2.47]). To provide similar results for FC tube correction (29.3% GDM; RR 1.81, [1.11–2.96]) required + 0.2 mmol/L adjustment of IADPSG criteria. Conclusions: FC tubes present a practical alternative to the HAPO protocol in remote settings but give + 0.2 mmol/L higher glucose readings. Modification of IADPSG criteria would reduce perceived ‘overdiagnosis’ and improve LGA risk-assessment. |
| first_indexed | 2024-12-16T16:28:35Z |
| format | Article |
| id | doaj.art-4b0ff7fa797b4abaa6d48e2a4ccd3b56 |
| institution | Directory Open Access Journal |
| issn | 2214-6237 |
| language | English |
| last_indexed | 2024-12-16T16:28:35Z |
| publishDate | 2021-03-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of Clinical & Translational Endocrinology |
| spelling | doaj.art-4b0ff7fa797b4abaa6d48e2a4ccd3b562022-12-21T22:24:39ZengElsevierJournal of Clinical & Translational Endocrinology2214-62372021-03-0123100247Underestimation of risk for large babies in rural and remote Australia: Time to change plasma glucose collection protocolsEmma L. Jamieson0Erica P. Spry1Andrew B. Kirke2Carly Roxburgh3David N. Atkinson4Julia V. Marley5The 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; Corresponding author at: The Rural Clinical School of WA, PO Box 412, Bunbury 6230, Western Australia.Kimberley Aboriginal Medical Services, 12 Napier Terrace, Broome 6725, Australia; The University of Western Australia, The Rural Clinical School of Western Australia, 12 Napier Terrace, PO Box 1377, Broome 6725, AustraliaThe University of Western Australia, The Rural Clinical School of Western Australia, Building 3 Edith Cowan University Campus, Robertson Drive, PO Box 412, Bunbury 6230, AustraliaThe University of Western Australia, The Rural Clinical School of Western Australia, 35 Stirling Terrace, Albany 6330, AustraliaThe University of Western Australia, The Rural Clinical School of Western Australia, 12 Napier Terrace, PO Box 1377, Broome 6725, AustraliaKimberley Aboriginal Medical Services, 12 Napier Terrace, Broome 6725, Australia; The University of Western Australia, The Rural Clinical School of Western Australia, 12 Napier Terrace, PO Box 1377, Broome 6725, AustraliaAims: Preanalytical glycolysis in oral glucose tolerance tests (OGTT) leads to substantial underestimation of gestational diabetes mellitus (GDM) and hence risk for large-for-gestational-age (LGA) babies. This paper quantified the impact of glycolysis on identification of LGA risk in a prospective rural and remote Australian cohort. Methods: For 495 women, OGTT results from room temperature fluoride-oxalate (FLOX) tubes were algorithmically corrected for estimated glycolysis compared to 1) the Hyperglycaemia and Adverse Pregnancy Outcomes (HAPO) study protocol (FLOX tubes in ice-slurry); and 2) room temperature fluoride-citrate (FC) tubes. GDM was defined by International Association of the Diabetes and Pregnancy Study Groups (IADPSG) criteria. Unadjusted and corrected OGTT were related to LGA outcome. Results: Correction for FC tubes increased GDM incidence from 9.7% to 44.6%. After correction for HAPO protocol, GDM incidence was 27.7% and prediction of LGA risk (RR 1.82, [1.11–2.99]) improved compared to unadjusted rates (RR 1.12, [0.51–2.47]). To provide similar results for FC tube correction (29.3% GDM; RR 1.81, [1.11–2.96]) required + 0.2 mmol/L adjustment of IADPSG criteria. Conclusions: FC tubes present a practical alternative to the HAPO protocol in remote settings but give + 0.2 mmol/L higher glucose readings. Modification of IADPSG criteria would reduce perceived ‘overdiagnosis’ and improve LGA risk-assessment.http://www.sciencedirect.com/science/article/pii/S2214623720301010Gestational diabetesGlycolysisDiagnosticsRural and remote healthIndigenous healthPregnancy outcomes |
| spellingShingle | Emma L. Jamieson Erica P. Spry Andrew B. Kirke Carly Roxburgh David N. Atkinson Julia V. Marley Underestimation of risk for large babies in rural and remote Australia: Time to change plasma glucose collection protocols Journal of Clinical & Translational Endocrinology Gestational diabetes Glycolysis Diagnostics Rural and remote health Indigenous health Pregnancy outcomes |
| title | Underestimation of risk for large babies in rural and remote Australia: Time to change plasma glucose collection protocols |
| title_full | Underestimation of risk for large babies in rural and remote Australia: Time to change plasma glucose collection protocols |
| title_fullStr | Underestimation of risk for large babies in rural and remote Australia: Time to change plasma glucose collection protocols |
| title_full_unstemmed | Underestimation of risk for large babies in rural and remote Australia: Time to change plasma glucose collection protocols |
| title_short | Underestimation of risk for large babies in rural and remote Australia: Time to change plasma glucose collection protocols |
| title_sort | underestimation of risk for large babies in rural and remote australia time to change plasma glucose collection protocols |
| topic | Gestational diabetes Glycolysis Diagnostics Rural and remote health Indigenous health Pregnancy outcomes |
| url | http://www.sciencedirect.com/science/article/pii/S2214623720301010 |
| work_keys_str_mv | AT emmaljamieson underestimationofriskforlargebabiesinruralandremoteaustraliatimetochangeplasmaglucosecollectionprotocols AT ericapspry underestimationofriskforlargebabiesinruralandremoteaustraliatimetochangeplasmaglucosecollectionprotocols AT andrewbkirke underestimationofriskforlargebabiesinruralandremoteaustraliatimetochangeplasmaglucosecollectionprotocols AT carlyroxburgh underestimationofriskforlargebabiesinruralandremoteaustraliatimetochangeplasmaglucosecollectionprotocols AT davidnatkinson underestimationofriskforlargebabiesinruralandremoteaustraliatimetochangeplasmaglucosecollectionprotocols AT juliavmarley underestimationofriskforlargebabiesinruralandremoteaustraliatimetochangeplasmaglucosecollectionprotocols |