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102 Gestational Diabetes Screening: Relationship of Non-Fasting Plasma Glucose and 50 Gm Glucose Challenge Test Values to Time from the Last Meal
308
January 1992
SPO Abstracts
Am J Obstet Gynecol
101 OUTCOME OF PREGNANCY IN PATIENTS WITH PREEXISTING RENAL DISEASE. TK Sorensen! TR Easterling, TJ Benedetti. University of Washington Medical Center, Seattle. Thirty pregnancies in 27 patienL~ with chronic renal diseasc were reviewed. Chronic renal disease was defined as serum creatinine 21.2 mg/dl or creatinine clearance < 90 ml/min during pregnancy or urine protein> 3 gm/24 hours. 5 patients had severe disease with scrum creatinine> 2.5. Cardiac output was measured by Doppler technique. Low birth weight «2500 gr) 63% premature «37 wks) 63% growth retarded (SGA) 44% Chronic hypertension 92% Preeclampsia 50% 40% Fetal distress Cesarean section 53% Perinaw loss (after 2nd trimester) 17% Anomalies 3% Five of 6 (82%) diabetics had markedly elevated cardiac output in contrast to an underlying hemodynamic pattern of elevated total peripheral resistance in 60% of the remaining patients; pregnancy outcomes in the diabetics were similar to the group as a whole. Three of the 5 patients with severe disease had detioriation of disease requiring dialysis during pregnancy. In conclusion, our patients did not appear to have an increased rate of fetal anomalies, but were at high risk for prematurity, growth retardation, fetal distress, operative delivery, and preeclampsia. Renal function worsened only in patients with severe disease.
102
GESTATIONAL DIABETES SCREENING: RELATIONSHIP OF NON-FASTING PLASMA GLUCOSE AND 50 GM GLUCOSE CHALLENGE TEST VALUES TO TIME
FROM THE LAST MEAl. Serrner MX, N,-tor CO)<-, Farine 0, Cohen ~, Ritchie JWK, Gare Ox, Kenshole A, McArthur K)(, Siringer AJo.;,
Holzapfel S". University of Toronto Perinatal Complex, Toronto, Ontario, Canada Backsround: Use of Non-Fasting Plasma Glucose [NFPG] as a
screening test for Gestational Diabetes [GO] has been suggested.
but variabi l ity in relation to meals is a concern. Glucose
ChaL lenge Test [GeT] has the advantage of a standard glucose load but might also be variable among non-fasting subjects. Objective: Assess influence of time since last food ingestion (to nearest hour) on NFPG and non-fasting GCT values. Setting: Three Toronto teaching hospitals. Subjects: 1318 consenting, consecutive patients, age 24 and over had NFPG and GeT at 26 wks gestational age. Time from the last meal was obtained. Of these 1199 (91%) went on to Oral Glucose Tolerance Test. National Diabetes Data Group criteria was used to define GO. Results: Mean age was 31 yrs with median G2-P1 status. Mean NFPG and GCT results (rrmol/l) are shown by time since last meal. ANOVA showed highly significant (p
Time
1 2 3 4 5
GCT 6.61 6.41 6.39 6.89 7.02
SE 0.091 0.077 0.090 0.152 0.131
NFPG 5.11
4.73 4.54 4.32 4.28
SE 0.058 0.047 0.047 0.065 0.043
cases. For NFPG, using Tukey's studentized range test, all pairwise differences were s i gni f i cant at p
3v. 4h. and 4v. 5h. For GCT,
the non-monoton; c i nf luence of time meant that onLy the
5v. (1,2,3) and 4v. (2,3)
comparisons were significant. Conclusions: Both NFPG and non-fasting GCT are highLy influenced by time from the last meal. The monotonic relationship for NFPG contrasts strikingly with the J-shaped curve for GCT. Although sample size is still limited for proving definitive differences, ROC curve analysis supports the hypothesis that cut-point for non-fasting GCT should vary according to the time since the last meal. Analysis of additional 1700 patients will be completed by DecefTber 1991. Continuation to 4000 subjects is planned.
103
GESTATIONAL DIABETES SCREENING TEST PERFORMANCE REVISITED: INTERIM INSIGHTS FROM A PROSPECTIVE STUDY. Sermer M', Naylor COx Farine 0, Cohen H, Ritchie JWK, Gare ox, Kenshole AX, McArthur K~
Biringer A'" Holzapfel S)l. University of Toronto Perinatal COITlllex, Toronto, Ontario, Canada Background: Not since work by O'Sull ivan have screening tests for Gestational Diabetes [GO] been fully appraised by att~ting to adninister a 100 gm Oral Glucose ToLerance Test [oGTT] to all subjects regardless of screening test resul ts. Objective: Assess and compare GO screening performance of Non-Fasting PLasma GLucose [NFPGl and 50 gm Glucose Chal Lenge Test [GCT], using National Diabetes Data Group criteria. Setting: Three Toronto teaching hospitals. Subjects: 1318 consenting, consecutive patients, age 24 and over had NFPG and GCT at 26 weeks
gestational age. Of these 1199 (91%) went simi Lar to non-compl iant subjects and the population. Results: Mean age was 31 yrs, status. Incidence of GO was 4.3%. Results
on to OGTT; the~" were general obstetrical with median G2-P1 (in %) are shown by
NFPG and GCT cut-points (lTITIOl/L): GCT 6.8 7.0 7.2 7.4 Sens . 90 88 80 80
7.8 77
S~c.
PPV
~
9
M
~
73
IT
N
10
12
~
~
W
W
W
4.2 92 31
4.4 82 44
4.6 78 55
4.8 65 63
5.0 63 71
5.2 51
S~c.
4.0 94 18
PPV NPV
5
6
6
7
7
9
99
~
99
98
98
98
Sens.
15
~
W
NFPG
13
8.0 75
~
_
10
7.6 77
17
IT 9 97
Conclusions: Balancing false positive [FP] and false negative [FN] rates, NFPG is clearly inferior to GCT. However, even the GCT has a large and significant 23% FN rate (l-sens.) with the standard 7.8 ITITIOl/L cut-point. PPV of GCT and NFPG is poor, due
to Low prevalence and a high FP rate. Sample size is too smaL L to rule out equivalence of NFPG and GCT, once NFPG is adjusted for time from the Last meal, but current data are not promising. AnaLysis of additional 1700 patients wiLl be completed by December 1991. Continuation to 4000 subjects is planned.
104 A COMPARISON OF PTU VERSUS TAPAZOLE IN THE TREATMENT OF HYPERTHYROIDISM D. Wing, MD x , L. Millar, MD x , P. Koonings, MDx, M. Montoro, MO x , J.Mestman, MO x University of Southern California, Los Angeles We compared the efficacy of PrU and Tapazole in the treatment of hyperthyroidism in pregnancy. Between 1974 and 1990, 153 hyperthyroid patients were medically managed in our clinic. A total of 129 charts (84%) were retrieved. Of these, 95 patients were treated with PrU and 34 were treated with Tapazole. The time to remission with PrU and Tapazole was not statistically different. Twenty six of the 95 (27%) treated with PTU remained hyperthyroid; while 9 of the 34 patients (26%) treated with Tapazole remained hyperthyroid. Treatment with PTU or Tapazole reflecting a euthyroid state decreased the incidence of LBW infants equally in both groups. PrU was discontinued in two patients secondary to rash. The incidence of major congenital malformations was 3% in both groups. One tapazole exposed infant had an inguinal hernia. The anomalies seen with infants exposed to PrU included: VSD, pulmonic stenosis, and a PDA in a term infant. No scalp defects were seen in Tapazole exposed infants. In summary both PTU and Tapazole are equally efficacious in treating hyperthyroidism and have comparable fetal outcomes.
January 1992
SPO Abstracts
Am J Obstet Gynecol
101 OUTCOME OF PREGNANCY IN PATIENTS WITH PREEXISTING RENAL DISEASE. TK Sorensen! TR Easterling, TJ Benedetti. University of Washington Medical Center, Seattle. Thirty pregnancies in 27 patienL~ with chronic renal diseasc were reviewed. Chronic renal disease was defined as serum creatinine 21.2 mg/dl or creatinine clearance < 90 ml/min during pregnancy or urine protein> 3 gm/24 hours. 5 patients had severe disease with scrum creatinine> 2.5. Cardiac output was measured by Doppler technique. Low birth weight «2500 gr) 63% premature «37 wks) 63% growth retarded (SGA) 44% Chronic hypertension 92% Preeclampsia 50% 40% Fetal distress Cesarean section 53% Perinaw loss (after 2nd trimester) 17% Anomalies 3% Five of 6 (82%) diabetics had markedly elevated cardiac output in contrast to an underlying hemodynamic pattern of elevated total peripheral resistance in 60% of the remaining patients; pregnancy outcomes in the diabetics were similar to the group as a whole. Three of the 5 patients with severe disease had detioriation of disease requiring dialysis during pregnancy. In conclusion, our patients did not appear to have an increased rate of fetal anomalies, but were at high risk for prematurity, growth retardation, fetal distress, operative delivery, and preeclampsia. Renal function worsened only in patients with severe disease.
102
GESTATIONAL DIABETES SCREENING: RELATIONSHIP OF NON-FASTING PLASMA GLUCOSE AND 50 GM GLUCOSE CHALLENGE TEST VALUES TO TIME
FROM THE LAST MEAl. Serrner MX, N,-tor CO)<-, Farine 0, Cohen ~, Ritchie JWK, Gare Ox, Kenshole A, McArthur K)(, Siringer AJo.;,
Holzapfel S". University of Toronto Perinatal Complex, Toronto, Ontario, Canada Backsround: Use of Non-Fasting Plasma Glucose [NFPG] as a
screening test for Gestational Diabetes [GO] has been suggested.
but variabi l ity in relation to meals is a concern. Glucose
ChaL lenge Test [GeT] has the advantage of a standard glucose load but might also be variable among non-fasting subjects. Objective: Assess influence of time since last food ingestion (to nearest hour) on NFPG and non-fasting GCT values. Setting: Three Toronto teaching hospitals. Subjects: 1318 consenting, consecutive patients, age 24 and over had NFPG and GeT at 26 wks gestational age. Time from the last meal was obtained. Of these 1199 (91%) went on to Oral Glucose Tolerance Test. National Diabetes Data Group criteria was used to define GO. Results: Mean age was 31 yrs with median G2-P1 status. Mean NFPG and GCT results (rrmol/l) are shown by time since last meal. ANOVA showed highly significant (p
Time
1 2 3 4 5
GCT 6.61 6.41 6.39 6.89 7.02
SE 0.091 0.077 0.090 0.152 0.131
NFPG 5.11
4.73 4.54 4.32 4.28
SE 0.058 0.047 0.047 0.065 0.043
cases. For NFPG, using Tukey's studentized range test, all pairwise differences were s i gni f i cant at p
3v. 4h. and 4v. 5h. For GCT,
the non-monoton; c i nf luence of time meant that onLy the
5v. (1,2,3) and 4v. (2,3)
comparisons were significant. Conclusions: Both NFPG and non-fasting GCT are highLy influenced by time from the last meal. The monotonic relationship for NFPG contrasts strikingly with the J-shaped curve for GCT. Although sample size is still limited for proving definitive differences, ROC curve analysis supports the hypothesis that cut-point for non-fasting GCT should vary according to the time since the last meal. Analysis of additional 1700 patients will be completed by DecefTber 1991. Continuation to 4000 subjects is planned.
103
GESTATIONAL DIABETES SCREENING TEST PERFORMANCE REVISITED: INTERIM INSIGHTS FROM A PROSPECTIVE STUDY. Sermer M', Naylor COx Farine 0, Cohen H, Ritchie JWK, Gare ox, Kenshole AX, McArthur K~
Biringer A'" Holzapfel S)l. University of Toronto Perinatal COITlllex, Toronto, Ontario, Canada Background: Not since work by O'Sull ivan have screening tests for Gestational Diabetes [GO] been fully appraised by att~ting to adninister a 100 gm Oral Glucose ToLerance Test [oGTT] to all subjects regardless of screening test resul ts. Objective: Assess and compare GO screening performance of Non-Fasting PLasma GLucose [NFPGl and 50 gm Glucose Chal Lenge Test [GCT], using National Diabetes Data Group criteria. Setting: Three Toronto teaching hospitals. Subjects: 1318 consenting, consecutive patients, age 24 and over had NFPG and GCT at 26 weeks
gestational age. Of these 1199 (91%) went simi Lar to non-compl iant subjects and the population. Results: Mean age was 31 yrs, status. Incidence of GO was 4.3%. Results
on to OGTT; the~" were general obstetrical with median G2-P1 (in %) are shown by
NFPG and GCT cut-points (lTITIOl/L): GCT 6.8 7.0 7.2 7.4 Sens . 90 88 80 80
7.8 77
S~c.
PPV
~
9
M
~
73
IT
N
10
12
~
~
W
W
W
4.2 92 31
4.4 82 44
4.6 78 55
4.8 65 63
5.0 63 71
5.2 51
S~c.
4.0 94 18
PPV NPV
5
6
6
7
7
9
99
~
99
98
98
98
Sens.
15
~
W
NFPG
13
8.0 75
~
_
10
7.6 77
17
IT 9 97
Conclusions: Balancing false positive [FP] and false negative [FN] rates, NFPG is clearly inferior to GCT. However, even the GCT has a large and significant 23% FN rate (l-sens.) with the standard 7.8 ITITIOl/L cut-point. PPV of GCT and NFPG is poor, due
to Low prevalence and a high FP rate. Sample size is too smaL L to rule out equivalence of NFPG and GCT, once NFPG is adjusted for time from the Last meal, but current data are not promising. AnaLysis of additional 1700 patients wiLl be completed by December 1991. Continuation to 4000 subjects is planned.
104 A COMPARISON OF PTU VERSUS TAPAZOLE IN THE TREATMENT OF HYPERTHYROIDISM D. Wing, MD x , L. Millar, MD x , P. Koonings, MDx, M. Montoro, MO x , J.Mestman, MO x University of Southern California, Los Angeles We compared the efficacy of PrU and Tapazole in the treatment of hyperthyroidism in pregnancy. Between 1974 and 1990, 153 hyperthyroid patients were medically managed in our clinic. A total of 129 charts (84%) were retrieved. Of these, 95 patients were treated with PrU and 34 were treated with Tapazole. The time to remission with PrU and Tapazole was not statistically different. Twenty six of the 95 (27%) treated with PTU remained hyperthyroid; while 9 of the 34 patients (26%) treated with Tapazole remained hyperthyroid. Treatment with PTU or Tapazole reflecting a euthyroid state decreased the incidence of LBW infants equally in both groups. PrU was discontinued in two patients secondary to rash. The incidence of major congenital malformations was 3% in both groups. One tapazole exposed infant had an inguinal hernia. The anomalies seen with infants exposed to PrU included: VSD, pulmonic stenosis, and a PDA in a term infant. No scalp defects were seen in Tapazole exposed infants. In summary both PTU and Tapazole are equally efficacious in treating hyperthyroidism and have comparable fetal outcomes.