WHO 75 gram OGTT-A single step procedure for screening and diagnosis of gestational diabetes mellitus

Chandana M. Puttaraju, Manorama Eti


Background: Indian women have an eleven fold increased risk of developing glucose intolerance during pregnancy compared to Caucasian women .Universal screening for GDM is essential in India. This study was undertaken to find out a single step procedure which serves both as a screening and a diagnostic tool. 

Methods: This study was carried out in a tertiary care teaching institute in Karnataka. 839 pregnant women with gestational age between 24-28 weeks were subjected to 50 gram OGCT and venous blood was drawn after 1 hour. These patients were requested to come after 72 hours on empty stomach for WHO-75 gram OGTT. Fasting and 2 hour blood samples after 75 gram of glucose were drawn.

Results: Amongst the 839 pregnant women who underwent 50 gram OGCT, 136 (16.2%) women had one hour plasma glucose >140 mg/dl. Subsequent 75 gram OGTT revealed that only 43 (31.62%) of screen positive patients were diabetic.93 women who tested positive by 50 gram OGCT were false positive cases (10.58%). Prevalence of GDM in study population was 6.3 % (53/839). Screening OGCT missed 10 (15.87%) of gestational diabetes mellitus cases which were picked up by 75 gram WHO OGTT only.

Conclusions: The diagnosis of Gestational Diabetes Mellitus by OGTT based on initial OGCT screening leaves 15.87% undiagnosed. The two step method of screening OGCT and diagnosing GDM with subsequent OGTT is tedious and not economical. Instead a single step WHO 75 gram fasting OGTT with 2 hour PPG ≥ 140 mg/dl is simple and precise.



Full Text:



Anjana RM, Pradeepa R, Deepa M, Datta M, Sudha V, Unnikrishnan R, et al. Prevalence of diabetes and prediabetes (impaired fasting glucose and/ or impaired glucose tolerance) in urban and rural India :Phase I results of the Indian Council of Medical Research –INdia DIAbetes (ICMR-INDIAB)Study. Diabetologia. 2011;54(12): 3022-7.

Metzger, Boyd E, Coustan DR. Summary and recommendations of the fourth international workshop-conference on gestational diabetes mellitus: the organising committee. Diabetes Care. 1998;21 (Suppl 2):B161-7.

Raja MW, Baba TA, Hanga AJ, Bilquees S, Rasheed ,Haq IU, et al. A study to estimate the prevalence of gestational diabetes mellitus in an urban block of Kashmir valley (North India). Int J Med Sci Public Health. 2014;3:191-5.

Gopalakrishnan V, Singh R, Pradeep Y, Kapoor D, Rani AK, Pradhan S, Yadav SB, et al. Evaluation of the prevalence of gestational diabetes mellitus in North Indians using the International Association of Diabetes and Pregnancy Study groups (IADPSG) criteria. J Postgrad Med. 2015;61(3):155-8.

Jindal R, Siddiqui MA, Gupta N, Wangnoo SK. Prevalence of glucose intolerance at 6 weeks postpartum in Indian women with gestational diabetes mellitus. Diabetes Metab Syndr. 2015;9:143-6.

Damm P. Future risk of diabetes in mother and child after gestational diabetes. Int J Gynaecol Obstet 2009;104:25-6.

HAPO Study Co-operative Research group. Metzger BE, Lowe LP, Dyer AR, Trimble ER, Chaovarindr U, et al. Hyperglycaemia and adverse pregnancy outcomes. N Engl J Med. 2008;358:1991-2002.

Dornhorst A, Paterson CM, Nicholls JS, Wadsworth J, Chiu DC, Elkeles RS, et al. High prevalence of gestational diabetes in women from ethnic minority groups. Diabet Med. 1992;9:820-5.

Cosson E. Screening and insulin sensitivity in gestational diabetes. Abstract volume of the 40th annual meeting of the EASD. 2004;A 350.

Crowther CA, Hiller JE, Moss JR, McPhee AJ, Jeffries WS, Robinson JS, et al. Effect of treatment of gestational diabetes mellitus. N Engl J Med. 2005; 352:2477-86.

Gayle C, Germain S, Marsh MS, Rajasingham D, Brackenridge A, Carroll P, et al. Comparing pregnancy outcomes for intensive versus routine antenatal treatment of a GDM based on a 75 gm OGTT 2- h blood glucose (>140mg/dl). Diabetologia. 2010; 53:S435.

Magon N. Gestational diabetes mellitus: Get, set, go. From diabetes capital of the world to diabetes care capital of the world. Indian J Endocr Metab. 2011;15:161-9.

Ferrara A, Kahn HS, Quesenberry CP, Riley C, Hedderson MM. An increase in the incidence of gestational diabetes mellitus: Northern California, 1991–2000. Obstet Gynecol. 2004;103:526-533.

Reiher H, Fuhramann K, Noack S, Woltanski KP, Jutzi E, Hahn von Dorsche H, et al. Age dependent insulin secretion of the endocrine pancreas in vitro from foetuses of diabetic and non-diabetic patients. Diabetes Care. 1983;6:446-51

Nahum GG, Wilson SB, Stanislaw H. Early-pregnancy glucose screening for gestational diabetes mellitus. J Reprod Med. 2002;47:656-62.

Huynh J, Ratnaike S, Bartalotta C, Permezel M, Houlihan C, et al. Challenging the glucose challenge test. Aust N Z J Obstet Gynaecol. 2011;51(1): 22-25.

Das V, Kamra S, Mishra A. Screening for gestational diabetes and maternal and foetal outcome. J Oster Gynecol India. 2004;54:449-51.

Seshiah V, Balaji V , Balaji MS et al. Gestational diabetes mellitus in India. J Assoc Physicians India. 2004;52:707-11.

Mohan V, Mahalakshmi MM, Bhavadharini B, Maheshwari K, Kalaiyarasi G, Anjana RM, et al. Comparison of screening for gestational diabetes mellitus by oral glucose tolerance tests done in non-fasting(random) and fasting states. Acta Diabetol. 2014;51:1007-13.

Schmidt MI, Duncan BB, Reichelt AJ, Branchtein L, Matos M C, Costa e Forti A, Yamashita T, et al. Brazilian Gestational Diabetes Study Group. Gestational diabetes mellitus diagnosed with a 2-h 75-g oral glucose tolerance test and adverse pregnancy outcomes. Diabetes care. 2001;24:1151-1155.

Seshiah V, Balaji V, Balaji MS, Sekar A, Sanjeevi CB et al. One step procedure for screening and diagnosis of gestational diabetes mellitus. J Obstet Gynecol India. 2005;55:525-29

Pettitt DJ, Bennett PH, Hanson RL, et al. Comparison of World Health Organization and National Diabetes Data Group procedures to detect abnormalities of glucose tolerance during pregnancy. Diabetes Care. 1994;17:1264-8.

Zhu WW, Fan L,Yang HX, Kong LY, Su SP, Wang ZL, Hu YL, Zhang MH, Sun LZ, Mi Y, Du XP, Zhang H ,Wang YH ,Huang YP, Zhong LR ,Wu HR, Li N ,Wang YF, Kapur A. Fasting plasma glucose at 24-28 weeks to screen for gestational diabetes mellitus: new evidence from China. Diabetes Care. 2013;36:12038-2040.

Balaji V, Balaji M, Anjanakshi C, Cynthia A, Arthi T, Seshaiah V. Inadequacy of fasting plasma glucose to diagnose gestational diabetes mellitus in Asian Indian Women. Diabetes Res Clin Pract. 2011;94:e21-e23.

Meltzer SJ, Synder J, Morin L, et al. Validation of normative data for 75 g oral glucose tolerance test (OGTT) in a Montreal pregnant population considering ethnicity. In: Matsdinsky FM (ed). Abstract book of the 64th Scientific Sessions of the American Diabetes Association, Florida. American Diabetes Association. 2004; A19.

Kendrick JM. Screening and diagnosing gestational diabetes mellitus revisited: implications from HAPO. J Perinat Neonatal Nurs. 2011;25:226-32

Bodmer-Roy S, Morin L, Cousineau J, Rey E. Pregnancy outcomes in women with and without gestational diabetes mellitus according to the International Association of Diabetes and Pregnancy Study Groups criteria. Obstet Gynecol. 2012;120:746-52.

Reyes-Munoz E, Parra A, Castillo-Mora, Ortega-Gonzalez C, et al. Effect of the diagnostic criteria of the international association of diabetes and pregnancy groups on the prevalence of gestational diabetes in urban Mexican women: A cross-sectional study. Endocr Pract. 2012; 18:146-151.

Nallaperumal S, Bhavadharini B, Mahalakshmi MM, Maheswari K, Jalaja R, Moses A, Mohan Vet al . Comparison of the world health organization and the International association of diabetes and pregnancy study groups criteria in diagnosing gestational diabetes mellitus in South Indians. Indian J Endocr Metab. 2013;17:906-9.

Yue DK, Molyneaux LM, Ross GP, Constantino MI, Child AG, Turtle JR. Why does ethnicity affect prevalence of gestational diabetes mellitus? The underwater volcano theory. Diabet Med. 1996;13:748-52.

Nilofer AR, Raju VS, Dakshayini BR, Zaki SA. Screening in high risk group of gestational diabetes mellitus with its maternal and fetal outcomes. Indian J Endocr Metab. 2012;16:S74-8.

Kalra P, Kachhwaha CP, Singh HV. Prevalence of Gestational Diabetes Mellitus and its outcome in western Rajasthan. Indian J Endocr Metab. 2013; 17:677-80.

Verma AK, Singh B, Mengi V. Gestational diabetes in rural women of Jammu. Indian J Community Med 2008;33:54-5