Glucose Tolerance Test

Published Date: 19th July 2016

Publication Authors: Albert S, , Myagerimath R

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Introduction 

Diabetes is a disorder of carbohydrate metabolism requiring immediate lifestyle changes. Over 650 000 women give birth in England and Wales each year with 2–5% of these women being diabetic. Approximately 87.5% of pregnancies complicated by diabetes are due to gestational diabetes mellitus (GDM) that is dependent on various factors. GDM is associated with risks to the pregnant woman and developing fetus, hence the recommendation that at risk women be screened with oral glucose tolerance test by NICE.

Methodology 

Twelve months retrospective audit of pregnant women offered OGTT from January to December 2011. Pregnant women booked and offered OGTT were identified from the OGTT diary for this period. Details of the women were noted including results of the test and their expected dates of deliveries. Pregnancies with positive results were then analysed for progression, management. Delivery and infant outcomes were obtained from labour records and neonatal diary for outcomes in terms of weight, abnormality and hypoglycaemia.

Results 

One thousand five hundred and five women records were reviewed, 328 (22%) of these failed to attend the screening test. One hundred and forty-eight (10%) notes could not be assessed because of poor documentation only 1029 (68%) patients had OGTT. Indications for the test were appropriate as per NICE guideline. Of 1029 patients that had the test, 895 (87%) were normal and 134 (13%) results were consistent with GDM. All pregnancies reached term. Ninety-two (69%) pregnancies were induced at term with 58 (63%) delivering normally. Thirty-three (36%) women were delivered by caesarean section. All babies were normal discharged at birth. No neonate was transferred to NICU immediately on delivery or shortly after. Fifty-nine (44%) women were offered postnatal GTT but only 34 (58%) attended with 25 (42%) failing to attend.

Conclusion 

Our results show OGTT was correctly offered to at risk women in accordance with NICE. A good number of women (22%) failed to attend for the test. Significant numbers of women developed GDM in pregnancy (13%) and were correctly managed. There were no increases in caesarean section rates. All babies were discharged with their mothers. Postnatal uptake of OGTT was 34 (58%). Compliance could be higher if women attended their GP for 6 weeks postnatal check during which plasma glucose measurement (instead of OGTT) would be performed together with counselling and discussion of life style changes in keeping with NICE guideline with removing cost of test for Trust.

Myagerimath, R; Albert, S; Nwosu, EC. (2013).  Outcome of glucose tolerance test in a district general hospital . BJOG: An International Journal of Obstetrics and Gynaecology. 120 (Supplement), 134

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