The Sensitivity and Specificity of the Glucose Challenge Test in a Universal Two-Step Screening Strategy for Gestational Diabetes Mellitus Using the 2013 World Health Organization Criteria

The International Association of Diabetes and Pregnancy Study Groups (IADPSG) recommends a universal one-step screening strategy with the 75-g oral glucose tolerance test (OGTT) for gestational diabetes mellitus (GDM) (1). Since the adoption of the IADPSG recommendation by the World Health Organization (WHO), the IADPSG criteria are commonly referred to as the 2013 WHO criteria (2). The IADPSG recommendation remains controversial due to the significant increase in GDM prevalence, increased workload, the need for a fasting test, and the risk for increased medicalization of care (3). Several professional associations therefore still recommend a universal two-step screening strategy, using a nonfasting 50-g glucose challenge test (GCT) to determine whether an OGTT should be performed (3). The GCT is easier to perform and is generally better tolerated than an OGTT. In addition, a two-step screening strategy with a GCT could limit the number of OGTTs. The GCT has been used in combination with the 100-g OGTT or the 75-g OGTT with various diagnostic criteria, but data are lacking on the sensitivity and specificity of the GCT in conjunction with the 2013 WHO criteria for GDM. We performed a multicentric prospective cohort study, the Belgian Diabetes in Pregnancy Study (BEDIP-N), between 2014 and 2017, enrolling 2,006 women between 6 and 14 weeks of pregnancy (4). Participants without prediabetes or diabetes in early pregnancy (defined by …