Screening for gestational diabetes: Examining a breakfast meal test

Abstract

Objective: This study was performed to analyse the carbohydrate quantity of the non-standardised breakfast meal test consumed as part of a screening test for gestational diabetes. Design: A prospective descriptive design was utilised. Setting: Screening for gestational diabetes was performed in the High-Risk Antenatal Clinic at Tygerberg Academic Hospital, Cape Town, South Africa. Subjects: Fifty pregnant women who met the local selection criteria for diabetes screening. Outcome measures: The contents of the patient-provided breakfast meal tests were evaluated individually for total carbohydrate amount and compared with the 75 grams of carbohydrate provided by the oral glucose tolerance test (OGTT). Results: The median carbohydrate amount was 71 g but the range (55–145 g) was wide. Only seven meals (14%) fell within 10% of the 75 g carbohydrate target. Conclusion: The patient-provided breakfast meal showed wide variation in carbohydrate amount. If a meal test is to be used instead of the formal OGTT a carefully measured, prepared, palatable, readily available product would need to be sourced and provided. Layman’s summary: It is necessary to screen for the development of diabetes during pregnancy. The standard test with 75 g of glucose is unpalatable and is sometimes replaced by a meal test. However, when this meal test is provided by the women themselves without standardisation, the sugar and starch quantities are too variable. Careful consideration needs to be given to an alternative screening test if it is to be reliable. Strong lay message: Non-standardised screening meal tests for gestational diabetes should not be used.