The use of one week of capillary glucose testing in place of oral glucose tolerance testing to diagnose gestational diabetes  — ASN Events
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The use of one week of capillary glucose testing in place of oral glucose tolerance testing to diagnose gestational diabetes  (#105)

Ruby Chang 1 2 , Zoe Lysaght 1
  1. Obstetric Medicine, Royal Hospital for Women, Sydney, NSW, Australia
  2. School of Medicine, University of New South Wales, Sydney, NSW, Australia

Background/Aims: 

Capillary glucose testing has been proposed as an alternative method to diagnose gestational diabetes (GDM) in women who are unable to perform standard oral glucose tolerance testing (OGTT). No guidelines currently exist on what diagnostic criteria should be used and cases are often assessed individually by clinicians. 

Methods: 

A retrospective chart analysis was performed at a tertiary obstetric teaching hospital in Sydney from January 2023 to December 2025. Women who underwent capillary glucose testing in place of OGTT were identified. Baseline characteristics were collected along with rates of GDM diagnosis, birth outcomes, obstetric and neonatal complications. 

Results: 

149 women were referred for capillary glucose testing in place of a standard OGTT in pregnancy. 50 (33%) were diagnosed with hyperglycaemia consistent with GDM, with the most common indication for capillary testing due to patient refusal to undergo OGTT (33%). A history of bariatric surgery was the primary indication in 15% of cases and a diagnosis of hyperemesis gravidarum was in 11.4%. Isolated fasting hyperglycaemia was the most common criterion that led to a GDM diagnosis. 

Two patients diagnosed with GDM on capillary glucose testing  had a subsequently normal OGTT result. This led to a removal of their diagnosis. An additional patient had their diagnosis removed after further capillary glucose testing demonstrated no evidence of hyperglycaemia. 

Birth outcomes were similar between those diagnosed with GDM on capillary testing and those not diagnosed. Mean gestational weight in the GDM group was 3360g compared to 3306g in the non GDM group. Rate of vaginal births were 48% in the GDM group compared to 62% in the non GDM group. 

Women diagnosed with GDM via capillary glucose testing experienced higher rates of maternal complications: hypertensive disorders of pregnancy, postpartum haemorrhage and 3rd/4th degree tears. Their neonates also experienced higher rates of neonatal hypoglycaemia, jaundice, respiratory distress syndrome and neonatal intensive care admission. 

Conclusions: 

Use of capillary glucose testing in place of oral glucose tolerance testing diagnosed a significant proportion of women with GDM.  Those diagnosed with GDM through capillary glucose testing experienced higher rates of maternal and neonatal complications.