Glucose Challenge Screen for Gestational Diabetes
As I posted about a few days ago, this week I had a one-hour glucose challenge test to screen for Gestational Diabetes (GDM). Today I received a phone call from my OB’s office informing me that my results were back and they were within the “normal” levels. Getting a negative result is comforting, but then I went back to hunting for statistical data on what this result really means.
According to an article I found in Obstetrics & Gynaecology, a 1994 study (“Poor sensitivity of the fifty-gram one-hour glucose screening test for hyperglycemia“) by van Turnhout HE, Lotgering FK, Wallenburg HC reported the sensitivity and specificity of the 1-hour glucose challenge test were 27% and 89%, respectively, with a prevalence rate of 5%.
In statistics, sensitivity and specificity are markers of how good of a test you’re considering. The sensitivity of a test tells you, “Out of all the people who have the condition, what percent of them will test positive?” Similarly, the specificity of a test tells you, “Out of all the people who don’t have the condition, what percent of them will test negative?”
If a test were perfect, we would expect both of these to be 100%. This would mean that 100% of people who have the condition really test positive, and 100% of the people who don’t have the condition really test negative. Of course, in the real world, this never really happens.
What Can I Conclude?
Another way we can gauge the performance of a test is to find its positive predictive value and its negative predictive value. I’m going to assume the sensitivity and specificity in the study cited above are correct. The same study above also gives a positive predictive value of 11% and a negative predictive value of 96%, but what do these numbers mean?
Let’s assume we give the same 1-hour glucose challenge test to 10,000 pregnant women. With a prevalence rate of 5%, we would expect 500 women to have GDM and 9500 not to have GDM. Of the 500 with GDM, since the sensitivity is 27%, we know 27% of 500 would screen positive, for a total of 135 women. These are women who have GDM and whose screening will come back positive. Meanwhile, of the 9500 women without GDM, since the specificity is 89%, we would expect 89% of 9500 or 8455 women to have a true negative result. The status of all of our 10,000 participants is displayed in the table below:
|Women with GDM||Women without GDM|
|Women who test positive||135||1045|
|Women who test negative||365||8455|
According to this table, a total of 135+1045=1180 women would test positive. Of the women who get a positive result, only 135 of them really have GDM; this is the positive predictive value and, in this case, it’s 135/1180 = 11.44%.
What about the women who, like me, get a negative result? There are 8820 of us, and 8455 of us don’t have GDM. This gives a negative predictive value of 8455/8820 = 95.86%.
Was This Worth $40?
My results were negative, so I am one of the women with a negative result. The values above tell me that since I got a negative result on my glucose screening, I can assume there’s about a 96% chance I don’t have GDM. I’m waiting to be billed for this screening, but I’ll go with my initial $40 estimate. Even after this analysis, I’m still wondering if the knowledge I gained was worth the $40 I paid for it. (“Everything is worth what its purchaser will pay for it,” so I suppose this must be too.)
I feel unqualified to answer the “Worth it?” question because I don’t know a way to quantify the importance of this test. It seems clear that if a condition is really, really awful, then finding out you’ve got it is probably worth $40, and so is finding out you’re home free.
Is GDM really, really awful? It certainly has the potential to affect both my health and the health of my unborn child, so it seems better to know about it than not. But there are lots and lots of things that could affect our health that I don’t know about, and won’t be screened for, and probably won’t ever hear about.
One thing I wish I did have, for this screening and all of the others I have been (or will be) offered, is data ahead of time. I want to know the false positive and false negative rates. I want to know the sensitivity and the specificity and the predictive values. And I want to know how much money it’s going to cost me, and how much of a hassle it’s going to be. Lastly, I would like to know more about the medical significance of the condition, and since I’m not a medical doctor, I need it in some kind of quantifiable metric for when I do these kinds of calculations.