{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,13]],"date-time":"2025-10-13T00:14:40Z","timestamp":1760314480473,"version":"build-2065373602"},"reference-count":47,"publisher":"MDPI AG","issue":"20","license":[{"start":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T00:00:00Z","timestamp":1760054400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Lata Medical Research Foundation, Nagpur, India","award":["Intramural"],"award-info":[{"award-number":["Intramural"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: The definitions and approaches used to diagnose gestational diabetes (GD) are varied. The two-step approach recommended by the American College of Obstetricians and Gynecologists (ACOG) combines the sensitivity of a glucose challenge test (GCT) with the specificity of a 3-hour oral glucose tolerance test (OGTT). We investigated if minor modification of the two-step procedure can provide improved detection of GD by identifying a risk group of pregnant women with high risk of GD. Methods: We conducted a prospective cohort study of pregnant women enrolled early during pregnancy and followed till delivery. All participants underwent the ACOG-recommended two-step procedure for GD diagnosis. Based on GCT and OGTT results, the participants were divided into four risk groups (RGs): GCT-negative (RG0), GCT-positive but OGTT normal (RG1), single abnormal value on OGTT or raised HbA1c (RG2) and diagnosed GD (RG3). Baseline evaluation included dietary history (24 hour recall) and physical activity. A series of multivariable logistic regression analyses were conducted to estimate the odds of maternal and fetal outcomes. Results: A total of 1041 pregnant women were included in the study, of whom 16 (1.6%) were diagnosed as GD. Our two-step approach identified 48 (4.6%) women as GD, while RG2, RG1 and RG0 comprised 75 (7.2%), 218 (20.9%) and 700 (67.2%), respectively. Compared to RG0, RG2 showed a higher likelihood of antepartum complications [odds ratio and 95% confidence interval 2.38 (1.16\u20134.15)], any adverse outcome without [2.04 (1.17\u20133.55)] or with cesarean section [2.09 (1.21\u20133.61)] and primary cesarean section [1.68 (1.01\u20132.81)] after adjustment for potential confounders. RG2 was also significantly associated with pregnancy-induced hypertension, meconium-stained amniotic fluid and premature rupture of membranes. Conclusions: In the study participants, we identified a subgroup (RG2) at high risk of GD with perinatal outcomes showing profile consistent with that of GD.<\/jats:p>","DOI":"10.3390\/jcm14207151","type":"journal-article","created":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T13:47:08Z","timestamp":1760104028000},"page":"7151","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Opportunity Screening for Early Detection of Gestational Diabetes: Results from the MERGD Study"],"prefix":"10.3390","volume":"14","author":[{"given":"Manju","family":"Mamtani","sequence":"first","affiliation":[{"name":"M&H Research, LLC, San Antonio, TX 78249, USA"},{"name":"Lata Medical Research Foundation, Nagpur 440022, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6032-8943","authenticated-orcid":false,"given":"Kunal","family":"Kurhe","sequence":"additional","affiliation":[{"name":"Lata Medical Research Foundation, Nagpur 440022, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ashwini","family":"Patel","sequence":"additional","affiliation":[{"name":"Lata Medical Research Foundation, Nagpur 440022, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Manisha","family":"Jaisinghani","sequence":"additional","affiliation":[{"name":"Lata Medical Research Foundation, Nagpur 440022, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kanchan V.","family":"Pipal","sequence":"additional","affiliation":[{"name":"Lata Medical Research Foundation, Nagpur 440022, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Savita","family":"Bhargav","sequence":"additional","affiliation":[{"name":"Lata Medical Research Foundation, Nagpur 440022, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shailendra","family":"Mundhada","sequence":"additional","affiliation":[{"name":"Dhruv Pathology and Molecular Diagnostic Laboratory, Nagpur 440010, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Prabir Kumar","family":"Das","sequence":"additional","affiliation":[{"name":"Lata Medical Research Foundation, Nagpur 440022, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Seema","family":"Parvekar","sequence":"additional","affiliation":[{"name":"Daga Memorial Women\u2019s Hospital, Nagpur 440002, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vaishali","family":"Khedikar","sequence":"additional","affiliation":[{"name":"Lata Medical Research Foundation, Nagpur 440022, India"},{"name":"Daga Memorial Women\u2019s Hospital, Nagpur 440002, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2558-7421","authenticated-orcid":false,"given":"Archana B.","family":"Patel","sequence":"additional","affiliation":[{"name":"Lata Medical Research Foundation, Nagpur 440022, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hemant","family":"Kulkarni","sequence":"additional","affiliation":[{"name":"M&H Research, LLC, San Antonio, TX 78249, USA"},{"name":"Lata Medical Research Foundation, Nagpur 440022, India"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,10,10]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"938","DOI":"10.1097\/GRF.0b013e31815a5494","article-title":"Metabolic changes in pregnancy","volume":"50","author":"Lain","year":"2007","journal-title":"Clin. 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