Screening Accuracy of the 50 g-Glucose Challenge Test in Twin Compared With Singleton Pregnancies

Liran Hiersch*, Baiju R. Shah, Howard Berger, Michael Geary, Sarah D. Mcdonald, Beth Murray-Davis, Jun Guan, Ilana Halperin, Ravi Retnakaran, Jon Barrett, Nir Melamed

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


Context: The optimal 50 g-glucose challenge test (GCT) cutoff for the diagnosis of gestational diabetes mellitus (GDM) in twin pregnancies is unknown. Objective: This work aimed to explore the screening accuracy of the 50 g-GCT and its correlation with the risk of large for gestational age (LGA) newborn in twin compared to singleton pregnancies. A population-based retrospective cohort study (2007-2017) was conducted in Ontario, Canada. Participants included patients with a singleton (n=546892 [98.4%]) or twin (n=8832 [1.6%]) birth who underwent screening for GDM using the 50 g-GCT. Methods: We compared the screening accuracy, risk of GDM, and risk of LGA between twin and singleton pregnancies using various 50 g-GCT cutoffs. Results: For any given 50 g-GCT result, the probability of GDM was higher (P=.0.007), whereas the probability of LGA was considerably lower in the twin compared with the singleton group, even when a twin-specific growth chart was used to diagnose LGA in the twin group (P<.001). The estimated false-positive rate (FPR) for GDM was higher in twin compared with singleton pregnancies irrespective of the 50 g-GCT cutoff used. The cutoff of 8.2 mmol/L (148 mg/dL) in twin pregnancies was associated with an estimated FPR (10.7%-11.1%) that was similar to the FPR associated with the cutoff of 7.8 mmol/L (140 mg/dL) in singleton pregnancies (10.8%). Conclusion: The screening performance of the 50 g-GCT for GDM and its correlation with LGA differ between twin and singleton pregnancies.

Original languageEnglish
Pages (from-to)2854-2864
Number of pages11
JournalJournal of Clinical Endocrinology and Metabolism
Issue number10
StatePublished - 1 Oct 2022


  • GCT
  • GDM
  • cutoff
  • diagnosis
  • gestational diabetes
  • glucose challenge test
  • multifetal
  • multiple
  • screening
  • singleton
  • singletons
  • threshold
  • twin
  • twins


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