Applying Current Screening Tools for Gestational Diabetes Mellitus to a European Population: Is It Time for Change?
Open Access
- 14 September 2013
- journal article
- Published by American Diabetes Association in Diabetes Care
- Vol. 36 (10), 3040-3044
- https://doi.org/10.2337/dc12-2669
Abstract
OBJECTIVE: The optimal screening regimen for gestational diabetes mellitus (GDM) remains controversial. Risk factors used in selective screening guidelines vary. Given that universal screening is not currently adopted in our European population, we aimed to evaluate which selective screening strategies were most applicable. RESEARCH DESIGN AND METHODS: Between 2007 and 2009, 5,500 women were universally screened for GDM, and a GDM prevalence of 12.4% using International Association of Diabetes in Pregnancy Study Groups (IADPSG) criteria was established. We retrospectively applied selective screening guidelines to this cohort. RESULTS: When we applied National Institute for Health and Clinical Excellence (NICE), Irish, and American Diabetes Association (ADA) guidelines, 54% (2,576), 58% (2,801), and 76% (3,656) of women, respectively, had at least one risk factor for GDM and would have undergone testing. However, when NICE, Irish, and ADA guidelines were applied, 20% (120), 16% (101), and 5% (31) of women, respectively, had no risk factor and would have gone undiagnosed. Using a BMI ≥30 kg/m2 for screening has a specificity of 81% with moderate sensitivity at 48%. Reducing the BMI to ≥25 kg/m2 (ADA) increases the sensitivity to 80% with a specificity of 44%. Women with no risk factors diagnosed with GDM on universal screening had more adverse pregnancy outcomes than those with normal glucose tolerance. CONCLUSIONS: This analysis provides a strong argument for universal screening. However, if selective screening were adopted, the ADA guidelines would result in the highest rate of diagnosis and the lowest number of missed cases.This publication has 16 references indexed in Scilit:
- Fetal growth and developmental programmingjpme, 2012
- Hyperglycemia and Adverse Pregnancy OutcomesThe New England Journal of Medicine, 2008
- Adverse pregnancy outcome in women with mild glucose intolerance: is there a clinically meaningful threshold value for glucose?Acta Obstetricia et Gynecologica Scandinavica, 2008
- Screening for gestational diabetes: The effect of varying blood glucose definitions in the prediction of adverse maternal and infant health outcomesAustralian and New Zealand Journal of Obstetrics and Gynaecology, 2007
- Pregnancy plasma glucose levels exceeding the American Diabetes Association thresholds, but below the National Diabetes Data Group thresholds for gestational diabetes mellitus, are related to the risk of neonatal macrosomia, hypoglycaemia and hyperbilirubinaemiaDiabetologia, 2006
- Effect of Treatment of Gestational Diabetes Mellitus on Pregnancy OutcomesThe New England Journal of Medicine, 2005
- Gestational diabetes: The consequences of not treatingAmerican Journal of Obstetrics and Gynecology, 2005
- Gestational diabetes: do lean young caucasian women need to be tested?Diabetes Care, 1998
- Selective Screening for Gestational Diabetes MellitusThe New England Journal of Medicine, 1997
- Gestational diabetes: Does the presence of risk factors influence perinatal outcome?American Journal of Obstetrics and Gynecology, 1994