Benefit of selective screening of gestational diabetes mellitus (GDM)

ObjectiveDespite the short-term and long-term health implications of gestational diabetes mellitus (GDM), opinions are divided on selective vis-à-vis universal screening. We validated the accuracy of screening tests for GDM.Research design and methodsPregnant women (n=491) were recruited to this prospective, blind comparison with a gold standard study. We did selective screening between 13 and 20 weeks using reagent-strip glycosuria, random capillary blood glucose (RBG) and the presence of ≥1 risk factor(s). Between 20 and 34 weeks, we did universal screening following the ‘one-step’ approach using glycated hemoglobin (HbA1c), fasting venous plasma glucose (FPG), and the 1-hour and the ‘gold standard’ 2-hour oral glucose tolerance test (OGTT). Tests accuracy was estimated following the WHO and the National Institute for Health and Care Excellence (NICE) diagnostic criteria. Overall test performance was determined from the area under the receiver operating characteristic curve (AUC).ResultsGDM prevalence per 2-hour OGTT was 9.0% for the WHO criteria and 14.3% for the NICE criteria. Selective screening using glycosuria, RBG and risk factors missed 97.4%, 87.2% and 45.7% of cases, respectively. FPG threshold ≥5.1 mmol/L had the highest clinically relevant sensitivity (68%) and specificity (81%), but FPG threshold ≥5.6 mmol/L had higher positive predictive value. Although sensitivity of 1-hour OGTT was 39.5%, it had the highest accuracy and diagnostic OR. Regarding test performance, 1-hour OGTT and FPG were very good (AUC>0.8), RBG was poor (AUC≈0.60), whereas HbA1c was invaluable (AUC<0.5).ConclusionsSelective screening using glycosuria and random blood glucose is unnecessary due to its low sensitivity. Fasting glucose ≥5.1 mmol/L could be applicable for screening at the population level. Where 2-hour OGTT is not available, FPG ≥5.6 mmol/L, complemented by the presence of risk factors, could be useful in making therapeutic decision.

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A risk score for selective screening for gestational diabetes mellitus

European Journal of Obstetrics & Gynecology and Reproductive Biology ◽

10.1016/j.ejogrb.2009.04.016 ◽

2009 ◽

Vol 145 (1) ◽

pp. 71-75 ◽

Cited By ~ 16

Author(s):

Chadakarn Phaloprakarn ◽

Siriwan Tangjitgamol ◽

Sumonmal Manusirivithaya

Keyword(s):

Diabetes Mellitus ◽

Gestational Diabetes ◽

Gestational Diabetes Mellitus ◽

Risk Score ◽

Selective Screening

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Selective screening for gestational diabetes mellitus in adolescent pregnancies

Obstetrics and Gynecology ◽

10.1016/s0029-7844(98)00550-x ◽

1999 ◽

Vol 93 (5) ◽

pp. 738-742 ◽

Cited By ~ 11

Author(s):

M KHINE

Keyword(s):

Diabetes Mellitus ◽

Gestational Diabetes ◽

Gestational Diabetes Mellitus ◽

Selective Screening ◽

Adolescent Pregnancies

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Universal rather than selective screening for gestational diabetes mellitus may improve fetal outcomes

Diabetes & Metabolism ◽

10.1016/s1262-3636(07)70260-4 ◽

2006 ◽

Vol 32 (2) ◽

pp. 140-146 ◽

Cited By ~ 48

Author(s):

E Cosson ◽

M Benchimol ◽

L Carbillon ◽

I Pharisien ◽

J Pariès ◽

...

Keyword(s):

Diabetes Mellitus ◽

Gestational Diabetes ◽

Gestational Diabetes Mellitus ◽

Selective Screening ◽

Fetal Outcomes

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Selective Screening for Gestational Diabetes Mellitus

New England Journal of Medicine ◽

10.1056/nejm199711273372204 ◽

1997 ◽

Vol 337 (22) ◽

pp. 1591-1596 ◽

Cited By ~ 143

Author(s):

C. David Naylor ◽

Mathew Sermer ◽

Erluo Chen ◽

Dan Farine

Keyword(s):

Diabetes Mellitus ◽

Gestational Diabetes ◽

Gestational Diabetes Mellitus ◽

Selective Screening

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Appropriate Timing of Gestational Diabetes Mellitus Diagnosis in Medium- and Low-Risk Women: Effectiveness of the Italian NHS Recommendations in Preventing Fetal Macrosomia

Journal of Diabetes Research ◽

10.1155/2020/5393952 ◽

2020 ◽

Vol 2020 ◽

pp. 1-8

Author(s):

Paola Quaresima ◽

Federica Visconti ◽

Eusebio Chiefari ◽

Maria Mirabelli ◽

Massimo Borelli ◽

...

Keyword(s):

Diabetes Mellitus ◽

Gestational Diabetes ◽

Gestational Diabetes Mellitus ◽

Fetal Macrosomia ◽

Selective Screening ◽

Early Screening ◽

Screening Strategies ◽

Normal Glucose Tolerant ◽

Normal Glucose ◽

Glucose Tolerant

Background. Screening strategies for gestational diabetes mellitus (GDM) earlier than 24-28 weeks of gestation should be considered to prevent adverse pregnancy outcomes. Nonetheless, there is uncertainty about which women would benefit most from early screening and which screening strategies should be offered to women with GDM. The Italian National Healthcare Service (NHS) recommendations on selective screening for GDM at 16-18 weeks of gestation are effective in preventing fetal macrosomia in high-risk (HR) women, but the appropriateness of timing and effectiveness of these recommendations in medium- (MR) and low-risk (LR) women are still controversial. Patients and Methods. We retrospectively enrolled 769 consecutive singleton pregnant women who underwent both anomaly scan at 19-21 weeks of gestation and screening for GDM at 16-18 and/or 24-28 weeks of gestation, in agreement with the NHS recommendations and risk stratification criteria. Comparison of maternal characteristics, fetal biometric parameters at anomaly scan (head circumference (HC), biparietal diameter (BPD), abdominal circumference (AC), femur length (FL), estimated fetal weight (EFW)), and neonatal birth weight (BW) percentile among risk groups was examined. Results. 219 (28.5%) women were diagnosed with GDM, while 550 (71.5%) were normal glucose-tolerant women. Out of 164 HR women, only 62 (37.8%) underwent the recommended early screening for GDM at 16-18 weeks of gestation. AC and EFW percentiles, as well as neonates’ BW percentiles, were significantly higher in HR women diagnosed with GDM at 24-28 weeks of gestation with respect to normal glucose-tolerant women, as well as MR and LR women who tested positive for GDM. Comparative analysis between MR and LR women with GDM and women with normal glucose tolerance revealed significant differences in both AC and EFW percentiles (P<0.05), while there was no significant difference in neonatal BW percentiles. Conclusion. In MR and LR women with GDM, a mild acceleration of fetal growth can be detected at the time of anomaly scan. However, in these at-risk categories, the NHS recommendations for screening and treatment of GDM at 24-28 weeks of gestation are still effective in normalizing BW and preventing fetal macrosomia, thus supporting a risk factor-based selective screening program for GDM.

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Prevalence of gestational diabetes mellitus: variations related to screening strategy used

Acta Endocrinologica ◽

10.1530/eje.0.1460831 ◽

2002 ◽

pp. 831-837 ◽

Cited By ~ 33

Author(s):

JJ Jimenez-Moleon ◽

A Bueno-Cavanillas ◽

JD Luna-Del-Castillo ◽

M Garcia-Martin ◽

P Lardelli-Claret ◽

...

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Gestational Diabetes ◽

Gestational Diabetes Mellitus ◽

Statistical Significance ◽

Low Risk ◽

Selective Screening ◽

Family History Of Diabetes ◽

Screening Strategies ◽

Obstetric Population

OBJECTIVE: To determine the prevalence of gestational diabetes mellitus in a large general obstetric population and its variations depending on the presence of risk factors, and to evaluate how the gestational diabetes screening strategies applied might modify the observed prevalence in the population. DESIGN: A retrospective cohort study. METHODS: The study population was a total of 2574 pregnant women. Information about risk factors, screening and diagnosis of gestational diabetes was obtained. Frequency of risk factors under the American College of Obstetrics and Gynecologists (ACOG) and the American Diabetes Association (ADA) criteria, and observed and expected prevalence of gestational diabetes mellitus were calculated and compared for statistical significance. RESULTS: Age > or = 30 years, family history of diabetes, obesity and previous fetal macrosomia were the most frequent risk factors. Under ACOG recommendations, 45% of our general obstetric population would have been exempt from gestational diabetes mellitus screening, as compared with only 15.5% under ADA guidelines. Sixty-five patients were diagnosed as having gestational diabetes mellitus, giving an overall prevalence of 2.5% (confidence interval 2.0-3.2). Among the low-risk women, prevalence values were 0.6% and 0.5% respectively under ACOG and ADA criteria, whereas for those presenting one or more risk factors rates were 4% and 2.9% respectively. CONCLUSIONS: In our general obstetric population, gestational diabetes mellitus prevalence was found to be approximately six times lower among low-risk gravidae than among the high-risk subjects, suggesting that selective screening might be beneficial. Nevertheless, selective gestational diabetes mellitus screening under ADA criteria seems to entail the same disadvantages as the selective screening strategies without any apparent benefits.

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