Screening in high-risk group of gestational diabetes mellitus with its maternal and fetal outcomes

Background: Gestational Diabetes Mellitus (GDM) is associated with several adverse maternal and perinatal outcomes. Thus, screening for early detection of GDM and its treatment is important.Methods: This was hospital based descriptive study done over one year in department of Obstetrics and Gynecology, TUTH, Nepal. Six hundred ninety-seven women fulfilling the inclusion criteria were enrolled at 18-22 weeks of gestation. High risk factors were assessed and GCT was performed in women with risk factors during enrollment. Diagnostic OGTT was performed in women who screened positive (GCT ≥130mg/dl). Screen negative high-risk women were re-screened at 24-28 weeks. In women without known risk factors, GCT was performed at 24-28 weeks and OGTT was performed when screen positive. The diagnosis of GDM was made according to Carpenter and Coustan criteria.Results: Out of 697 enrolled women, 12 were excluded for various reasons and 685 women were analyzed. Women having risk of GDM were 28.9%. The prevalence of GDM was 2.92% and 2.48% with GCT cut off 130 mg/dl and 140 mg/dl respectively. Lowering the threshold to 130 mg/dl identified three extra cases (p=0.010). The prevalence among high risk group was 8.58% and 7.07% with the cut off value 130 mg/dl and 140 mg/dl respectively with three extra cases detected on taking cut off value 130 mg/dl (p=0.014). Among low risk women the prevalence of GDM was same i.e. 0.61% with both the cut off values.Conclusions: Lowering threshold of GCT to 130 mg/dl could identify significant percentage of extra cases of GDM especially in high risk women.

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Occurrence of gestational diabetes mellitus, maternal and fetal outcomes beyond the 28th week of gestation in women at high risk of gestational diabetes. A prospective study

Diabetes & Metabolism ◽

10.1016/j.diabet.2007.03.003 ◽

2007 ◽

Vol 33 (4) ◽

pp. 290-295 ◽

Cited By ~ 11

Author(s):

M. Virally ◽

M. Laloi-Michelin ◽

T. Meas ◽

N. Ciraru ◽

N. Ouled ◽

...

Keyword(s):

Diabetes Mellitus ◽

High Risk ◽

Gestational Diabetes ◽

Gestational Diabetes Mellitus ◽

Prospective Study ◽

Fetal Outcomes ◽

A Prospective Study

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Oral glucose tolerance testing at gestational weeks ≤16 could predict or exclude subsequent gestational diabetes mellitus during the current pregnancy in high risk group

European Journal of Obstetrics & Gynecology and Reproductive Biology ◽

10.1016/j.ejogrb.2004.11.006 ◽

2005 ◽

Vol 121 (1) ◽

pp. 51-55 ◽

Cited By ~ 14

Author(s):

Tamás Bitó ◽

Tibor Nyári ◽

László Kovács ◽

Attila Pál

Keyword(s):

Diabetes Mellitus ◽

High Risk ◽

Gestational Diabetes ◽

Glucose Tolerance ◽

Risk Group ◽

High Risk Group ◽

Oral Glucose ◽

Oral Glucose Tolerance ◽

Oral Glucose Tolerance Testing ◽

Tolerance Testing

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Risk of Gestational Diabetes Mellitus (GDM) Using Clinical Prediction Model Based on Maternal Characteristics

Journal of Armed Forces Medical College Bangladesh ◽

10.3329/jafmc.v11i1.30675 ◽

2016 ◽

Vol 11 (1) ◽

pp. 64-68 ◽

Cited By ~ 1

Author(s):

Sharmin Jahan ◽

Mohammad Ali

Keyword(s):

Diabetes Mellitus ◽

High Risk ◽

Gestational Diabetes ◽

Gestational Diabetes Mellitus ◽

Prediction Model ◽

Predictive Value ◽

Area Under Curve ◽

Risk Group ◽

Clinical Prediction ◽

Clinical Prediction Model

Introduction: The healthcare delivery challenges in Bangladesh are phenomenal. Improving maternal and child health, reducing the high maternal and infant mortality & morbidity are challenging. Arrangement of additional expenditure for GDM screening is again challenging. The efficiency of screening could be enhanced by considering womens risks of gestational diabetes on the basis of their clinical characteristics.Objectives: To find out the use of the clinical prediction model of gestational diabetes mellitus (GDM) is valid for Bangladeshi pregnant women and to assess the risk of gestational diabetes by using clinical prediction model based on maternal characteristics.Materials and Methods: A cross sectional study was carried out from July 2011 to June 2012 among purposively selected 217 pregnant women of ?24 weeks of gestation in the Gynae and Obstetric outpatient department of Combined Military Hospital, Dhaka. Data were collected by face to face interview, anthropometric measurement and record review. Two step oral glucose tests were done for diagnosis of GDM.Results: According to Chadakaran clinical prediction model 84 (38.7%) respondents were at high risk, 92 (42.4%) were at intermediate risk and 41(18.9%) found at low risk of gestational diabetes but only 24(11.05%) developed gestational diabetes. Highest occurrence of gestational diabetes was found in high risk group 17 (20.2%) with zero occurrence in low risk group. Risk score performance at the level of ?380, sensitivity was 100% and specificity 21.8%, 13.6% positive predictive value, 100% negative predictive value and area under curve was 0.385. At the level of 460 score the sensitivity and specificity was found closest (70.8% and 65.3%, respectively) and area under curve was highest 0.657. The receiver operating characteristics curve of the risk score in the study sample for predicting women with glucose tolerance test demonstrated an area 0.763 (95%, 0.682 0.845).Conclusion: The use of clinical prediction model is a simple, non invasive, cost effective useful method to identify women at increased risk of gestational diabetes mellitus and could be short listed for further testing.Journal of Armed Forces Medical College Bangladesh Vol.11(1) 2015: 64-68

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