Universal two-step screening strategy for gestational diabetes has weak relevance in French Mediterranean women: Should we simplify the screening strategy for gestational diabetes in France?
ABSTRACT Currently, there is no international consensus for gestational diabetes mellitus (GDM) diagnosis. This is a report of our experience of GDM screening according to the 1996 French guidelines.
For 5 years, all pregnant women followed at our hospital (n=11,545) were prospectively screened for GDM between weeks 24 and 28 of pregnancy with a two-step strategy: the O'Sullivan test (OS) with a threshold at 130 mg/dL, followed by a 100-g OGTT if positive. GDM was diagnosed according to Carpenter and Coustan criteria.
Prevalence of GDM was 4.26% [344/1451 of patients with an OS of 130-199 mg/dL (12.1%); and 148 patients with an OS greater than 200 mg/dL]. The false-positive rate for the OS was 76.8%. Compared with 140 mg/dL, a threshold of 130 mg/dL caused 401 additional negative OGTTs in 90% of cases. In 80.7% GDM patients, fasting glucose was less than 95 mg/dL. The time lag between OS and OGTT was 3 weeks (1-84 days). Risk factors associated with GDM were maternal age, preconception overweight and obesity, parity, personal history of GDM or macrosomia, and familial history of obesity (P<0.05), but not diabetes. Also, 20% of GDM patients had no risk factors, whereas they were present in 75% of patients without GDM.
In our population, a two-step screening strategy for GDM was neither relevant nor efficient. It could be simplified with a single-step definitive screening strategy using a 75-g OGTT, as used in the HAPO study, and as recommended by the IADPSG and the recent French Expert Consensus. At present, there are still no evidence-based arguments to help in deciding between selective or universal screening for GDM.
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ABSTRACT: Abstract There is a debate about whether universal or risk factors based screening is most appropriate for gestational diabetes diagnosis. The aim of our retrospective study was to compare in our population the universal screening test recommended by the International Association of Diabetes in Pregnancy Study Group (IADPSG) panel and the American Diabetes Association (ADA) versus the selective screening proposed by the United Kingdom National Institute for Health and Clinical Excellence guidelines (NICE) but modified by the Italian National Institute of Health. From May 2010 to October 2011 all consecutive pregnant women were screened for gestational diabetes according to the IADPSG's panel criteria, while all the risk factors for each patient were registered. Of the 1015 pregnant women included in the study 113 (11%) were diagnosed with gestational diabetes, and 26 (23%) of them wouldn't have been identified by the selective screening proposed by the Italian National Institute of Health. However, all the risk factors considered by the selective screening revealed a good predictive role except for maternal age ≥ 35 years (OR: 0.98). In the group without the risk factors considered it was reported the predictive role for gestational diabetes of prepregnancy BMI and nulliparity. The selective risk factors based screening proposed by the Italian National Institute of Health has detected 77% of gestational diabetes cases in our population, sparing the oral glucose tolerance test for more than 40% of pregnant women at the same time. More information on the clinical impact of this choice could be obtained by a strict analysis of treatment, perinatal outcome and follow-up of an adequate sample size of "missed" gestational diabetes.The journal of maternal-fetal & neonatal medicine: the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians 11/2013; 27(14). DOI:10.3109/14767058.2013.860961 · 1.36 Impact Factor
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ABSTRACT: The use of the new International Association of Diabetes and Pregnancy Study Group criteria (IADPSGC) for the diagnosis of gestational diabetes mellitus (GDM) results in an increased prevalence of GDM. Whether their introduction improves pregnancy outcomes has yet to be established. We sought to evaluate the cost-effectiveness of one-step IADPSGC for screening and diagnosis of GDM compared with traditional two-step Carpenter/Coustan (CC) criteria.RESEARCH DESIGN AND METHODS: GDM risk factors and pregnancy and newborn outcomes were prospectively assessed in 1,750 pregnant women from April 2011 to March 2012 using CC and in 1,526 pregnant women from April 2012 to March 2013 using IADPSGC between 24 and 28 weeks of gestation. Both groups received the same treatment and follow-up regimes.RESULTS: The use of IADPSGC resulted in an important increase in GDM rate (35.5% vs. 10.6%) and an improvement in pregnancy outcomes, with a decrease in the rate of gestational hypertension (4.1-3.5%: -14.6%, P < 0.021), prematurity (6.4-5.7%: -10.9%, P < 0.039), cesarean section (25.4-19.7%: -23.9%, P < 0.002), small for gestational age (7.7-7.1%: -6.5%, P < 0.042), large for gestational age (4.6-3.7%: -20%, P < 0.004), Apgar 1-min score <7 (3.8-3.5%: -9%, P < 0.015), and admission to neonatal intensive care unit (8.2-6.2%: -24.4%, P < 0.001). Estimated cost savings was of €14,358.06 per 100 women evaluated using IADPSG versus the group diagnosed using CC.CONCLUSIONS: The application of the new IADPSGC was associated with a 3.5-fold increase in GDM prevalence in our study population, as well as significant improvements in pregnancy outcomes, and was cost-effective. Our results support their adoption.Diabetes Care 06/2014; 37(9). DOI:10.2337/dc14-0179 · 8.57 Impact Factor
Diabetes care 10/2013; 36(10):2877-8. DOI:10.2337/dc13-0833 · 7.74 Impact Factor