An audit of a comprehensive screening programme for diabetes in pregnancy

Abstract

Universal screening of gestational diabetes (GDM) has been advocated but is seldom practised in the United Kingdom. We report 12 months' audit of a comprehensive screening programme for women attending a teaching hospital for antenatal care. The population served is almost exclusively Caucasian. Of 4,016 women who booked in for delivery at the hospital, 3,3 16 (83%) completed the screening protocol. Sixty-seven women (1.7%) were found to have gestational diabetes after a 75 gram oral glucose tolerance test (OG n) by WHO criteria. Of these, 43 were identified by following the screening protocol (one at booking following a random venous plasma glucose result of >7.0 mmoUL, 42 after a third trimester 50 gram glucose challenge) and 24 as a result of OGTTs performed on clinical grounds. Clinical suspicion was usually raised by the identification of clinical risk factors for diabetes. Seventy OGTTs were requested despite a normal third trimester 50 gram challenge result and generated eight abnormal results, although these were at a latergestation than those generated by abnormal 50 gram results. Fifty two women (78%) were referred to the combined diabetes-antenatal clinic. Only eight women (12%) received insulin. Thirty five women (52%) returned for postnatal O G n , of which four were abnormal. We have confirmed the low prevalence of GDM in a predominantly Caucasian population and would question the value of first trimester screening in such a population. The screening protocol is only valuable if abnormal results are acted upon and, while there is disagreement among clinicians regarding the value of treating GDM, not all women with abnormal results receive dietary advice. Practical Diabetes Int 1998; 15(2): 45-48

Hyperglycemia in pregnancy: prevalence, impact, and management challenges

“…The ADIPS recommends the 75 g OGTT at 6–12 weeks postnatal period, 12 and the UK NICE recommends a fasting plasma assessment; 13 however, the OGTT will also identify impaired glucose tolerance (2-hour postload sample ≥11.1 mmol/L) as well as impaired fasting glucose so may be preferred and the test that adequately identifies abnormal postnatal glucose metabolism and insulin resistance may depend on population characteristics. 38 , 39 However, rates of attendance at this postnatal assessment are low 40 , 41 and may reflect women’s perception of personal low risk as described earlier and also a lack of perceived importance placed on this condition by clinicians.…”

The identification and treatment of women with hyperglycaemia in pregnancy: an analysis of individual participant data, systematic reviews, meta-analyses and an economic evaluation

“…We also identified three cohorts with IPD (the Atlantic DIP study, 59 Warwick/Coventry 60 and the BiB study 22 ), reporting GDM prevalence for a UK or Irish cohort. 42,44,118,[126][127][128][129][130][131][132][133][134] After data extraction, two publications 128,134 were excluded because they reported data from the same cohort. One additional paper (on the HAPO cohort 6 ) was included, having been identified for another review undertaken as part of this project (see Chapter 3).…”

“…This assumes that, conditional on diagnosis of GDM, the experience of having been risk factor screened prior to diagnosis influences uptake of further screening. Gregory et al 127 reported an uptake of follow-up for women with GDM who were identified with universal OGTT of 52%. For women who were previously screened by risk factors, a higher estimate of follow-up uptake was identified (83%) from a retrospective study 233 based on routine hospital data collected in Bradford.…”

“…We identified 13 studies 22,42,44,59,60,118,[126][127][128][129][131][132][133] undertaken over 25 years in varied areas of England and Ireland. We were able to demonstrate how prevalence changed over these 25 years and how participant characteristics and criteria influence prevalence.…”