Controversies in Screening and Diagnosis of Gestational Diabetes: Cuba’s Position

Abstract

médico con doble especialidad en endocrinología y en medicina familiar y maestría en salud integral de la mujer. Profesor auxiliar e investigador adjunto,

Does Universal Screening for Gestational Diabetes Mellitus Improve Neonatal Outcomes in a Socially Vulnerable Population: A Prospective Study in French Guiana

“…The main known risk factors were: age > 35 years (50%), family history of diabetes in a first or second-degree relative (50%), history of GDM (16%) and ethnic characteristic (black, and hispanic) (20). Several studies demonstrated the role of maternal age as a risk factor within the framework of GDM screening (7,8,21). The mean age in our study was indeed similar to reports from France and worldwide (13,14).…”

“…In contrast, in French Guiana, the prevalence of macrosomia (2.6%), corrected for age and sex, was low, despite frequent social precariousness (42). In Cuba, Cruz et al found macrosomia rates of 10% to 20% (7). This difference between our study and the prevalence of macrosomia in neighboring countries or in South America, where precariousness is also frequent, is probably linked with the routine hospital admission of high-risk pregnancies in French Guiana during the last 2 months and/or weekly follow-up in multidisciplinary consultations for patients with easy mobility.…”

“…Patients from isolated areas and, especially, patients with gestational diabetes mellitus (GDM) are usually transferred to the Level III maternity unit from the 8th month of pregnancy onward for monitoring, due to the geographic distances. The risk factors most often associated with GDM include being overweight (body mass index [BMI] >25), age (>35 years), history of GDM, familial diabetes, and ethnicity (7,8). Obstetrical and neonatal complications of GDM include macrosomia, preeclampsia, prematurity, shoulder dystocia, neonatal hypoglycemia, and cesarean delivery (8).…”

“…The diagnostic and screening criteria for patients with GDM vary between different countries. In 2011, Vignoles et al reported a GDM prevalence of 5.1% in Guadeloupe (French overseas department) using the World Health Organization (WHO) criteria (7,9); while in Mainland France the GDM prevalence was found between 5 and 8%, but a single center study detected during a systematic screening a prevalence of 14% based on the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria (10). Some studies have found differences in GDM prevalence that are linked to ethnicity; In 2012, a study conducted in the United States by Kim et al found variable GDM prevalence, with Pacific Islanders being at a relatively high risk (9.9%) (11).…”