Screening for pregestational and gestational diabetes in pregnancy: a survey of obstetrical centers in the northern part of Belgium

Abstract

BackgroundThere is lack of consensus concerning the best screening strategy for gestational diabetes (GDM). The aim of our survey was therefore to investigate attitudes and practices of all obstetrical centers in the northern part of Belgium regarding screening for pregestational diabetes in early pregnancy and screening for GDM. We also aimed to identify the penetrance of the ‘International Association of Diabetes in Pregnancy Study Groups’ (IADPSG) screening strategy for GDM.MethodsThe survey was conducted from May 2012 till January 2013. The survey was distributed to every obstetrical center in the northern part of Belgium by email and/or mail with reminders by phone and personal contact.ResultsFrom the 65 obstetrical centers, 69% responded. Of all centers, 27% had a structured database on the number of women with GDM. Of all centers, 82% screened for pregestational diabetes in early pregnancy and 56% of centers screened for GDM before 24 weeks. Screening before 24 weeks was mostly based on risk factors. Screening for GDM after 24 weeks, was done universally in 87% of centers. The mean estimated prevalence of GDM was 7 ± 5%. The most commonly used screening strategy was a two-step approach with a glucose challenge test (GCT) and 100 g oral glucose tolerance test (OGTT), used by 56% of centers, with 23 centers using the Carpenter & Coustan criteria. The 75 g OGTT with the IADPSG criteria was used by 33% of centers but 4 of these centers still used a GCT before proceeding to the full OGTT.ConclusionsThis survey demonstrates that in the northern part of Belgium, there still is a large variation in screening strategy for pregestational diabetes in early pregnancy and GDM. Only 25% of centers have already implemented the one-step IADPSG screening strategy.

A proposal for the use of uniform diagnostic criteria for gestational diabetes in Europe: an opinion paper by the European Board & College of Obstetrics and Gynaecology (EBCOG)

“…A recent review also shows that screening and management of GDM is very variable across Europe, partly due to the ongoing controversy and inadequate clinician awareness of GDM [23]. A recent survey performed in the northern part of Belgium highlights that policies are often also inconsistent even within one region [24]. Comparisons between countries are very challenging because of the different screening strategies and diagnostic criteria used and different ethnicities.…”

“…Several countries in Europe such as Ireland, France and the French-speaking part of Belgium, have started to use a 75 g OGTT with IADPSG criteria, but often this is performed only in high-risk women and not universally [24][25][26][27]. In some countries in Europe, such as Germany, a 75 g OGTT with IADPSG criteria is not performed as a one-step screening strategy but instead a 75 g OGTT is performed only following an abnormal GCT [28].…”

“…However, there are currently no data on the validity of GCT as a universal screening test in a twostep strategy with IADPSG criteria. Some countries and regions in Europe use selective screening with the previous WHO diagnostic criteria (the UK and the Netherlands, for example), while others use the ACOG screening strategy (the Flemish part of Belgium, for example) [24,29,30]. Other countries use risk-factor-based or universal screening and the criteria of the EASD or the National Diabetes Data Group [31,32] Developing a consensus on screening for GDM in Europe is challenging, as ethnic populations are diverse across Europe and healthcare delivery systems differ.…”

Glucose Intolerance after a Recent History of Gestational Diabetes Based on the 2013 WHO Criteria

“…Leuven is a medium size city in the region of Flanders and has a population with a rather low background number of women from ethnic minorities (EM) (10.9%) [ 10 ]. Accurate data on the prevalence of GDM are lacking in Belgium and the current practice for screening for GDM varies across different centers [ 11 ]. Women are not yet universally screened for overt diabetes at first prenatal visit in our hospital.…”

Implementing a Reminder System in the Northern Part of Belgium to Stimulate Postpartum Screening for Glucose Intolerance in Women with Gestational Diabetes: The “Sweet Pregnancy” Project

“…There are currently no data on the general prevalence of GDM in Flanders. A survey performed in 2013 has shown that screening practices for GDM vary largely between centers [ 25 , 26 ]. The most commonly used screening strategy for GDM in Flanders is still a two-step approach with a 50 g glucose challenge test and 100 g OGTT with the Carpenter and Coustan criteria for GDM, used by 56% of centers, followed by the one-step screening strategy with the 75 g OGTT using the 2013 WHO criteria for GDM, implemented by 25% of centers [ 26 ].…”