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?

Chevalier, Nicolas; Fénichel, Patrick; Giaume, V.; Loizeau, S.; Bongain, A.; Daideri, G.; Brucker‐Davis, Françoise; Hiéronimus, S.

doi:10.1016/j.diabet.2011.01.004

Cited by 20 publications

(9 citation statements)

References 26 publications

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“…The prevalence of gestational hypertension, prematurity, and cesarean sections and the number of LGA and SGA were reduced, and fewer newborns presented 1-min Apgar scores ,7. Thus, the introduction of these criteria was cost-effective, in spite of a rise in the prevalence of GDM by a factor of 3.5, as was to be expected (10)(11)(12)(13)(14)(18)(19)(20). Savings were primarily due to a reduction in cesarean sections, as well as to fewer neonate admissions to intensive care.…”

Section: Discussionmentioning

confidence: 91%

Introduction of IADPSG Criteria for the Screening and Diagnosis of Gestational Diabetes Mellitus Results in Improved Pregnancy Outcomes at a Lower Cost in a Large Cohort of Pregnant Women: The St. Carlos Gestational Diabetes Study

et al. 2014

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OBJECTIVE The use of the new International Association of the Diabetes and Pregnancy Study Groups 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 to 3.5%: −14.6%, P < 0.021), prematurity (6.4 to 5.7%: −10.9%, P < 0.039), cesarean section (25.4 to 19.7%: −23.9%, P < 0.002), small for gestational age (7.7 to 7.1%: −6.5%, P < 0.042), large for gestational age (4.6 to 3.7%: −20%, P < 0.004), Apgar 1-min score <7 (3.8 to 3.5%: −9%, P < 0.015), and admission to neonatal intensive care unit (8.2 to 6.2%: −24.4%, P < 0.001). Estimated cost savings was of €14,358.06 per 100 women evaluated using IADPSGC 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.

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Section: Discussionmentioning

confidence: 91%

Introduction of IADPSG Criteria for the Screening and Diagnosis of Gestational Diabetes Mellitus Results in Improved Pregnancy Outcomes at a Lower Cost in a Large Cohort of Pregnant Women: The St. Carlos Gestational Diabetes Study

et al. 2014

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“…However, in previous studies, 20-50% of women with GDM had no risk factors for this condition (1,15,22,23). One reason for this might be the nature of the risk factors: Many of them are based on previous pregnancy history, including prior GDM or previous macrosomic newborns, but these factors do not apply to primiparous women.…”

Section: Discussionmentioning

confidence: 98%

The changing face of gestational diabetes: the effect of the shift from risk factor-based to comprehensive screening

Koivunen

Kajantie

Torkki

et al. 2015

European Journal of Endocrinology

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Objective: To evaluate the effect of the change in the gestational diabetes (GDM) screening policy from risk-factor based to comprehensive screening on the prevalence and type of GDM and characteristics of GDM pregnancies. Design: Population-based register study in Finland. Subjects were GDM women who gave birth before (2006, nZ5185) and after (2010, nZ6683) the policy change. All the other women in those years without pre-pregnancy diabetes acted as controls (51 759 and 52 398 respectively). Methods: GDM women with singleton pregnancy were identified through The Finnish Medical Birth Register by abnormal oral glucose tolerance test or initiation of insulin. Main outcome measures were prevalence of GDM (total and insulin/ diet-treated), and caesarean section rate. Results: The proportion of screened mothers increased from 27.5 to 51.3% and the total prevalence of GDM from 9.1 to 11.3%. This increase consisted mainly of diet-treated mothers, while the number and proportion of insulin-treated mothers decreased (21.8% vs13.3%, P!0.001). The proportion of primiparous women increased (34.5-39.4%, P!0.0001) and mean pre-pregnancy BMI decreased (28.6-28.2, P!0.001). The overall caesarean section rate remained the same but increased among women with .1%) adjusted odds ratios being 1.22 (95% CI 1.14, 1.31) during comprehensive and 1.10 (95% CI 1.02, 1.19) during risk factor-based screening. Conclusions: The shift to comprehensive screening led to a significant increase in women with GDM, who were more often primiparous and had a lower BMI. Comprehensive screening did not perform better in diagnosing women needing insulin treatment.

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“…Aggressive management of these low-risk women, while reducing the risk of LGA, might lead to fetal growth restriction. In a study by Chevalier et al [44] on 2014 women who underwent systematic screening, treatment of GDM was associated with a SGA rate of 20%, versus 13.3% in patients with risk factors. In our study, the incidence of SGA tended to be higher in GDM without risk factors than in GDM with risk factors, but this did not reach statistical significance.…”

Section: Commentmentioning

confidence: 96%

“…In order to implement selective screening without missing women with risk factors, an ''opt-out'' approach whereby women without risk factors are exempted from testing would be less demanding on the health provider than an ''opt-in'' approach. The choice between universal and selective screening should depend on the organization of prenatal care and the characteristics of the pregnant population [44], which differ widely between centers around the world.…”

Section: Commentmentioning

confidence: 99%

Selective rather than universal screening for gestational diabetes mellitus?

Miailhe¹,

Kayem²,

Girard³

et al. 2015

European Journal of Obstetrics & Gynecology and Reproductiv

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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?

Cited by 20 publications

References 26 publications

Introduction of IADPSG Criteria for the Screening and Diagnosis of Gestational Diabetes Mellitus Results in Improved Pregnancy Outcomes at a Lower Cost in a Large Cohort of Pregnant Women: The St. Carlos Gestational Diabetes Study

Introduction of IADPSG Criteria for the Screening and Diagnosis of Gestational Diabetes Mellitus Results in Improved Pregnancy Outcomes at a Lower Cost in a Large Cohort of Pregnant Women: The St. Carlos Gestational Diabetes Study

The changing face of gestational diabetes: the effect of the shift from risk factor-based to comprehensive screening

Selective rather than universal screening for gestational diabetes mellitus?

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