Universal versus selective screening for gestational diabetes mellitus among antenatal clinic attendees in Abakaliki: using the one-step 75 gram oral glucose tolerance test

Abstract

Aim To compare universal screening with selective risk factor based screening for GDM, using the one-step 75 g oral glucose tolerance test (OGTT). Materials and method A cross-sectional, comparison between universal and selective risk factor based screening for GDM, among 400 antenatal care clients at Alex-Ekwueme Federal University Teaching Hospital Abakaliki (AE-FUTHA). All the participants had 75 g OGTT at 24–28 weeks of gestation and risk factor screening for GDM. All 400 participants formed the universal group while participants with one or more of the considered risk factors formed the selective risk factor group. Data were analyzed using IBM SPSS version 20. Statistical comparison was done using t- test for continuous variables. Logistics regression was used to determine the level of associations of the independent predictors for hyperglycemia. Level of significance was set at P < 0.05. Results The point prevalence of GDM using universal and selective screening were 11.51 and 7.93% respectively, giving a selective screening miss rate of 31.11%. The sensitivity, specificity, positive predictive value and negative predictive value were 73.58, 48.82, 19.12 and 92.51% respectively for the selective risk factor based screening compared to universal screening. On multivariate analysis; age ≥ 35 years, weight ≥ 90 kg, history of previous GDM and hypertension were significantly related to the development of hyperglycemia. Conclusion Selective risk factor based screening missed 31.11% of patients with GDM when compare to Universal screening with one step 75 g OGTT. Universal screening for GDM using the one step 75 g OGTT is recommended for pregnant women and more studies are needed to compare pregnancy outcomes for pregnant women diagnosed with GDM with and without risk factors.

Evolution of Gestational Diabetes Mellitus across Continents in 21st Century

“…The results showed that the GDM incidence was higher with the universal screening (11.51%) than for the selective screening (7.93%), which provided a miss rate of 31.11%. They also found positive correlations between hyperglycemia and previous history of GDM and hypertension, weight ≥ 90 kg, and age ≥ 35 years [ 39 ].…”

Historical and statistical aspects of risk groups analysis and testing in the context of gestational diabetes mellitus

“…In a retrospective study comparing universal and selective screening (based on high risk using ADA criteria), 18,000 patients were examined [19]. If only high-risk patients were screened, 3% of women would remain with undiagnosed GDM.…”

Gestational Diabetes and Preterm Birth: What Do We Know? Our Experience and Mini-Review of the Literature

“…There are two main approaches to screening for GDM: universal testing, which evaluates all patients, and selective testing, which focuses on high-risk individuals. High-risk individuals include overweight or obese women with a history of giving birth to large babies, a family history of type 2 diabetes, or a personal history of gestational diabetes [4,5].…”