Universal vs. risk-factor-based screening for gestational diabetes—an analysis from a 5-Year Portuguese Cohort

Abstract

Purpose The criteria to screen for Gestational Diabetes Mellitus are not internationally consensual. In opposition to the universal screening performed in Portugal, certain countries advocate a risk-factor-based screening. We aim to compare obstetric and neonatal outcomes in pregnant women with and without risk factors treated for Gestational Diabetes Mellitus. Methods Retrospective and multicentric study of 12,006 pregnant women diagnosed with Gestational Diabetes Mellitus between 2011 and 2015, in Portugal. Gestational Diabetes Mellitus was diagnosed according to the International Association of the Diabetes and Pregnancy Study Groups criteria. Risk factors: body mass index > 30kg/m 2 , history of Gestational Diabetes Mellitus, history of macrossomic newborn (birth weight > 4000 g) or first-degree relatives with Type 2 Diabetes Mellitus. Exclusion criteria: lack of data concerning risk factors (n = 1563). Results At least one risk factor was found in 68.2% (n = 7123) pregnant women. Pregnant women with risk factors were more frequently medicated with insulin (p < 0.001), caesarean section was more commonly performed (p < 0.001), their newborns were more frequently large-for-gestational-age (p < 0.001) and neonatal morbidity was higher (p = 0.040) in comparison to pregnant women without risk factors. The Diabetes Mellitus reclassification test showed an increased frequency of intermediate hyperglycaemia and Diabetes Mellitus in women with risk factors (p < 0.001). Conclusion Almost one-third of pregnant women would have remained undiagnosed if risk-based-factor screening were implemented in Portugal. Women without risk factors presented fewer obstetric and neonatal complications. However, more than one third required insulin therapy.

Intimate Partner Violence: A Risk Factor for Gestational Diabetes

“…The high costs and technical challenges of the OGTT have resulted in many countries using risk factor-based selective screening, followed by OGTT diagnosis, as the cornerstone of GDM diagnosis [6]. Unfortunately, the currently available risk factors (overweight or obesity, excessive gestational weight gain, advanced maternal age, family history of diabetes, previous history of GDM, and adverse pregnancy outcomes) have poor predictive value and fail to identify a large percentage of women with GDM, thus limiting their use as screening tools [29,35,36]. Therefore, the identification of novel risk factors or biomarkers that could be targeted to prompt OGTT screening and GDM diagnosis has become an increasing focus of GDM research.…”

An Update on Screening Strategies for Gestational Diabetes Mellitus: A Narrative Review

“… 80 A more recent retrospective study in more than 12,000 women confirmed that women with GDM diagnosed according to the IADPSG criteria without risk factors had fewer obstetric and neonatal complications compared with those having risk factors. 82 In contrast, several studies showed that missed GDM cases without risk factors had worse pregnancy outcomes than women without GDM. 77 , 78 For example, data from the Irish ATLANTIC-DIP study reported that selective screening based on risk factors in a Caucasian population missed 20% (using National Institute for Health and Care Excellence (NICE) criteria), 16% (following Irish guidelines), and 5% (with ADA guidelines) of women diagnosed with GDM using IADPSG criteria.…”

Perspectives on gestational diabetes mellitus in South Africa

“…The primary healthcare services, which are generally the first port of call for pregnant women, are often fraught with difficulties, from problems with access to lack of continuity of care and understaffing, bringing into question the true appreciation of the disease burden. While risk factor-based screening remains the cornerstone of screening strategies in LMICs owing to its cost and ease, numerous studies [37,38] have demonstrated the poor predictive value of this approach to screening, with a local study [28] showing that 10.6% of HFDP cases would have been missed.…”