Evaluation of the impact of universal testing for gestational diabetes mellitus on maternal and neonatal health outcomes: a retrospective analysis

Abstract

BackgroundGestational diabetes (GDM) affects a substantial proportion of women in pregnancy and is associated with increased risk of adverse perinatal and long term outcomes. Treatment seems to improve perinatal outcomes, the relative effectiveness of different strategies for identifying women with GDM however is less clear.This paper describes an evaluation of the impact of a change in policy from selective risk factor based offering, to universal offering of an oral glucose tolerance test (OGTT) to identify women with GDM on maternal and neonatal outcomes.MethodsRetrospective six year analysis of 35,674 births at the Women’s and Newborn unit, Bradford Royal Infirmary, United Kingdom.ResultsThe proportion of the whole obstetric population diagnosed with GDM increased almost fourfold following universal offering of an OGTT compared to selective offering of an OGTT; Rate Ratio (RR) 3.75 (95% CI 3.28 to 4.29), the proportion identified with severe hyperglycaemia doubled following the policy change; 1.96 (1.50 to 2.58). The case detection rate however, for GDM in the whole population and severe hyperglycaemia in those with GDM reduced by 50-60%; 0.40 (0.35 to 0.46) and 0.51 (0.39 to 0.67) respectively. Universally offering an OGTT was associated with an increased induction of labour rate in the whole obstetric population and in women with GDM; 1.43 (1.35 to 1.50) and 1.21 (1.00 to1.49) respectively. Caesarean section, macrosomia and perinatal mortality rates in the whole population were similar. For women with GDM, rate of caesarean section; 0.70 (0.57 to 0.87), macrosomia; 0.22 (0.15 to 0.34) and perinatal mortality 0.12 (0.03 to 0.46) decreased following the policy change.ConclusionsUniversally offering an OGTT was associated with increased identification of women with GDM and severe hyperglycaemia and with neonatal benefits for those with GDM. There was no evidence of benefit or adverse effects in neonatal outcomes in the whole obstetric population.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2393-14-317) contains supplementary material, which is available to authorized users.

Maternal and fetal outcome of comparative study between old & adopted new value of screening of Gestational Diabetes Mellitus in tertiary centre in Saudi Arabia

“…The method was also cost effective. This type of universal screening was supported in earlier studies by [11] (in the year 2000) and recently by [12] and [13] etc.…”

The identification and treatment of women with hyperglycaemia in pregnancy: an analysis of individual participant data, systematic reviews, meta-analyses and an economic evaluation

“…Criteria recommending that all women are offered testing, rather than only 'high-risk' women, will increase the prevalence of GDM irrespective of glucose level thresholds used. 124 Differing population characteristics explain some of the diversity in prevalence estimates. In the BiB study, 22 GDM prevalence in SA women was two-to threefold greater than in WB women (see Tables 4 and 12).…”

“…Uptake of the offer varied between the two cohorts [63% (the BiB study 22 ) vs. 58% (the Atlantic DIP study 59 )]. 124,137 We have examined the following characteristics because they are associated with a greater risk of GDM development, and their use as indicators for OGTT is recommended by institutions including NICE 18 and the ADA.…”

“…Offering all women an OGTT may avoid missed cases through selection; however, the uptake of a universal offer of OGTT is between 63% and 75% depending on population and, therefore, a universal offer will also miss cases. 124,137,150 Furthermore, offering an OGTT to all women may unnecessarily 'medicalise' some pregnancies at relatively lower risk, and this may adversely affect the woman's experience and possibly increase the risk of medical interventions such as induction of labour and C-section.…”

“…124 Prevalence of GDM is increasing alongside rising levels of obesity and inactivity, which can increase insulin resistance, 125 mirroring the increasing rate of type 2 diabetes in the non-pregnant population.…”