A Pilot Community-Based Screening Program for Gestational Diabetes

Abstract

A pilot community-based screening program for gestational diabetes has been in operation in Cleveland, Ohio, since April 1, 1977. A socioeconomic and racially heterogeneous group of pregnant women are being routinely tested at approximately 24-28 wk of gestation by a capillary whole blood glucose determination, 2-h after a 75-g oral challenge. The results of the first 2225 screenings are analyzed in terms of the variables of maternal race, age, and stage of gestation. The overall incidence of positive screenings (greater than or equal to 120 mg/dl) is shown to be 11.5%, with significantly more positive tests among the whites than the nonwhites. Follow-up oral glucose tolerance testing results in an overall detection rate for abnormal carbohydrate metabolism of 3.1%. The data suggest that a 2-h screening procedure is more efficient than a 1-h procedure in that fewer confirmatory glucose tolerance tests need to be performed in order to yield this rate of detection. It may soon be feasible to introduce such a program on a wider community basis in concert with regionalized perinatal care.

Screening for Gestational Diabetes: Optimum Timing and Criteria for Retesting

“…The outcome of this longitudinal study confirms the cross-sectional study of Merkatz et al 4 and suggests that all pregnant patients should be screened between 27 and 31 wk of gestation. Before this gestational age the pregnancy does not appear to significantly affect carbohydrate metabolism as to elicit GDM, nor is there a relationship to subsequent infant birth weight when a positive GCT is found.…”

Geographic, Ethnic, and Racial Variations in the Incidence of Gestational Diabetes Mellitus

“…13 Sutherland 31 Mestman 12 •I* *"Gestational diabetes" has been defined differently in these studies, with oral glucose loads between 50 g and 100 g, or 25 g intravenously, and with different methods of assessing an abnormal result. R HADDE.M was 40 times more prevalent than in the South Boston population (60% white, 40% non-white) studied by O'Sullivan, 25 and 10 times more prevalent than in the Cleveland population (61% white, 39% non-white) studied by Merkatz et al 13 Although O'Sullivan did not find a racial difference in his population, Merkatz did show that the white pregnant women of Cleveland were more likely to show glucose values in the upper end of the normal distribution, although they were also older, taller, thinner, and studied later in gestation than the non-white women. The hyperglycemic Pima women did show an increase in perinatal mortality, macrosomia, toxemia, and cesarean section, but not of congenital malformations.…”

Is gestational diabetes a clinical entity?

“…Gabbe et al found amongst 196 Class A diabetic mothers that 13% had a history of previous stillbirth [28]. Likewise, Merkatz et al [10] noted that among 124 multiparous women with gestational diabetes who had a total of 288 pregnancies, the perinatal mortality was 9.7% (18 stillbirths and 10 neonatal deaths). In other words, in previous pregnancies when diabetes was unsuspected, possibly because it was less severe, perinatal mortality is at least five times higher than among normal mothers.…”

“…O'Sullivan [61, studying a mixed Caucasoid and American negro population from Boston, USA, reported an incidence of gestational diabetes of 2.5% amongst 752 pregnant women. Merkatz et al [10], using a 75-g glucose load rather than the 100-g load of O'Sullivan, administered mainly between 20-32 weeks of pregnancy and using a modified form of O'Sullivan's criteria, found an incidence of 3.3% among 1352 whites and of 2.9% among 855 blacks living in Cleveland, USA, the difference being statistically significant. A figure for the overall incidence of gestational diabetes in an obstetric population subjected to universal screening seems to vary between 1.6% [11], 2.5% when a full oral glucose tolerance test was performed on all subjects [12] and a top figure of 3.0% [101.…”