Appropriate Timing of Gestational Diabetes Mellitus Diagnosis in Medium- and Low-Risk Women: Effectiveness of the Italian NHS Recommendations in Preventing Fetal Macrosomia

Abstract

Background. Screening strategies for gestational diabetes mellitus (GDM) earlier than 24-28 weeks of gestation should be considered to prevent adverse pregnancy outcomes. Nonetheless, there is uncertainty about which women would benefit most from early screening and which screening strategies should be offered to women with GDM. The Italian National Healthcare Service (NHS) recommendations on selective screening for GDM at 16-18 weeks of gestation are effective in preventing fetal macrosomia in high-risk (HR) women, but the appropriateness of timing and effectiveness of these recommendations in medium- (MR) and low-risk (LR) women are still controversial. Patients and Methods. We retrospectively enrolled 769 consecutive singleton pregnant women who underwent both anomaly scan at 19-21 weeks of gestation and screening for GDM at 16-18 and/or 24-28 weeks of gestation, in agreement with the NHS recommendations and risk stratification criteria. Comparison of maternal characteristics, fetal biometric parameters at anomaly scan (head circumference (HC), biparietal diameter (BPD), abdominal circumference (AC), femur length (FL), estimated fetal weight (EFW)), and neonatal birth weight (BW) percentile among risk groups was examined. Results. 219 (28.5%) women were diagnosed with GDM, while 550 (71.5%) were normal glucose-tolerant women. Out of 164 HR women, only 62 (37.8%) underwent the recommended early screening for GDM at 16-18 weeks of gestation. AC and EFW percentiles, as well as neonates’ BW percentiles, were significantly higher in HR women diagnosed with GDM at 24-28 weeks of gestation with respect to normal glucose-tolerant women, as well as MR and LR women who tested positive for GDM. Comparative analysis between MR and LR women with GDM and women with normal glucose tolerance revealed significant differences in both AC and EFW percentiles (P<0.05), while there was no significant difference in neonatal BW percentiles. Conclusion. In MR and LR women with GDM, a mild acceleration of fetal growth can be detected at the time of anomaly scan. However, in these at-risk categories, the NHS recommendations for screening and treatment of GDM at 24-28 weeks of gestation are still effective in normalizing BW and preventing fetal macrosomia, thus supporting a risk factor-based selective screening program for GDM.

Continuous Glucose Monitoring in Women with Normal OGTT in Pregnancy

“…Our data seem large enough to suggest that the management of glucose levels, after CGM results, makes the 2 groups, controls and GDM subjects, completely similar for fetal outcomes. Concerning this field, our data seem to confirm recent publications on this topic that did not show differences in fetal growth and birth weight percentiles of neonates born to GDM mothers (classified as medium or low risk) and NGT women [ 41 , 42 ].…”

Gestational Diabetes and Risk Assessment of Adverse Perinatal Outcomes and Newborns Early Motoric Development

“…Better understanding the association between GDM and maternal, fetal, and neonatal outcomes can help us find the most appropriate timing for diagnosis of GDM and for intervention. Early detection and prevention of all adverse events related to GDM is a core stone of modern approach to a GDM problem and its consequences [ 52 ].…”

Diabetes during Pregnancy: A Maternal Disease Complicating the Course of Pregnancy with Long-Term Deleterious Effects on the Offspring. A Clinical Review

“…Quaresima et al estimated the significance of timing for GDM screening at 16–18 and 24–28 weeks of gestation to prevent fetal macrosomia in the population-based, retrospective cohort study of 769 pregnant women, stratified into three groups according to the risk factors to develop GDM in the late second trimester [ 111 ]. Abdominal circumference and estimated fetal weight in high-risk (HR) women with obesity, history of GDM, or evidence of glucose intolerance during the first trimester of pregnancy were compared to medium-risk (MR) and low-risk (LR) pregnant women and their offspring.…”

“…It was concluded that diagnosis and treatment for GDM at 24–28 weeks of gestation in women with medium and low risk are sufficient to prevent fetal macrosomia [ 111 ]. However, infants born to HR women diagnosed with GDM at 24–28 weeks of gestation have higher abdominal circumference estimated fetal weight and higher birthweight compared to normal glucose-tolerant women or MR and LR women with GDM [ 111 ]. These studies highlight the importance of early detection of glucose intolerance in pregnant women, even in the first trimester of pregnancy.…”