Diagnostic and Prognostic Performances Over 9 Years of a Selective Screening Strategy for Gestational Diabetes Mellitus in a Cohort of 18,775 Subjects

Abstract

OBJECTIVEWe aimed to evaluate a selective screening strategy for gestational diabetes mellitus (GDM) based on the presence of risk factors: BMI ≥25 kg/m2, age ≥35 years, family history of diabetes, personal history of GDM, or birth of a child with macrosomia.RESEARCH DESIGN AND METHODSOf 20,630 deliveries between 2002 and 2010, we selected 18,775 deliveries in women with no known diabetes and for whom all risk factors were known. GDM was universally screened and defined as fasting plasma glucose level ≥5.3 mmol/L and/or 2-h postload (75 g) glucose level ≥7.8 mmol/L.RESULTSThe prevalence of at least one risk factor has increased since 2002 (P < 0.001) from 51.7 to 61.5%, with no change in the GDM prevalence (mean 14.4%, intention to screen). At least one risk factor was present in 58.5% of women who represented 65.3% of all those with GDM. The presence of risk factors was significantly associated with GDM (odds ratio 1.4 [95% CI 1.3–1.5], P < 0.001) and with GDM-related events (preeclampsia/large for gestational age/dystocia) (P < 0.001) with the following incidences: no GDM/no risk factor 8.8%, no GDM/risk factor 11.1%, GDM/no risk factor 16.7%, and GDM/risk factor 18.2%.CONCLUSIONSThe presence of risk factors increased during the last decade. This condition is predictive of GDM and GDM-related events. However, a selective screening would lead to missing one-third of the women with GDM who, even without risk factors, had more events than women without GDM. Therefore, these data stand against the present selective screening currently proposed in the French guidelines.

Gestational diabetes mellitus screening and outcomes

“…The rate of adverse events in this group was similar to all the other women with GDM. Similar findings have been recently reported (24,25).…”

The impact of ovulation induction and ovarian stimulation on the risk of pregnancy-induced hypertension and on neonatal outcomes: A case/control study

“…However, the rate of GDM was particularly high, more than 13% in all of the groups, as we already observed in our total cohort [33], and the possibly greater risk associated with PCOS/ovarian induction or stimulation/ART might have been concealed by the high rate of GDM and its risk factors in our specific population [33], some of which are also possible risk factors for infertility (age, obesity).…”

Screening for dysglycaemia during pregnancy: Proposals conciliating International Association of Diabetes and Pregnancy Study Group (IADPSG) and US National Institutes of Health (NIH) panels

“…It was observed that the presence of conventional risk factors as reported in the French guidelines was indeed predictive of GDM and associated with a poorer prognosis, independently of GDM status [17]. However, this selective screening would have missed one-third of the women with GDM who, even without risk factors, still had more events than women without GDM.…”