Early random capillary glucose level screening and multidisciplinary antenatal teamwork to improve outcome in gestational diabetes mellitus

Berg, Marie; Adlerberth, Annika; Sultan, Bo; Wennergren, Margareta; Wallin, Gunnar

doi:10.1080/00016340601110747

Cited by 18 publications

(16 citation statements)

References 26 publications

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“…Sweden is considered to have a rather low prevalence of GDM (i.e., around 1.4%) [12]. Using the current screening methods and thresholds in Sweden, this study confirmed this level of GDM.…”

Section: Discussionsupporting

confidence: 74%

“…Applying the diagnostic criteria of the International Association of Diabetes and Pregnancy Study Group (IADPSG) and the international multi-centre HAPO has demonstrated significant variability of prevalences of GDM among participating countries and even among participating study centres within the same country [11]. From a global perspective, Sweden is considered a low risk country for GDM with an annual prevalence of 1 to 2.6% of this pregnancy-related disorder [12,13]. There is, however, no international consensus regarding how women should be screened for GDM, whether screening should be undertaken universally, or whether women who present risk factors [14] should undergo screening, i.e.…”

Section: Introductionmentioning

confidence: 99%

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No consensus on gestational diabetes mellitus screening regimes in Sweden: pregnancy outcomes in relation to different screening regimes 2011 to 2012, a cross-sectional study

Lindqvist

Persson

Lindkvist

et al. 2014

BMC Pregnancy Childbirth

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BackgroundAlthough associated adverse pregnancy outcomes, no international or Swedish consensus exists that identifies a cut-off value or what screening method to use for definition of gestational diabetes mellitus. This study investigates the following: i) guidelines for screening of GDM; ii) background and risk factors for GDM and selection to OGTT; and iii) pregnancy outcomes in relation to GDM, screening regimes and levels of OGTT 2 hour glucose values.MethodsThis cross-sectional and population-based study uses data from the Swedish Maternal Health Care Register (MHCR) (2011 and 2012) combined with guidelines for GDM screening (2011–2012) from each Maternal Health Care Area (MHCA) in Sweden. The sample consisted of 184,183 women: 88,140 in 2011 and 96,043 in 2012. Chi-square and two independent samples t-tests were used. Univariate and multivariate logistic regression analyses were performed.ResultsFour screening regimes of oral glucose tolerance test (OGTT) (75 g of glucose) were used: A) universal screening with a 2-hour cut-off value of 10.0 mmol/L; B) selective screening with a 2-hour cut-off value of 8.9 mmol/L; C) selective screening with a 2-hour cut-off value of 10.0 mmol/L; and D) selective screening with a 2-hour cut-off value of 12.2 mmol/L. The highest prevalence of GDM (2.9%) was found with a 2-hour cut-off value of 8.9 mmol/L when selective screening was applied. Unemployment and low educational level were associated with an increased risk of GDM. The OR was 4.14 (CI 95%: 3.81-4.50) for GDM in obese women compared to women with BMI <30 kg/m2. Women with non-Nordic origin presented a more than doubled risk for GDM compared to women with Nordic origin (OR = 2.24; CI 95%: 2.06-2.43). Increasing OGTT values were associated with increasing risks of adverse pregnancy outcomes.ConclusionsThere was no consensus regarding screening regimes for GDM from 2011 through 2012 when four different regimes were applied in Sweden. Increasing levels of OGTT 2-hour glucose values were strongly associated with adverse pregnancy outcomes. Based on these findings, we suggest that Sweden adopts the recent recommendations of the International Association of Diabetes and Pregnancy Study Group (IADPSG) concerning the performance of OGTT and the diagnostic criteria for GDM.

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“…Sweden is considered to have a rather low prevalence of GDM (i.e., around 1.4%) [12]. Using the current screening methods and thresholds in Sweden, this study confirmed this level of GDM.…”

Section: Discussionsupporting

confidence: 74%

Section: Introductionmentioning

confidence: 99%

No consensus on gestational diabetes mellitus screening regimes in Sweden: pregnancy outcomes in relation to different screening regimes 2011 to 2012, a cross-sectional study

Lindqvist

Persson

Lindkvist

et al. 2014

BMC Pregnancy Childbirth

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show abstract

“…No agreement on a single threshold glucose value exists, above which maternal or perinatal complications are markedly increased (14). Previous studies (10, 15, 16) and the present study show that the degree of the severity of GDM, as indicated by high glucose values and the need of insulin treatment, clearly influences the complication rates. In our study, the diet‐treated GDM women had a low incidence of fetal macrosomia comparable to that of the non‐diabetic controls, whereas GDM patients needing insulin in addition to their diet showed a significantly higher incidence of fetal macrosomia than the controls or the diet‐treated GDM women.…”

Section: Discussioncontrasting

confidence: 52%

Detection of pregnancies with high risk of fetal macrosomia among women with gestational diabetes mellitus

Suhonen

Hiilesmaa

Kaaja

et al. 2008

Acta Obstet Gynecol Scand

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“…GDM is associated with other pregnancy complications and is an indicator of future development of diabetes mellitus type 2 [2]. In Sweden, the prevalence of GDM is reported in 1.2 - 2.3% of the pregnant women [3-6]. Since the 1990s, Sweden has officially adopted the European recommendation of selective screening for GDM [7].…”

Section: Introductionmentioning

confidence: 99%

Surprisingly low compliance to local guidelines for risk factor based screening for gestational diabetes mellitus - A population-based study

Persson

Winkvist

Mogren

2009

BMC Pregnancy Childbirth

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BackgroundScreening for gestational diabetes mellitus (GDM) is routine during pregnancy in many countries in the world. The screening programs are either based on general screening offered to all pregnant women or risk factor based screening stipulated in local clinical guidelines. The aims of this study were to investigate: 1) the compliance with local guidelines of screening for GDM and 2) the outcomes of pregnancy and birth in relation to risk factors of GDM and whether or not exposed to oral glucose tolerance test (OGTT).MethodsThis study design was a population-based retrospective cross-sectional study of 822 women. A combination of questionnaire data and data collected from medical records was applied. Compliance to the local guidelines of risk factor based screening for GDM was examined and a comparison of outcomes of pregnancy and delivery in relation to risk factor groups for GDM was performed.ResultsOf the 822 participants, 257 (31.3%) women fulfilled at least one criterion for being exposed to screening for GDM according to the local clinical guidelines. However, only 79 (30.7%) of these women were actually exposed to OGTT and of those correctly exposed for screening, seven women were diagnosed with GDM. Women developing risk factors for GDM during pregnancy had a substantially increased risk of giving birth to an infant with macrosomia.ConclusionSurprisingly low compliance with the local clinical guidelines for screening for GDM during pregnancy was found. Furthermore, the prevalence of the risk factors of GDM in our study was almost doubled compared to previous Swedish studies. Pregnant women developing risk factors of GDM during pregnancy were found to be at substantially increased risk of giving birth to an infant with macrosomia. There is a need of actions improving compliance to the local guidelines.

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Early random capillary glucose level screening and multidisciplinary antenatal teamwork to improve outcome in gestational diabetes mellitus

Abstract: Early non-fasting random universal screening and multidisciplinary antenatal teamwork intervention seems to be favourable, with low rates of excessive fetal growth, instrumental vaginal delivery and caesarean section.

Cited by 18 publications

References 26 publications

No consensus on gestational diabetes mellitus screening regimes in Sweden: pregnancy outcomes in relation to different screening regimes 2011 to 2012, a cross-sectional study

No consensus on gestational diabetes mellitus screening regimes in Sweden: pregnancy outcomes in relation to different screening regimes 2011 to 2012, a cross-sectional study

Detection of pregnancies with high risk of fetal macrosomia among women with gestational diabetes mellitus

Surprisingly low compliance to local guidelines for risk factor based screening for gestational diabetes mellitus - A population-based study

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