Risk factor screening to identify women requiring oral glucose tolerance testing to diagnose gestational diabetes: A systematic review and meta-analysis and analysis of two pregnancy cohorts

Abstract

BackgroundEasily identifiable risk factors including: obesity and ethnicity at high risk of diabetes are commonly used to indicate which women should be offered the oral glucose tolerance test (OGTT) to diagnose gestational diabetes (GDM). Evidence regarding these risk factors is limited however. We conducted a systematic review (SR) and meta-analysis and individual participant data (IPD) analysis to evaluate the performance of risk factors in identifying women with GDM.MethodsWe searched MEDLINE, Medline in Process, Embase, Maternity and Infant Care and the Cochrane Central Register of Controlled Trials (CENTRAL) up to August 2016 and conducted additional reference checking. We included observational, cohort, case-control and cross-sectional studies reporting the performance characteristics of risk factors used to identify women at high risk of GDM. We had access to IPD from the Born in Bradford and Atlantic Diabetes in Pregnancy cohorts, all pregnant women in the two cohorts with data on risk factors and OGTT results were included.ResultsTwenty nine published studies with 211,698 women for the SR and a further 14,103 women from two birth cohorts (Born in Bradford and the Atlantic Diabetes in Pregnancy study) for the IPD analysis were included. Six studies assessed the screening performance of guidelines; six examined combinations of risk factors; eight evaluated the number of risk factors and nine examined prediction models or scores. Meta-analysis using data from published studies suggests that irrespective of the method used, risk factors do not identify women with GDM well.Using IPD and combining risk factors to produce the highest sensitivities, results in low specificities (and so higher false positives). Strategies that use the risk factors of age (>25 or >30) and BMI (>25 or 30) perform as well as other strategies with additional risk factors included.ConclusionsRisk factor screening methods are poor predictors of which pregnant women will be diagnosed with GDM. A simple approach of offering an OGTT to women 25 years or older and/or with a BMI of 25kg/m2 or more is as good as more complex risk prediction models. Research to identify more accurate (bio)markers is needed.Systematic Review Registration: PROSPERO CRD42013004608

Risk Factors for the Prediction of Hyperglycemia during Pregnancy – A Cohort Study from a Brazilian Public Primary Care Center

“…The performance of risk predictors was evaluated in terms of sensitivity (Sens), specificity (Sp), positive and negative predictive values (PPV and NPV, respectively), accuracy, and positive and negative likelihood ratios (PLR and NLR, respectively) with their odds ratio (OR) and 95% CI. Performance analysis also included the assessment of falsepositive results, defined by the formula 1-Sp 16,17,33,34 .…”

“…Also in agreement with other reports, we observed that the higher Sp shown by FG, HbA1c and HOMA-IR indicate them as the best predictors for ruling out GDM risk and the need for a diagnostic test 10,13,42,44,45 . universal screening are not available 16,17,46 . Therefore, the literature seems to support our results.…”

“…These as well other risk factors have already been tested as GDM predictors, but the results were either conflicting or inconclusive [12][13][14][15][16][17] . The fact that the prevalence of risk factors is low and dependent on the population studied, and the diversity of GDM diagnostic criteria interfere with the predictive performance of these markers 11,13,14 .…”

Prevalens av diabetes blant gravide og svangerskapsutfall i Nordland og Troms 2004–15

“…Vår studie viste økt prevalens av svangerskapsdiabetes i samsvar med nasjonale tall samt internasjonale rapporter (2). Prevalens av svangerskapsdiabetes varierer med etnisitet (13), og ulike studier bruker forskjellige risikofaktorer som grunnlag for å identifisere kvinner med økt risiko for svangerskapsdiabetes, noe som gjør sammenlikning utfordrende (14). Tall fra Medisinsk fødselsregister viste fylkesvise forskjeller i prevalens fra 2,8 % til 11 % i 2017 (1).…”

The role of melatonin in development of gestational diabetes mellitus

“…[7,11]. В то же время многочис-ленные исследования показали, что риск ГСД имеется у женщин, страдающих ожирением [12,13], метаболическим синдромом [14,15], поликистозом яичников, эндометриозом [16], а также у имеющих в анамнезе гормональные причины невынашивания беременности [17], осложнение ГСД предыдущей беременности [7,10,18]. Результаты наших исследований вы-явили заболевания трех и более функциональ-ных систем (эндокринной, сердечно-сосуди-стой, иммунной, желудочно-кишечного тракта) у 85 % матерей, беременность у которых ослож-нилась гестационным диабетом.…”