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

Abstract

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.

Compliance with National Institute of Health and Care Excellence risk-based screening for Gestational Diabetes Mellitus in nulliparous women

“…This study supports previous work which also showed poor compliance with local guidelines ranging from 31 to 61% appropriate risk based screening in Swedish and Thai cohorts respectively. (23,28) This study also is in keeping with an Irish national survey conducted at 19 units. Their aim was to assess implementation of local GDM screening guidelines.…”

Caesarean Section and Maternal Obesity

“…However, it is well described that attendance for postnatal glucose tolerance testing is poor (Russell et al, 2006;Persson et al, 2009). Obese women should be informed that even in the presence of a negative postnatal GTT they are at increased risk of type 2 diabetes later in life and that weight loss can reduce this risk.…”

Diagnostic significance of ultrasonographic score in detection of gestational diabetes mellitus

“…Oni su u populaciji komparabilnih trudnica u Švedskoj zabeležili prevalencu bolesti od 31.3% (Persson et al, 2009). Takođe, u saglasju je sa prevalencom šećerne bolesti trudnica u studiji Di Cianni-a i saradnika (Di Cianni et al, 2003).…”

“…U populacionoj studiji preseka Persson i saradnika, koja je obuhvatila 822 trudnice podvrgnute skriningu GDM-a, 15.9% činile su žene koje su imale faktore rizika u aktuelnoj trudnoći (Persson et al, 2009). Od ovih faktora asimetrična akceleracija fetalnog rasta bila je najzastupljenija sa 59%, potom povećane vrednosti nasumično određivane glikemije sa 42%, dok je polihidramnion bio najmanje zastupljen sa 1% (Persson et al, 2009). Trudnice koje su razvile GDM rizične faktore tokom trudnoće bile su značajno većih vrednosti BMI u odnosu na trudnice bez faktora rizika u aktuelnoj trudnoći, 27.8 prema 24.3, p<0.001, što je slično našim rezultatima.…”

“…Drugi problem je taj što i u zemljama sa razvijenim zdravstvenim sistemom i čvrsto uspostavljenim skrining programima, čak 30% visoko rizičnih pacijenata ne bude testirano u periodu od 24. do 28. nedelje GCT-om zbog organizacionih razloga i previda (Persson et al, 2009). …”