The Case for Early and Universal Screening for Gestational Diabetes Mellitus: Findings from 9314 Pregnant Women in a Major City in Nigeria

Abstract

Introduction: Risk-based screening has been replaced by universal screening as the recommended course of care for gestational diabetes mellitus (GDM). As of 2016, no state in Nigeria had implemented a policy of universal screening for GDM. This research aimed to assess findings from a universal screening programme and its implication for scaling up universal and early screening for GDM. Methods: This was a descriptive cross-sectional study conducted in Rivers State Nigeria between February 2017 and January 2020. Multistage sampling was used to recruit 9314 pregnant women from 30 primary, secondary, and tertiary health facilities in the state. An interviewer-administered structured questionnaire was used by trained healthcare workers to collect socio-demographic, obstetric and medical information. All study participants had a plasma glucose test on their first hospital visit and a diagnosis made using the World Health Organization (WHO) criteria. Data obtained was analysed using the IBM Statistical Package for Social Sciences (SPSS) version 23. Results: Most women [5683 (61.0%)] were aged 25-34 (mean 29.60 ± 5.64) years. The preva-

Screening for Gestational Diabetes Mellitus: Is There a Need for Early Screening for All Women in Developing Countries?

“…About one in every three women diagnosed with GDM was diagnosed before 24 weeks, which is lower than previous findings that one in every two women diagnosed with GDM was diagnosed in the first and second trimesters [ 9 ]. These findings support early screening for GDM, which will detect women who develop GDM before 24 weeks and would have been missed by universal screening after 24 weeks.…”

“…In the present study, the prevalence of GDM was 7.8%, which is lower than the pooled prevalence of GDM in Nigeria reported in a systematic review (11%), and this was attributed to differences in female characteristics of the study participants and differences in the screening methods utilized [ 8 ]. A prevalence of 5.2% was also reported and it was concluded that the prevalence of GDM in Nigeria was on the rise and that the disparities in prevalence reports could be attributed to better screening tools, better screening policies, and increased exposure to risk factors [ 9 ].…”

“…Screening for GDM is usually carried out between 24 and 28 weeks for all pregnant women with a 75 g oral glucose tolerance test (OGTT), as proposed by the International Association of Diabetes and Pregnancy Study Groups (IADPSG), and this was adopted by the World Health Organization (WHO) in 2013. Risk-based screening is practiced in Nigeria, where the prevalence of GDM is high [ 8 ], and is targeted toward women with an increased risk of GDM at 24-28 weeks [ 9 ]. Early screening is usually reserved for women with a high risk of GDM, and it has been found that the prevalence of GDM in the first and second trimesters is significant and that up to one in 20 cases of GDM may be missed by risk-based screening alone [ 9 ].…”

“…Risk-based screening is practiced in Nigeria, where the prevalence of GDM is high [ 8 ], and is targeted toward women with an increased risk of GDM at 24-28 weeks [ 9 ]. Early screening is usually reserved for women with a high risk of GDM, and it has been found that the prevalence of GDM in the first and second trimesters is significant and that up to one in 20 cases of GDM may be missed by risk-based screening alone [ 9 ].…”

A first trimester prediction model and nomogram for gestational diabetes mellitus based on maternal clinical risk factors in a resource-poor setting

“…Considering the impact of GDM and its complications on both maternal and fetal well-being, the need for universal screening via Oral Glucose Tolerance Test (OGTT) becomes evident. Due to its proven benefit over risk factor-based screening, universal screening is highly recommended, even in early pregnancy, given availability of financial, material, space, and human resources [ 9 , 10 ]. However, implementing oral glucose tolerance testing during pregnancy for all women, and more than once in some, is both operationally challenging and costly, hence the continued emphasis on the need to improve risk factor-based screening approach in most developing countries especially in sub-Saharan Africa.…”