BACKGROUND: To determine the effectiveness of a population-based risk factor scoring to decrease unnecessary testing for the diagnosis of gestational diabetes mellitus (GDM). METHODS: We formed a risk factor scoring over five, which questions maternal age, body mass index and first-degree relatives with a diagnosis of diabetes mellitus, a prior macrosomic fetus and adverse outcome during the previous pregnancies. All participants underwent a 50-g glucose challenge test (GCT) followed by a 100-g oral glucose tolerence test (OGTT). We opened the 50-g GCT envelope if the participant had a risk score > or = 1 and opened the 100-g OGTT envelope if the 50-g GCT value was > or = 7.2 mmol/l. After all patients delivered we also built other strategies and tested their detection rates. RESULTS: Fourteen patients (3.3%) were diagnosed as having gestational diabetes mellitus via a 100-g OGTT. None of the patients with a score of zero had gestational diabetes mellitus. Logistic regression analysis revealed that an increase in the score by one caused a three times increase in gestational diabetes mellitus risk (OR = 3, CI = 1.9-5). Compared with the universal screening, our strategy to screen if the risk score was > or = 1, followed by a 50-g GCT with a 7.2-mmol/l cut-off value, decreased the number of women to be screened by 30% and diagnosed all cases with GDM. Screening the patients with a score > or = 2 would have decreased the number of women to be screened by 63%, still diagnosing 85% of cases with GDM. Also, risk factor-based screening strategies cause a 50% and 53% reduction in the number of OGTT applied, respectively. CONCLUSION: A well integrated, population-based scoring will decrease the number of unnecessary testing but still diagnose 85-100% of GDM cases.
BACKGROUND: To determine the effectiveness of a population-based risk factor scoring to decrease unnecessary testing for the diagnosis of gestational diabetes mellitus (GDM). METHODS: We formed a risk factor scoring over five, which questions maternal age, body mass index and first-degree relatives with a diagnosis of diabetes mellitus, a prior macrosomic fetus and adverse outcome during the previous pregnancies. All participants underwent a 50-g glucose challenge test (GCT) followed by a 100-g oral glucose tolerence test (OGTT). We opened the 50-g GCT envelope if the participant had a risk score > or = 1 and opened the 100-g OGTT envelope if the 50-g GCT value was > or = 7.2 mmol/l. After all patients delivered we also built other strategies and tested their detection rates. RESULTS: Fourteen patients (3.3%) were diagnosed as having gestational diabetes mellitus via a 100-g OGTT. None of the patients with a score of zero had gestational diabetes mellitus. Logistic regression analysis revealed that an increase in the score by one caused a three times increase in gestational diabetes mellitus risk (OR = 3, CI = 1.9-5). Compared with the universal screening, our strategy to screen if the risk score was > or = 1, followed by a 50-g GCT with a 7.2-mmol/l cut-off value, decreased the number of women to be screened by 30% and diagnosed all cases with GDM. Screening the patients with a score > or = 2 would have decreased the number of women to be screened by 63%, still diagnosing 85% of cases with GDM. Also, risk factor-based screening strategies cause a 50% and 53% reduction in the number of OGTT applied, respectively. CONCLUSION: A well integrated, population-based scoring will decrease the number of unnecessary testing but still diagnose 85-100% of GDM cases.
Authors: C S Göbl; L Bozkurt; P Rivic; G Schernthaner; R Weitgasser; G Pacini; M Mittlböck; D Bancher-Todesca; M Lechleitner; A Kautzky-Willer Journal: Diabetologia Date: 2012-09-22 Impact factor: 10.122
Authors: Diane Farrar; Mark Simmonds; Maria Bryant; Debbie A Lawlor; Fidelma Dunne; Derek Tuffnell; Trevor A Sheldon Journal: PLoS One Date: 2017-04-06 Impact factor: 3.240
Authors: Marije Lamain-de Ruiter; Anneke Kwee; Christiana A Naaktgeboren; Arie Franx; Karel G M Moons; Maria P H Koster Journal: Diagn Progn Res Date: 2017-02-08
Authors: Brittney M Donovan; Patrick J Breheny; Jennifer G Robinson; Rebecca J Baer; Audrey F Saftlas; Wei Bao; Andrea L Greiner; Knute D Carter; Scott P Oltman; Larry Rand; Laura L Jelliffe-Pawlowski; Kelli K Ryckman Journal: PLoS One Date: 2019-04-12 Impact factor: 3.240
Authors: Grammata Kotzaeridi; Julia Blätter; Daniel Eppel; Ingo Rosicky; Martina Mittlböck; Gülen Yerlikaya-Schatten; Christian Schatten; Peter Husslein; Wolfgang Eppel; Evelyn A Huhn; Andrea Tura; Christian S Göbl Journal: Eur J Clin Invest Date: 2021-06-18 Impact factor: 5.722