Carmelo Capula1, Eusebio Chiefari2, Massimo Borelli3, Rosa Oliverio1, Anna Vero1, Daniela Foti2, Luigi Puccio1, Raffaella Vero1, Antonio Brunetti4. 1. Operative Unit of Endocrinology and Diabetes, Hospital Pugliese-Ciaccio, 88100 Catanzaro, Italy. 2. Department of Health Sciences, University "Magna Græcia" of Catanzaro, 88100 Catanzaro, Italy. 3. Department of Life Sciences, University of Trieste, 34127 Trieste, Italy. 4. Department of Health Sciences, University "Magna Græcia" of Catanzaro, 88100 Catanzaro, Italy. Electronic address: brunetti@unicz.it.
Abstract
AIMS: The Italian National Institute of Health has recently introduced a selective screening based on the risk profile of pregnant women, which while recommending against screening of women at low risk (LR) for GDM, it recommends an early test for women at high risk (HR) for GDM. Herein, we assessed the accuracy and cost-effectiveness of this screening and developed a new index that improves these requirements. METHODS: We retrospectively enrolled 3974 pregnant women. GDM was diagnosed with a 2h 75-g OGTT at 16-18 weeks (early test) or 24-28 weeks of gestation, according to the IADPSG guidelines. RESULTS: 55.6% of HR women had GDM, although only 38.4% underwent early screening. Among 2654 women at medium risk, 20.9% had GDM; paradoxically, among 770 LR women, that would not have been screened, 26.6% received a GDM diagnosis. Based on these unsatisfactory results, we elaborated the Capula's index, that reduced both screening tests (p<0.001) and potentially undetected GDM cases (p<0.001), and corrected the paradoxical prevalence estimates of GDM obtained with the current Italian guidelines. Also, Capula's index improved correlation of GDM risk profile with obstetric and neonatal adverse events. CONCLUSIONS: Capula's index improves accuracy of selective screening for GDM.
AIMS: The Italian National Institute of Health has recently introduced a selective screening based on the risk profile of pregnant women, which while recommending against screening of women at low risk (LR) for GDM, it recommends an early test for women at high risk (HR) for GDM. Herein, we assessed the accuracy and cost-effectiveness of this screening and developed a new index that improves these requirements. METHODS: We retrospectively enrolled 3974 pregnant women. GDM was diagnosed with a 2h 75-g OGTT at 16-18 weeks (early test) or 24-28 weeks of gestation, according to the IADPSG guidelines. RESULTS: 55.6% of HR women had GDM, although only 38.4% underwent early screening. Among 2654 women at medium risk, 20.9% had GDM; paradoxically, among 770 LR women, that would not have been screened, 26.6% received a GDM diagnosis. Based on these unsatisfactory results, we elaborated the Capula's index, that reduced both screening tests (p<0.001) and potentially undetected GDM cases (p<0.001), and corrected the paradoxical prevalence estimates of GDM obtained with the current Italian guidelines. Also, Capula's index improved correlation of GDM risk profile with obstetric and neonatal adverse events. CONCLUSIONS: Capula's index improves accuracy of selective screening for GDM.
Authors: Raymond J Rodgers; Jodie C Avery; Vivienne M Moore; Michael J Davies; Ricardo Azziz; Elisabet Stener-Victorin; Lisa J Moran; Sarah A Robertson; Nigel K Stepto; Robert J Norman; Helena J Teede Journal: Endocr Connect Date: 2019-03 Impact factor: 3.335
Authors: Federica Visconti; Paola Quaresima; Eusebio Chiefari; Patrizia Caroleo; Biagio Arcidiacono; Luigi Puccio; Maria Mirabelli; Daniela P Foti; Costantino Di Carlo; Raffaella Vero; Antonio Brunetti Journal: Int J Environ Res Public Health Date: 2019-09-28 Impact factor: 3.390