A Modified Two-Step Screening Strategy for Gestational Diabetes Mellitus Based on the 2013 WHO Criteria by Combining the Glucose Challenge Test and Clinical Risk Factors.

Katrien Benhalima,Annouschka Laenen,Els Dufraimont,Annick Van Den Bruel,Carolien Moyson,Farah Mekahli,Christophe De Block,Toon Maes,Katrien De Clippel,Caro Minschart,Paul Van Crombrugge,Chantal Mathieu,Hilde Verlaenen,Anne Loccufier,Sofie Vandeginste,Chris Vercammen,Roland Devlieger,Yves Jacquemyn,Johan Verhaeghe

doi:10.3390/jcm7100351

Abstract

This study determines if a modified two-step screening strategy with a glucose challenge test (GCT) ≥ 7.2 mmol/L and clinical risk factors improves the diagnostic accuracy for gestational diabetes mellitus (GDM), based on 2013 WHO criteria, while limiting the number of oral glucose tolerance tests (OGTT). This was a prospective multicentric cohort study with 1811 participants receiving both GCT and 75 g OGTT in pregnancy. Participants and health care providers were blinded for GCT. Characteristics were analyzed across four glucose tolerance groups: abnormal (≥7.2 mmol/L), GCT GDM (n = 165), normal GCT GDM (n = 63), abnormal GCT normal glucose tolerant (NGT) (n = 472); normal GCT NGT (n = 1113). Compared to normal GCT NGT women, normal GCT GDM women had increased rates of obesity (23.8% vs. 10.5%, p < 0.001), ethnic minority background (19.3% vs. 8.2%, p < 0.001) and a history of GDM (13.8% vs. 4.6%, p = 0.03). By combined screening of GCT ≥ 7.2 mmol/L with these risk factors, sensitivity increased to respectively, 74.1–78.1% using one risk factor, and to 82.9% using any of these risk factors with a specificity of 57.5%. By using a modified two-step screening strategy, the number of women needing both a GCT and OGTT would be reduced to 25.5%, and 52.6% of all OGTTs could be avoided, compared to a universal one-step approach.

Highlights

Gestational diabetes mellitus (GDM) is an important modifiable risk factor for adverse pregnancy outcomes and is associated with an increased risk of developing type 2 diabetes mellitus in later life [1,2,3]
We show that the gestational diabetes mellitus (GDM) group that would be missed when using a universal two-step screening strategy with a glucose challenge test (GCT) threshold of 7.2 mmol/L and diagnosis of GDM based on the 2013 World Health Organization (WHO) criteria, was more often obese, more often had an ethnic minority (EM) background and a history of GDM compared to the normal GCT normal glucose tolerant (NGT) group
A modified two-step screening strategy with the GCT and clinical risk factors increased the sensitivity to 82.9%, and 52.6% of all oral glucose tolerance tests (OGTT) could be avoided, compared to the one-step approach

Summary

Introduction

Gestational diabetes mellitus (GDM) is an important modifiable risk factor for adverse pregnancy outcomes and is associated with an increased risk of developing type 2 diabetes mellitus in later life [1,2,3]. The ‘International Association of Diabetes and Pregnancy Study Groups’ (IADPSG) recommends a universal one-step approach with the 75 g oral glucose tolerance test (OGTT) for the screening of GDM [4]. The IADPSG recommendation remains controversial due to the important increase in GDM prevalence, the increased workload, the need for a fasting test, and the risk for increased medicalization of care [6,7,8]. Our aim was to evaluate the characteristics of women with GDM, who would be missed using a GCT threshold ≥ 7.2 mmol/L, and to determine whether a modified two-step screening strategy with the GCT ≥ 7.2 mmol/L and clinical risk factors could improve the diagnostic strategy while exposing as few women as possible to the burden of an OGTT. We aimed to evaluate the tolerance of the tests, and which screening strategy women preferred

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