Ethnic differences translate to inadequacy of high-risk screening for gestational diabetes mellitus in an Asian population: a cohort study

Yap-Seng Chong,Yung-Seng Lee,Harvard Lin,Li Chen,Kenneth Kwek,Joanna D Holbrook,Yiong-Huak Chan,Melvin Khee-Shing Leow,George Seow-Heong Yeo,Kok-Hian Tan,Michael S Kramer,Victor Samuel Rajadurai,Keith M Godfrey,Shirong Cai,Peter D Gluckman,Shu E Soh,Seang-Mei Saw

doi:10.1186/1471-2393-14-345

Abstract

BackgroundUniversal and high-risk screening for gestational diabetes mellitus (GDM) has been widely studied and debated. Few studies have assessed GDM screening in Asian populations and even fewer have compared Asian ethnic groups in a single multi-ethnic population.Methods1136 pregnant women (56.7% Chinese, 25.5% Malay and 17.8% Indian) from the Growing Up in Singapore Towards healthy Outcomes (GUSTO) birth cohort study were screened for GDM by 75-g oral glucose tolerance test (OGTT) at 26–28 weeks of gestation. GDM was defined using the World Health Organization (WHO) criteria. High-risk screening is based on the guidelines of the UK National Institute for Health and Clinical Excellence.ResultsUniversal screening detected significantly more cases than high-risk screening [crude OR 2.2 (95% CI 1.7-2.8)], particularly for Chinese women [crude OR = 3.5 (95% CI 2.5-5.0)]. Pre-pregnancy BMI > 30 kg/m2 (adjusted OR = 3.4, 95% CI 1.5-7.9) and previous GDM history (adjusted OR = 6.6, 95% CI 1.2-37.3) were associated with increased risk of GDM in Malay women while GDM history was the only significant risk factor for GDM in Chinese women (adjusted OR = 4.7, 95% CI 2.0-11.0).ConclusionRisk factors used in high-risk screening do not sufficiently predict GDM risk and failed to detect half the GDM cases in Asian women. Asian women, particularly Chinese, should be screened to avoid under-diagnosis of GDM and thereby optimize maternal and fetal outcomes.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2393-14-345) contains supplementary material, which is available to authorized users.

Highlights

Universal and high-risk screening for gestational diabetes mellitus (GDM) has been widely studied and debated
No significant differences were found between the 1136 women who had oral glucose tolerance test (OGTT) and the 111 women who did not have OGTT in terms of ethnicity
21 (7.2)c aValues are given as number (%). bUniversal screening is where all participants undergo oral glucose tolerance test (OGTT); High-risk screening is where only participants with one or more of the risk factors based on the guidelines from UK National Institute for Health and Clinical Excellence (NICE) have to undergo OGTT. cP < 0.001 compared to Universal Screening

Summary

Introduction

Universal and high-risk screening for gestational diabetes mellitus (GDM) has been widely studied and debated. The diagnostic criteria are still debated, the oral glucose tolerance test (OGTT) is generally recognized as the ‘gold standard’ for diagnosis of GDM [12]. It is controversial whether screening for GDM with an OGTT in pregnant women should be universal (testing all pregnancies) or selective (testing only pregnant women with risk factors for GDM) [13,14]. Results from several studies indicate that universal screening for GDM in certain populations is more sensitive and cost-effective [14,19,20], especially in terms of preventing future type 2 diabetes

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Discussion

Conclusion