Is Screening for Early Gestational Diabetes Mellitus Associated with a Better Prognosis? An Observational Study Including 8,713 Women

Abstract

In addition to screening for gestational diabetes mellitus (GDM) after 24 gestational weeks (GW), the IADPSG proposed to screen in early pregnancy and to refer women with early GDM (eGDM) for immediate care. The usefulness of this strategy is still unknown. We included women with a singleton pregnancy, without personal history of diabetes or bariatric surgery, who delivered in our hospital between 2012 and 2016. We compared the incidence of preeclampsia or large for gestational age infant or shoulder dystocia in women with an early screening before 22 WG -leading to care for eGDM (FPG) 92-125 mg/dL) or diabetes in pregnancy (DIP: FPG≥126 mg/dL) if present- (screened group) or without (unscreened group). Compared with women in the unscreened group (n=4634, 53.3%), those in the screened group (n=4079) had different ethnicities (p<0.0001) and more risk factors for GDM: overweight (48.6 vs. 45.7, p<0.01), family history of diabetes (27.8 vs. 25.0%, p<0.01), personal history of GDM (6.4 vs. 4.3%, p<0.01) and macrosomic infant (3.6 vs. 2.7%, p<0.05). Early screening increased from year 2012 to 2016 (p<0.0001). In the early screened group, the prevalence of GDM and DIP was 22.8% (including 10.3% of eGDM) and 0.9%, respectively. In the unscreened group, the prevalence of GDM was 17.2% and DIP 1.2%. The rate of insulin therapy was 8.6% in the screened group and 5.6% in the unscreened group (p<0.001). The rate of the composite criterion was similar in the screened and unscreened groups (12.5 vs. 11.8%, p=0.3534), also when we only considered women with risk factors for GDM (14.0 vs. 14.9%, p=0.3137). The incidence of other outcomes was similar in both groups. To conclude, a strategy including early FPG measurement during pregnancy may not improve pregnancy prognosis but we still need to adjust the results for confounding factors (ongoing) because the women in the early-screened group had a similar prognosis as those only screened after 22 GW despite a higher risk of complications. Disclosure E. Cosson: Consultant; Self; Lilly France. Board Member; Self; Novartis France. Consultant; Self; Roche Diagnostics France. Board Member; Self; Ascensia Diabetes Care. Consultant; Self; Bezins France. Board Member; Self; MSD France. D. Sandre Banon: None. F. Gary: None. I. Pharisien: None. J. Portal: None. P. Valensi: None. L. Carbillon: None.