Preference of Women for Gestational Diabetes Screening Method According to Tolerance of Tests and Population Characteristics.

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

doi:10.3389/fendo.2021.781384

Abstract

AimsTo determine the preferred method of screening for gestational diabetes mellitus (GDM).Methods1804 women from a prospective study (NCT02036619) received a glucose challenge test (GCT) and 75g oral glucose tolerance test (OGTT) between 24-28 weeks. Tolerance of screening tests and preference for screening strategy (two-step screening strategy with GCT compared to one-step screening strategy with OGTT) were evaluated by a self-designed questionnaire at the time of the GCT and OGTT.ResultsCompared to women who preferred one-step screening [26.2% (472)], women who preferred two-step screening [46.3% (834)] were less often from a minor ethnic background [6.0% (50) vs. 10.7% (50), p=0.003], had less often a previous history of GDM [7.3% (29) vs. 13.8% (32), p=0.008], were less often overweight or obese [respectively 23.1% (50) vs. 24.8% (116), p<0.001 and 7.9% (66) vs. 18.2% (85), p<0.001], were less insulin resistant in early pregnancy (HOMA-IR 8.9 (6.4-12.3) vs. 9.9 (7.2-14.2), p<0.001], and pregnancy outcomes were similar except for fewer labor inductions and emergency cesarean sections [respectively 26.6% (198) vs. 32.5% (137), p=0.031 and 8.2% (68) vs. 13.0% (61), p=0.005]. Women who preferred two-step screening had more often complaints of the OGTT compared to women who preferred one-step screening [50.4% (420) vs. 40.3% (190), p<0.001].ConclusionsA two-step GDM screening involving a GCT and subsequent OGTT is the preferred GDM screening strategy. Women with a more adverse metabolic profile preferred one-step screening with OGTT while women preferring two-step screening had a better metabolic profile and more discomfort of the OGTT. The preference for the GDM screening method is in line with the recommended Flemish modified two-step screening method, in which women at higher risk for GDM are recommended a one-step screening strategy with an OGTT, while women without these risk factors, are offered a two-step screening strategy with GCT.Clinical Trial RegistrationNCT02036619 https://clinicaltrials.gov/ct2/show/NCT02036619

Highlights

Gestational diabetes mellitus (GDM) is defined as diabetes diagnosed in the second or third trimester of pregnancy, given that overt diabetes early in pregnancy has been excluded (1)
Women who preferred a two-step screening strategy tolerated the glucose challenge test (GCT) in general significantly better than the oral glucose tolerance test (OGTT) compared to women who preferred a one-step screening approach and compared to women without clear preference (Table 1)
Women who preferred a two-step screening indicated that it was more cumbersome to be fasting for the OGTT compared to women who preferred a one-step screening strategy or had no clear preference and they reported more complaints of the OGTT (Table 1)

Summary

Introduction

Gestational diabetes mellitus (GDM) is defined as diabetes diagnosed in the second or third trimester of pregnancy, given that overt diabetes early in pregnancy has been excluded (1). Women with a history of GDM have a seven-fold increased risk of developing type 2 diabetes mellitus (T2DM) compared to normal glucose tolerant women (NGT). A universal one-step approach for GDM screening is recommended by the ‘International Association of Diabetes and Pregnancy Study Groups’ (IADPSG) with the 75g oral glucose tolerance test (OGTT) between 24-28 weeks of pregnancy (8). A modified two-step screening strategy with GCT combined with risk-factors was proposed based on the BEDIP-N study in Flanders This allows women at higher risk for GDM (women with a history of GDM, obesity and/or impaired fasting glycaemia in early pregnancy) to receive a one-step screening strategy with an OGTT, while women without these risk factors, are offered a two-step screening strategy with GCT (13). We aimed to determine which GDM screening method (a twostep screening strategy with a GCT or a one-step screening approach with a 75g OGTT) participants preferred. We aimed to determine the preference of GDM screening method according to the tolerance for the different screening tests and in relation to the population characteristics

Results

Discussion

Conclusion