Abstract
BackgroundEasily identifiable risk factors including: obesity and ethnicity at high risk of diabetes are commonly used to indicate which women should be offered the oral glucose tolerance test (OGTT) to diagnose gestational diabetes (GDM). Evidence regarding these risk factors is limited however. We conducted a systematic review (SR) and meta-analysis and individual participant data (IPD) analysis to evaluate the performance of risk factors in identifying women with GDM.MethodsWe searched MEDLINE, Medline in Process, Embase, Maternity and Infant Care and the Cochrane Central Register of Controlled Trials (CENTRAL) up to August 2016 and conducted additional reference checking. We included observational, cohort, case-control and cross-sectional studies reporting the performance characteristics of risk factors used to identify women at high risk of GDM. We had access to IPD from the Born in Bradford and Atlantic Diabetes in Pregnancy cohorts, all pregnant women in the two cohorts with data on risk factors and OGTT results were included.ResultsTwenty nine published studies with 211,698 women for the SR and a further 14,103 women from two birth cohorts (Born in Bradford and the Atlantic Diabetes in Pregnancy study) for the IPD analysis were included. Six studies assessed the screening performance of guidelines; six examined combinations of risk factors; eight evaluated the number of risk factors and nine examined prediction models or scores. Meta-analysis using data from published studies suggests that irrespective of the method used, risk factors do not identify women with GDM well.Using IPD and combining risk factors to produce the highest sensitivities, results in low specificities (and so higher false positives). Strategies that use the risk factors of age (>25 or >30) and BMI (>25 or 30) perform as well as other strategies with additional risk factors included.ConclusionsRisk factor screening methods are poor predictors of which pregnant women will be diagnosed with GDM. A simple approach of offering an OGTT to women 25 years or older and/or with a BMI of 25kg/m2 or more is as good as more complex risk prediction models. Research to identify more accurate (bio)markers is needed.Systematic Review Registration: PROSPERO CRD42013004608
Highlights
Gestational diabetes mellitus (GDM) is hyperglycaemia of variable severity first identified in pregnancy
Risk factor screening methods are poor predictors of which pregnant women will be diagnosed with GDM
A simple approach of offering an oral glucose tolerance test (OGTT) to women 25 years or older and/ or with a BMI of 25kg/m2 or more is as good as more complex risk prediction models
Summary
Gestational diabetes mellitus (GDM) is hyperglycaemia of variable severity first identified in pregnancy. Strategies include selectively offering a 75g or 100g oral glucose tolerance test (OGTT) to high risk women only, identified using specific risk factors (usually identifiable maternal characteristics) or the administration of a 50g glucose challenge test. Offering all women an OGTT may result in more women with GDM being identified and a reduction in adverse outcomes, as more affected women will receive treatment to reduce hyperglycaemia. Identifiable risk factors including: obesity and ethnicity at high risk of diabetes are commonly used to indicate which women should be offered the oral glucose tolerance test (OGTT) to diagnose gestational diabetes (GDM). Evidence regarding these risk factors is limited . We conducted a systematic review (SR) and meta-analysis and individual participant data (IPD) analysis to evaluate the performance of risk factors in identifying women with GDM
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