SAT-012 Screening for Gestational Diabetes Mellitus: Universal or Selective Screening? Screening for Gestational Diabetes Mellitus: Universal or Selective Screening?

Abstract

Screening for gestational diabetes mellitus: universal or selective screening?Introduction:The presence or absence of risk factors is often employed in screening for Gestational Diabetes Mellitus (GDM). The risk factors for GDM includes previous delivery of macrosomic babies, family history of type 2 diabetes mellitus, previous GDM among others. The impact of selective screening is yet to be fully evaluated in our environment.ObjectiveTo determine the impact of selective screening on diagnosis of gestational diabetes mellitusMethodsThe study was a prospective open cohort study carried out from 1st March to 30th November 2017 at the Lagos University Teaching Hospital (LUTH), Lagos, Nigeria. Ethical approval was obtained from the Health Research Ethics Committee of Lagos University Teaching Hospital (LUTH) before commencement of the studyAll the pregnant women were categorized into either risk group or control group based on the presence or absence of clinical risk factors for GDM. All participant had 75g Oral Glucose Tolerance test (OGTT) done at 24 to 28 weeks gestation and follow up till delivery.The data obtained were age, risk factors for GDM, fasting plasma glucose, one-hour post glucose load plasma glucose & two-hour post glucose load plasma glucose. The data were presented as mean, standard deviation, percentages & chi square. The p value ≤ 0.05 was considered significantResultsNinety pregnant women were screened for GDM. Forty-four women had risk factors for GDM while 46 were non risk group. Their mean age was 32.6± 5 years. The mean age for the risk & non-risk group were similar.The overall prevalence of GDM using the IADPSG criteria was 23.3%. The percentage of women in the risk group with GDM was 38.6% while those women in the non risk group with GDM was 8.7% which was statistically significant (p value 0.004).DiscussionThe most commonly identified risk factors for GDM in this study were family history of type 2 diabetes mellitus, history of unexplained miscarriage & previous history of delivery of macrosomic babies.Some women in the non-risk were diagnosed, even though the prevalence was lower than that observed among women with risk factors for GDM. Approximately one in ten women would have been missed if selective screening was employed in this study.Most of the women in the non-risk group who were diagnosed with GDM were managed with medical nutritional therapy while majority of women in the risk group had insulin therapy.ConclusionThe findings in our study further supports the idea of universal screening for GDM in order to avoid missed diagnosis.Keywords: gestational diabetes mellitus, Screening, oral glucose tolerance test