Abstract
BackgroundThe risks associated with gestational diabetes mellitus (GDM) are well recognized, and there is increasing evidence to support treatment of the condition. However, clear guidance on the ideal approach to screening for GDM is lacking. Professional groups continue to debate whether selective screening (based on risk factors) or universal screening is the most appropriate approach. Additionally, there is ongoing debate about what levels of glucose abnormalities during pregnancy respond best to treatment and which maternal and neonatal outcomes benefit most from treatment. Furthermore, the implications of possible screening options on health care costs are not well established. In response to this uncertainty there have been repeated calls for well-designed, randomised trials to determine the efficacy of screening, diagnosis, and management plans for GDM. We describe a randomised controlled trial to investigate screening uptake rates and the clinical and cost effectiveness of screening in primary versus secondary care settings.Methods/DesignThis will be an unblinded, two-group, parallel randomised controlled trial (RCT). The target population includes 784 women presenting for their first antenatal visit at 12 to 18 weeks gestation at two hospitals in the west of Ireland: Galway University Hospital and Mayo General Hospital. Participants will be offered universal screening for GDM at 24 to 28 weeks gestation in either primary care (n = 392) or secondary care (n = 392) locations. The primary outcome variable is the uptake rate of screening. Secondary outcomes include indicators of clinical effectiveness of screening at each screening site (primary and secondary) including gestational week at time of screening, time to access antenatal diabetes services for women diagnosed with GDM, and pregnancy and neonatal outcomes for women with GDM. In addition, parallel economic and qualitative evaluations will be conducted. The trial will cover the period from the woman’s first hospital antenatal visit at 12 to 18 weeks gestation, until the completion of the pregnancy.Trial registrationCurrent Controlled Trials: ISRCTN02232125
Highlights
The risks associated with gestational diabetes mellitus (GDM) are well recognized, and there is increasing evidence to support treatment of the condition
The risks associated with gestational diabetes mellitus are well recognized
All expectant mothers in Ireland are entitled to the Maternity and Infant Care Scheme, which consists of a shared programme of care provided by general practitioner (GP) in primary care and obstetricians in the hospital maternity units, or secondary care
Summary
Gestational diabetes mellitus (GDM) has been defined by the World Health Organization (WHO) as hyperglycaemia of variable severity with onset or first recognition during pregnancy [1]. Evidence is needed in order to determine if the site of GDM screening will impact health outcomes; It is possible that there may be differences between primary and secondary care in terms of timeliness of screening, access to results, communication of results to patients, or access to GDM treatment for those with positive test results. It is important to understand if offering a screening programme in primary care would improve uptake rates, access to treatment and pregnancy outcomes. Finding answers to these questions could have important implications for the planning and provision of future GDM screening services nationally. We will conduct a qualitative analysis of user and stakeholder attitudes, preferences, barriers and facilitators of screening at each site
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