European Journal of Obstetrics & Gynecology and Reproductive Biology
A risk score for selective screening for gestational diabetes mellitus
Introduction
Screening for gestational diabetes mellitus (GDM) has been included in a routine antenatal care program in many parts of the world [1], [2], [3]. However, considering the global demographic data that approximately 130 million women become pregnant annually [4], this practice would result in a large number of women requiring GDM screening. Thus, it is important for health care providers to set up an effective but affordable screening program for this metabolic disorder.
A 50-g glucose challenge test (GCT) is widely accepted as a standard method of GDM screening [3], [5]. Previously, several expert panels have recommended that the GCT be performed in all pregnant women to minimize adverse perinatal outcomes [6], [7]. A selective screening strategy was later proposed by the 4th International Workshop-Conference on GDM in 1997 [8], and revised by an expert committee in the 5th Workshop-Conference in 2005 [9]. The rationale for this selective approach was based on a cost-effective issue which could be improved by exempting women at low risk for GDM from the GCT [5], [8]. The low-risk group was defined as individuals meeting all of the following criteria: age <25 years; member of an ethnic group with low prevalence of GDM; normal pre-pregnancy weight; normal weight at delivery; no first-degree relatives with diabetes; no history of abnormal glucose metabolism; and no history of poor obstetric outcome [8], [9].
Supporting the selective approach, aside from the 4th and 5th Workshop-Conference strategies, one prior study found a significant reduction in the number of GDM screenings using a risk scoring model comprising age, body mass index (BMI), and race [10]. However, applying this risk function to some particular ethnic groups would be unsuccessful since their assigned scores are higher than the cutoff score to avoid the GCT (≤1 point), e.g. the scores of Asians and Hispanics are 5 and 2 points, respectively. Hence, a risk scoring approach consisting of general clinical data, such as, age, BMI, or family history of diabetes without the ethnic factor would be more practical because it could be employed in a general population.
The purpose of this study was to develop a simple risk score for predicting pregnant women who are likely to have an abnormal GCT, and to validate the score for further clinical use. Additionally, we assessed if this risk score could be used in place of a screening test (GCT) prior to a diagnostic oral glucose tolerance test (OGTT).
Section snippets
Materials and methods
This retrospective study obtained approval of the Bangkok Metropolitan Administration Ethics Committee for Researches Involving Human Subjects. To derive a risk score, we collected data from a cohort of all singleton pregnant women without overt diabetes who had certain last menstrual period (LMP), and started their booking in the first trimester (≤14 weeks’ gestation) at our institution between March and December 2005. This cohort (n = 1876) is referred to as the “derivation cohort”.
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Results
The derivation cohort included 1876 women, 586 of whom (31.2%) had positive GDM screening. Compared to gravidas with a normal GCT, those with an abnormal GCT were significantly older, had higher mean BMI and parity, and had greater numbers of family history of diabetes, prior macrosomia, and history of ≥2 spontaneous abortions (Table 1).
In a multivariable analysis of the derivation cohort (Table 2), age, first-visit BMI, family history of diabetes, prior macrosomia, and history of ≥2 abortions
Discussion
The GCT is a widely used method of GDM screening [3], [5]. However, this blood test is invasive and costly [11]. Concerned over the invasive nature of venepuncture and the unpleasant glucose flavor of the GCT, the last two International Workshop-Conferences recommended a selective approach to screening for GDM by using the GCT only in individuals with risk factors [8], [9]. The obvious drawback of this selective approach is that women need to have “all of the low-risk criteria” to be exempted,
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2016, American Journal of Obstetrics and GynecologyCitation Excerpt :Disagreements about inclusion at any stage of the selection process were resolved by consensus. From 10,152 citations, a total of 177 papers met inclusion criteria and described the development of ≥1 obstetric prognostic model (Figure 1).10-186 Overall, we identified 263 models for 40 different outcomes.
Gestational diabetes mellitus: Including serum pregnancy-associated plasma protein-A testing in the clinical management of primiparous women? A case-control study
2013, Diabetes Research and Clinical PracticeCitation Excerpt :Within such perspective, clarifying if any first trimester routine biochemical markers are altered in pregnant women who subsequently develop GDM would allow early detection of women at risk and subsequent interventions to reduce morbidities associated with GDM. Different tools to assess risk of GDM have been proposed and most have found that previous GDM is the best predictor of subsequent GDM [12–14]. However predictive values have frequently been low.
Influence of the couple on hypertensive disorders during pregnancy: A retrospective cohort study
2011, Pregnancy HypertensionCitation Excerpt :So, even if with different individual genetic predisposing or protective factors, in the couple there is the tendency to share a lot of external factors, such as diet, environmental factors, and stressing events. As shown in Fig. 3, the multivariate models considering some important known risk factors and the familial history seems to succeed very well in predicting PRHDs; therefore, we suggest that further screening programs for PRHDs should seriously take into consideration clinical history as well as molecular biology tests as shown in different studies for gestational diabetes mellitus [44,45]. Despite the retrospective layout of our study, the amount of clinical information available is really informative and could give new insides for planning a screening strategy.