Changed definition of disease and broader screening criteria had little impact on prevalence of gestational diabetes mellitus

Abstract

Introduction - There are major controversies in screening for gestational diabetes mellitus (GDM). The present study evaluates the impact of the 2017 revised guidelines for GDM screening and a changed definition of GDM in Norway.<p>

<p>Material and methods - We used a case-series design and included women with no pre-pregnancy diabetes mellitus, who gave birth after gestational week 29 to a singleton fetus at the University Hospital of North Norway, Tromsø, or at a local maternity ward in Troms county, during the first 6 months of 2013 (before group, n = 676) and 2018 (after group, n = 673). Data were collected from antenatal records, maternal health information sheets, and electronic medical records (Partus). We assessed the screening criteria age, parity, pre-pregnancy BMI, and ethnicity. Primary outcomes were change in size of the population eligible for GDM screening, screening adherence, and prevalence of GDM, and follow up of GDM (treatment and obstetric risk assessment at gestational week 36). Statistical analyses were done using IBM SPSS with chi-squared test. A p value less than 0.05 was considered statistically significant.<p>

<p>Results - The proportion of women eligible for GDM screening increased from 46.4% in the before group to 67.6% in the after group (+45%) (p < 0.01). However, screening adherence among eligible women was only 28.3% and 49.2% in the before and after groups, respectively (p < 0.01). Among screened women, 16.9% (15/89) and 10.7% (24/224), respectively, were diagnosed with GDM, resulting in an overall estimated prevalence of 2.2% (15/676) and 3.6% (24/673). Among women diagnosed with GDM, 13.3% received no follow up in 2013 and this proportion was 20.8% in 2018. The remaining women underwent obstetric risk assessment at gestational week 36 as advised in the guidelines.<p>

<p>Conclusions - The introduction of broader screening criteria and a more liberal case definition increased the population eligible for GDM screening by 45%. The higher proportion of women screened resulted in an insignificant higher prevalence of GDM. Screening adherence was poor in both study groups. Stakeholders for obstetric care need to consolidate quality measures and revisit the screening algorithm.