A Modified Two-Step Screening Strategy for Gestational Diabetes Mellitus Based on the 2013 WHO Criteria by Combining the Glucose Challenge Test and Clinical Risk Factors

• Published in: Journal of clinical medicine Vol. 7; no. 10; p. 351
• Main Authors: Benhalima, Katrien, Van Crombrugge, Paul, Moyson, Carolien, Verhaeghe, Johan, Vandeginste, Sofie, Verlaenen, Hilde, Vercammen, Chris, Maes, Toon, Dufraimont, Els, De Block, Christophe, Jacquemyn, Yves, Mekahli, Farah, De Clippel, Katrien, Van Den Bruel, Annick, Loccufier, Anne, Laenen, Annouschka, Minschart, Caro, Devlieger, Roland, Mathieu, Chantal
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI 13.10.2018; MDPI AG
• Subjects: 2013 WHO criteria; gestational diabetes mellitus; risk factors; screening; 2013 WHO criteria; risk factors; screening; gestational diabetes mellitus
• ISSN: 2077-0383; 2077-0383
• DOI: 10.3390/jcm7100351

This study determines if a modified two-step screening strategy with a glucose challenge test (GCT) ≥ 7.2 mmol/L and clinical risk factors improves the diagnostic accuracy for gestational diabetes mellitus (GDM), based on 2013 WHO criteria, while limiting the number of oral glucose tolerance tests (OGTT). This was a prospective multicentric cohort study with 1811 participants receiving both GCT and 75 g OGTT in pregnancy. Participants and health care providers were blinded for GCT. Characteristics were analyzed across four glucose tolerance groups: abnormal (≥7.2 mmol/L), GCT GDM ( = 165), normal GCT GDM ( = 63), abnormal GCT normal glucose tolerant (NGT) ( = 472); normal GCT NGT ( = 1113). Compared to normal GCT NGT women, normal GCT GDM women had increased rates of obesity (23.8% vs. 10.5%, < 0.001), ethnic minority background (19.3% vs. 8.2%, < 0.001) and a history of GDM (13.8% vs. 4.6%, = 0.03). By combined screening of GCT ≥ 7.2 mmol/L with these risk factors, sensitivity increased to respectively, 74.1⁻78.1% using one risk factor, and to 82.9% using any of these risk factors with a specificity of 57.5%. By using a modified two-step screening strategy, the number of women needing both a GCT and OGTT would be reduced to 25.5%, and 52.6% of all OGTTs could be avoided, compared to a universal one-step approach.