Universal two-step screening strategy for gestational diabetes has weak relevance in French Mediterranean women: Should we simplify the screening strategy for gestational diabetes in France?
2011
Chevalier, N. | Fénichel, P. | Giaume, V. | Loizeau, S. | Bongain, A. | Daideri, G. | Brucker-Davis, F. | Hiéronimus, S.
AIM: Currently, there is no international consensus for gestational diabetes mellitus (GDM) diagnosis. This is a report of our experience of GDM screening according to the 1996 French guidelines. METHODS: For 5years, all pregnant women followed at our hospital (n=11,545) were prospectively screened for GDM between weeks 24 and 28 of pregnancy with a two-step strategy: the O'Sullivan test (OS) with a threshold at 130mg/dL, followed by a 100-g OGTT if positive. GDM was diagnosed according to Carpenter and Coustan criteria. RESULTS: Prevalence of GDM was 4.26% [344/1451 of patients with an OS of 130–199mg/dL (12.1%); and 148 patients with an OS greater than 200mg/dL]. The false-positive rate for the OS was 76.8%. Compared with 140mg/dL, a threshold of 130mg/dL caused 401 additional negative OGTTs in 90% of cases. In 80.7% GDM patients, fasting glucose was less than 95mg/dL. The time lag between OS and OGTT was 3weeks (1–84days). Risk factors associated with GDM were maternal age, preconception overweight and obesity, parity, personal history of GDM or macrosomia, and familial history of obesity (P<0.05), but not diabetes. Also, 20% of GDM patients had no risk factors, whereas they were present in 75% of patients without GDM. CONCLUSION: In our population, a two-step screening strategy for GDM was neither relevant nor efficient. It could be simplified with a single-step definitive screening strategy using a 75-g OGTT, as used in the HAPO study, and as recommended by the IADPSG and the recent French Expert Consensus. At present, there are still no evidence-based arguments to help in deciding between selective or universal screening for GDM.
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